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Smith EMD, Aggarwal A, Ainsworth J, Al-Abadi E, Avcin T, Bortey L, Burnham J, Ciurtin C, Hedrich CM, Kamphuis S, Lambert L, Levy DM, Lewandowski L, Maxwell N, Morand E, Özen S, Pain CE, Ravelli A, Saad Magalhaes C, Pilkington C, Schonenberg-Meinema D, Scott C, Tullus K, Beresford MW. Defining remission in childhood-onset lupus: PReS-endorsed consensus definitions by an international task force. Clin Immunol 2024; 263:110214. [PMID: 38604255 DOI: 10.1016/j.clim.2024.110214] [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] [Received: 01/23/2024] [Revised: 03/30/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To derive childhood-onset SLE (cSLE) specific remission definitions for future treat-to-target (T2T) trials, observational studies, and clinical practice. METHODS The cSLE International T2T Task Force conducted Delphi surveys exploring paediatric perspectives on adult-onset SLE remission targets. A modified nominal group technique was used to discuss, refine, and agree on the cSLE remission target criteria. RESULTS The Task Force proposed two definitions of remission: 'cSLE clinical remission on steroids (cCR)' and 'cSLE clinical remission off steroids (cCR-0)'. The common criteria are: (1) Clinical-SLEDAI-2 K = 0; (2) PGA score < 0.5 (0-3 scale); (4) stable antimalarials, immunosuppressive, and biologic therapy (changes due to side-effects, adherence, weight, or when building up to target dose allowed). Criterion (3) in cCR is the prednisolone dose ≤0.1 mg/kg/day (maximum 5 mg/day), whereas in cCR-0 it is zero. CONCLUSIONS cSLE definitions of remission have been proposed, maintaining sufficient alignment with the adult-SLE definition to facilitate life-course research.
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Affiliation(s)
- E M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - A Aggarwal
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - J Ainsworth
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - E Al-Abadi
- Department of Paediatric Rheumatology, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - T Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Slovenia
| | - L Bortey
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - J Burnham
- Department of Pediatric Rheumatology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - C Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, UK
| | - C M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - S Kamphuis
- Department of Pediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - L Lambert
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - D M Levy
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - L Lewandowski
- Lupus Genomics and Global Health Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - N Maxwell
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - E Morand
- Centre for Inflammatory Diseases, Monash University, Melbourne, Australia
| | - S Özen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - C E Pain
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - A Ravelli
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
| | - C Saad Magalhaes
- Paediatric Rheumatology Division, Botucatu Medical School, Sao Paulo State, University (UNESP), Sao Paulo, Brazil
| | - C Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - D Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious diseases, Emma Children's Hospital, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | - C Scott
- Department of Pediatric Rheumatology, University of Cape Town, Cape Town, South Africa
| | - K Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Griffiths SL, Murray GK, Logeswaran Y, Ainsworth J, Allan SM, Campbell N, Drake RJ, Katshu MZUH, Machin M, Pope MA, Sullivan SA, Waring J, Bogatsu T, Kane J, Weetman T, Johnson S, Kirkbride JB, Upthegrove R. Implementing and Evaluating a National Integrated Digital Registry and Clinical Decision Support System in Early Intervention in Psychosis Services (Early Psychosis Informatics Into Care): Co-Designed Protocol. JMIR Res Protoc 2024; 13:e50177. [PMID: 38502175 PMCID: PMC10988369 DOI: 10.2196/50177] [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] [Received: 06/23/2023] [Revised: 01/21/2024] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Early intervention in psychosis (EIP) services are nationally mandated in England to provide multidisciplinary care to people experiencing first-episode psychosis, which disproportionately affects deprived and ethnic minority youth. Quality of service provision varies by region, and people from historically underserved populations have unequal access. In other disease areas, including stroke and dementia, national digital registries coupled with clinical decision support systems (CDSSs) have revolutionized the delivery of equitable, evidence-based interventions to transform patient outcomes and reduce population-level disparities in care. Given psychosis is ranked the third most burdensome mental health condition by the World Health Organization, it is essential that we achieve the same parity of health improvements. OBJECTIVE This paper reports the protocol for the program development phase of this study, in which we aimed to co-design and produce an evidence-based, stakeholder-informed framework for the building, implementation, piloting, and evaluation of a national integrated digital registry and CDSS for psychosis, known as EPICare (Early Psychosis Informatics into Care). METHODS We conducted 3 concurrent work packages, with reciprocal knowledge exchange between each. In work package 1, using a participatory co-design framework, key stakeholders (clinicians, academics, policy makers, and patient and public contributors) engaged in 4 workshops to review, refine, and identify a core set of essential and desirable measures and features of the EPICare registry and CDSS. Using a modified Delphi approach, we then developed a consensus of data priorities. In work package 2, we collaborated with National Health Service (NHS) informatics teams to identify relevant data currently captured in electronic health records, understand data retrieval methods, and design the software architecture and data model to inform future implementation. In work package 3, observations of stakeholder workshops and individual interviews with representative stakeholders (n=10) were subject to interpretative qualitative analysis, guided by normalization process theory, to identify factors likely to influence the adoption and implementation of EPICare into routine practice. RESULTS Stage 1 of the EPICare study took place between December 2021 and September 2022. The next steps include stage 2 building, piloting, implementation, and evaluation of EPICare in 5 demonstrator NHS Trusts serving underserved and diverse populations with substantial need for EIP care in England. If successful, this will be followed by stage 3, in which we will seek NHS adoption of EPICare for rollout to all EIP services in England. CONCLUSIONS By establishing a multistakeholder network and engaging them in an iterative co-design process, we have identified essential and desirable elements of the EPICare registry and CDSS; proactively identified and minimized potential challenges and barriers to uptake and implementation; and addressed key questions related to informatics architecture, infrastructure, governance, and integration in diverse NHS Trusts, enabling us to proceed with the building, piloting, implementation, and evaluation of EPICare. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50177.
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Affiliation(s)
- Siân Lowri Griffiths
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- CAMEO, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Yanakan Logeswaran
- Division of Psychiatry, University College London, London, United Kingdom
| | - John Ainsworth
- The University of Manchester, Manchester, United Kingdom
- NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Sophie M Allan
- Department of Clinical Psychology and Psychotherapies, Medical School, University of East Anglia, Norwich, United Kingdom
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Niyah Campbell
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Richard J Drake
- The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Mohammad Zia Ul Haq Katshu
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Matthew Machin
- The University of Manchester, Manchester, United Kingdom
| | - Megan A Pope
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Sarah A Sullivan
- Centre for Academic Mental Health, University of Bristol, Bristol, United Kingdom
- Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
| | - Justin Waring
- School of Social Policy, University of Birmingham, Birmingham, United Kingdom
| | - Tumelo Bogatsu
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Julie Kane
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Tyler Weetman
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - James B Kirkbride
- Division of Psychiatry, University College London, London, United Kingdom
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
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Hassan L, Eisner E, Berry K, Emsley R, Ainsworth J, Lewis S, Haddock G, Edge D, Bucci S. User engagement in a randomised controlled trial for a digital health intervention for early psychosis (Actissist 2.0 trial). Psychiatry Res 2023; 329:115536. [PMID: 37857132 DOI: 10.1016/j.psychres.2023.115536] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023]
Abstract
Digital Health Interventions (DHIs) can help support people with mental health problems. Achieving satisfactory levels of patient engagement is a crucial, yet often underexplored, pre-requisite for health improvement. Actissist is a co-produced DHI delivered via a smartphone app for people with early psychosis, based on Cognitive Behaviour Therapy principles. This study describes and compares engagement patterns among participants in the two arms of the Actissist 2.0 randomised controlled trial. Engagement frequency and duration were measured among participants using the Actissist app in the intervention arm (n = 87) and the ClinTouch symptom monitoring only app used as the control condition (n = 81). Overall, 47.1 % of Actissist and 45.7 % of ClinTouch users completed at least a third of scheduled alerts while active in the study. The mean frequency (77.1 versus 60.2 total responses) and the median duration (80 versus 75 days until last response) of engagement were not significantly higher among Actissist users compared to ClinTouch users. Older age, White ethnicity, using their own smartphone device and, among Actissist users, an increased sense of therapeutic alliance were significantly associated with increased engagement. Through exploiting detailed usage data, this study identifies possible participant-level and DHI-level predictors of engagement to inform the practical implementation of future DHIs.
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Affiliation(s)
- Lamiece Hassan
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Research and Innovation, Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Research and Innovation, Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Ainsworth
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Research and Innovation, Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Research and Innovation, Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Research and Innovation, Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Research and Innovation, Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK.
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Flitcroft I, Ainsworth J, Chia A, Cotter S, Harb E, Jin ZB, Klaver CCW, Moore AT, Nischal KK, Ohno-Matsui K, Paysse EA, Repka MX, Smirnova IY, Snead M, Verhoeven VJM, Verkicharla PK. IMI-Management and Investigation of High Myopia in Infants and Young Children. Invest Ophthalmol Vis Sci 2023; 64:3. [PMID: 37126360 PMCID: PMC10153576 DOI: 10.1167/iovs.64.6.3] [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: 05/02/2023] Open
Abstract
Purpose The purpose of this study was to evaluate the epidemiology, etiology, clinical assessment, investigation, management, and visual consequences of high myopia (≤-6 diopters [D]) in infants and young children. Findings High myopia is rare in pre-school children with a prevalence less than 1%. The etiology of myopia in such children is different than in older children, with a high rate of secondary myopia associated with prematurity or genetic causes. The priority following the diagnosis of high myopia in childhood is to determine whether there is an associated medical diagnosis that may be of greater overall importance to the health of the child through a clinical evaluation that targets the commonest features associated with syndromic forms of myopia. Biometric evaluation (including axial length and corneal curvature) is important to distinguishing axial myopia from refractive myopia associated with abnormal development of the anterior segment. Additional investigation includes ocular imaging, electrophysiological tests, genetic testing, and involvement of pediatricians and clinical geneticists is often warranted. Following investigation, optical correction is essential, but this may be more challenging and complex than in older children. Application of myopia control interventions in this group of children requires a case-by-case approach due to the lack of evidence of efficacy and clinical heterogeneity of high myopia in young children. Conclusions High myopia in infants and young children is a rare condition with a different pattern of etiology to that seen in older children. The clinical management of such children, in terms of investigation, optical correction, and use of myopia control treatments, is a complex and often multidisciplinary process.
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Affiliation(s)
- Ian Flitcroft
- Children's Health Ireland (CHI) at Temple Street, Dublin, Ireland
- Centre for Eye Research Ireland, Technological University of Dublin, Dublin, Ireland
| | - John Ainsworth
- Birmingham Children's Hospital, Steelhouse Lane Birmingham, United Kingdom
| | | | - Susan Cotter
- Southern California College of Optometry, Marshall B Ketchum University, Fullerton, California, United States
| | - Elise Harb
- Wertheim School Optometry and Vision Science, Berkeley, California, United States
- University of California - San Francisco, School of Medicine, San Francisco, California, United States
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Anthony T Moore
- University of California - San Francisco, School of Medicine, San Francisco, California, United States
| | - Ken K Nischal
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | | | - Evelyn A Paysse
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States
| | - Michael X Repka
- Wilmer Eye Institute, The John Hopkins University School of Medicine, Baltimore, Maryland, United States
| | | | - Martin Snead
- Department of Vitreoretinal Research, John van Geest Centre for Brain Repair, University of Cambridge, United Kingdom
| | - Virginie J M Verhoeven
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
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Smith EMD, Aggarwal A, Ainsworth J, Al-Abadi E, Avcin T, Bortey L, Burnham J, Ciurtin C, Hedrich CM, Kamphuis S, Lambert L, Levy DM, Lewandowski L, Maxwell N, Morand E, Ozen S, Pain CE, Ravelli A, Saad Magalhaes C, Pilkington C, Schonenberg-Meinema D, Scott C, Tullus K, Beresford MW. PReS-endorsed international childhood lupus T2T task force definition of childhood lupus low disease activity state (cLLDAS). Clin Immunol 2023; 250:109296. [PMID: 36934849 PMCID: PMC10500564 DOI: 10.1016/j.clim.2023.109296] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE To achieve a consensus-based definition of Low Disease Activity (LDA) for use in cSLE trials. METHODS The International cSLE T2T Task Force, comprising of paediatric rheumatologists/nephrologists, and adult rheumatologists undertook a series of Delphi surveys/consensus meetings to discuss, refine, and vote upon cSLE LDA criteria. RESULTS The Task Force agreed that LDA should be based upon the adult-SLE Lupus Low Disease Activity State definition (LLDAS), with modifications to make it applicable to cSLE (cLLDAS). They agreed upon five cLLDAS criteria: (1) SLE Disease Activity Index (SLEDAI)-2 K ≤4, with no activity in major organ systems; (2) no new features of lupus disease activity compared with the last assessment; (3) Physician Global Assessment score of ≤1 (0-3 scale); (4) prednisolone dose of ≤0.15 mg/kg/day, 7.5 mg/day/maximum; while on (5) stable antimalarials, immunosuppressives, and biologics. CONCLUSIONS A cSLE-appropriate definition of cLLDAS has been generated, maintaining alignment with the adult-SLE definition to promote life-course research.
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Affiliation(s)
- E M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - A Aggarwal
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - J Ainsworth
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - E Al-Abadi
- Department of Paediatric Rheumatology, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - T Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Slovenia
| | - L Bortey
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - J Burnham
- Department of Pediatric Rheumatology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - C Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, UK
| | - C M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - S Kamphuis
- Department of Pediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - L Lambert
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - D M Levy
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - L Lewandowski
- Lupus Genomics and Global Health Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - N Maxwell
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - E Morand
- Centre for Inflammatory Diseases, Monash University, Melbourne, Australia
| | - S Ozen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - C E Pain
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - A Ravelli
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
| | - C Saad Magalhaes
- Department of Pediatric Rheumatology, Botucatu Medical School, Sao Paulo State University, Sao Paulo, Brazil
| | - C Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - D Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious diseases, Emma Children's Hospital, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | - C Scott
- Clinical Research Centre, Department of Pediatric Rheumatology, University of Cape Town, Cape Town, South Africa
| | - K Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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6
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Neumann V, Davidge G, Harding M, Cunningham J, Davies N, Devaney S, Leeming G, Holm S, Ainsworth J. Examining public views on decentralised health data sharing. PLoS One 2023; 18:e0282257. [PMID: 36862723 PMCID: PMC9980819 DOI: 10.1371/journal.pone.0282257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
In recent years, researchers have begun to explore the use of Distributed Ledger Technologies (DLT), also known as blockchain, in health data sharing contexts. However, there is a significant lack of research that examines public attitudes towards the use of this technology. In this paper, we begin to address this issue and present results from a series of focus groups which explored public views and concerns about engaging with new models of personal health data sharing in the UK. We found that participants were broadly in favour of a shift towards new decentralised models of data sharing. Retaining 'proof' of health information stored about patients and the capacity to provide permanent audit trails, enabled by immutable and transparent properties of DLT, were regarded as particularly valuable for our participants and prospective data custodians. Participants also identified other potential benefits such as supporting people to become more health data literate and enabling patients to make informed decisions about how their data was shared and with whom. However, participants also voiced concerns about the potential to further exacerbate existing health and digital inequalities. Participants were also apprehensive about the removal of intermediaries in the design of personal health informatics systems.
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Affiliation(s)
- Victoria Neumann
- School of Computing and Communications, Lancaster University, Lancaster, United Kingdom
- * E-mail:
| | - Gail Davidge
- Centre for Social Ethics and Policy, The University of Manchester, Manchester, United Kingdom
| | - Mike Harding
- School of Computing and Communications, Lancaster University, Lancaster, United Kingdom
| | - James Cunningham
- Division of Informatics, Imaging & Data Sciences, The University of Manchester, Manchester, United Kingdom
| | - Nigel Davies
- School of Computing and Communications, Lancaster University, Lancaster, United Kingdom
| | - Sarah Devaney
- Centre for Social Ethics and Policy, The University of Manchester, Manchester, United Kingdom
| | - Gary Leeming
- Civic Data Cooperative, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Søren Holm
- Centre for Social Ethics and Policy, The University of Manchester, Manchester, United Kingdom
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - John Ainsworth
- Division of Informatics, Imaging & Data Sciences, The University of Manchester, Manchester, United Kingdom
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7
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Alkhaldi O, McMillan B, Maddah N, Ainsworth J. Interventions Aimed at Enhancing Health Care Providers' Behavior Toward the Prescription of Mobile Health Apps: Systematic Review. JMIR Mhealth Uhealth 2023; 11:e43561. [PMID: 36848202 PMCID: PMC10012012 DOI: 10.2196/43561] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) apps have great potential to support the management of chronic conditions. Despite widespread acceptance of mHealth apps by the public, health care providers (HCPs) are reluctant to prescribe or recommend such apps to their patients. OBJECTIVE This study aimed to classify and evaluate interventions aimed at encouraging HCPs to prescribe mHealth apps. METHODS A systematic literature search was conducted to identify studies published from January 1, 2008, to August 5, 2022, using 4 electronic databases: MEDLINE, Scopus, CINAHL, and PsycINFO. We included studies that evaluated interventions encouraging HCPs to prescribe mHealth apps. Two review authors independently assessed the eligibility of the studies. The "National Institute of Health's quality assessment tool for before-and-after (pretest-posttest design) studies with no control group" and "the mixed methods appraisal tool (MMAT)" were used to assess the methodological quality. Owing to high levels of heterogeneity between interventions, measures of practice change, specialties of HCPs, and modes of delivery, we conducted a qualitative analysis. We adopted the behavior change wheel as a framework for classifying the included interventions according to intervention functions. RESULTS In total, 11 studies were included in this review. Most of the studies reported positive findings, with improvements in a number of outcomes, including increased knowledge of mHealth apps among clinicians, improved self-efficacy or confidence in prescribing, and an increased number of mHealth app prescriptions. On the basis of the behavior change wheel, 9 studies reported elements of environmental restructuring such as providing HCPs with lists of apps, technological systems, time, and resources. Furthermore, 9 studies included elements of education, particularly workshops, class lectures, individual sessions with HCPs, videos, or toolkits. Furthermore, training was incorporated in 8 studies using case studies or scenarios or app appraisal tools. Coercion and restriction were not reported in any of the interventions included. The quality of the studies was high in relation to the clarity of aims, interventions, and outcomes but weaker in terms of sample size, power calculations, and duration of follow-up. CONCLUSIONS This study identified interventions to encourage app prescriptions by HCPs. Recommendations for future research should consider previously unexplored intervention functions such as restrictions and coercion. The findings of this review can help inform mHealth providers and policy makers regarding the key intervention strategies impacting mHealth prescriptions and assist them in making informed decisions to encourage this adoption.
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Affiliation(s)
- Ohoud Alkhaldi
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, United Kingdom
| | - Noha Maddah
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Department of Health Services and Hospitals Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah, Saudi Arabia
| | - John Ainsworth
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Sharma V, Pritchard-Jones R, Scott S, Ainsworth J. Accuracy of a tool to prioritise patients awaiting elective surgery: an implementation report. BMJ Health Care Inform 2023; 30:bmjhci-2022-100687. [PMID: 36669784 PMCID: PMC9872449 DOI: 10.1136/bmjhci-2022-100687] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/06/2023] [Indexed: 01/22/2023] Open
Abstract
STUDY OBJECTIVE The objective of this study was to evaluate the accuracy of a new elective surgery clinical decision support system, the 'Patient Tacking List' (PTL) tool (C2-Ai(c)) through receiver operating characteristic (ROC) analysis. METHODS We constructed ROC curves based on risk predictions produced by the tool and compared these with actual patient outcomes on a retrospective cohort of patients awaiting elective surgery. RESULTS A total of 11 837 patients were included across three National Health Service (NHS) hospitals in England. ROC analysis revealed an area under the curve of 0.95 (95% CI 0.92 to 0.98) for mortality and 0.8 (95% CI 0.78 to 0.82) for complications. DISCUSSION The PTL tool was successfully integrated into existing data infrastructures, allowing real-time clinical decision support and a low barrier to implementation. ROC analysis demonstrated a high level of accuracy to predict the risk of mortality and complications after elective surgery. As such, it may be a valuable adjunct in prioritising patients on surgical waiting lists.Health systems, such as the NHS in England, must look at innovative methods to prioritise patients awaiting surgery in order to best use limited resources. Clinical decision support tools, such as the PTL tool, can improve prioritisation and thus positively impact clinical care and patient outcomes. CONCLUSIONS The high level of accuracy for predicating mortality and complications after elective surgery using the PTL tool indicates the potential for clinical decision support tools to help tackle rising waiting lists and improve surgical planning.
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Affiliation(s)
- Videha Sharma
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
| | | | - Sharon Scott
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - John Ainsworth
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
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Maddah N, Verma A, Almashmoum M, Ainsworth J. Effectiveness of Public Health Digital Surveillance Systems for Infectious Disease Prevention and Control at Mass Gatherings: A Systematic Review (Preprint). J Med Internet Res 2022; 25:e44649. [DOI: 10.2196/44649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/07/2023] [Accepted: 02/28/2023] [Indexed: 03/04/2023] Open
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Elliott RS, Taylor E, Ainsworth J, Preston J, Smith EMDS. Improving communication of the concept of 'treat-to target' in childhood lupus: a public and patient (PPI) engagement project involving children and young people. BMC Rheumatol 2022; 6:69. [PMID: 36242078 PMCID: PMC9578343 DOI: 10.1186/s41927-022-00300-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A treat-to-target (T2T) approach, where treatment is escalated until a specific target is achieved, and re-escalated if the target is lost, has been proposed as a strategy to improve Childhood Systemic Lupus Erythematosus (cSLE) outcomes. Previous studies involving children and young people (CYP) have identified that the concept of T2T can be difficult to understand by CYP and their families. We aimed to explore the views of CYP participating in existing public and patient involvement (PPI) groups in relation to a proposed animation that is being developed to explain the concept of T2T to CYP who will be eligible for a future cSLE T2T trial. METHODS An illustrated animation storyboard was developed on PowerPoint, to be used alongside a contemporaneous voiceover to simulate the animation for CYP participating in three existing CYP PPI groups (GenerationR, Lupus UK, and YOUR RHEUM). Mixed methods were used to generate CYP feedback on the resource, including on-line surveys and qualitative topic-guided discussion, noting CYP suggestions for improvement. Changes were made iteratively to the resources. Pre/post workshop questionnaires to assess the impact of the resource on their understanding of T2T were completed anonymously. RESULTS 40 CYP were consulted; 16/40 (40%) from GenerationR (median age 15-years [IQR 12-15]), 12/40 (30%) from Lupus UK (median age 27-years [IQR 22-30]), and 12/40 (30%) from YOUR RHEUM (median age 17-years [IQR 16-21]). 62% of respondents had an underlying rheumatic condition. Pre-workshop median participant understanding of T2T was 2/10 [IQR 1-4], on a 1-10 scale (1 = "no understanding at all", 10 = "completely confident in my understanding"). After viewing the resource, participant understanding improved to a median of 9/10 [IQR 8-10], p < 0.0001). Overall, participants felt that the animation greatly improved their understanding of the concept of T2T, making several suggestions for improvement. CONCLUSION Involvement of CYP in research is crucial to help improve the design/delivery of studies, ensuring relevance to CYP and their families. This manuscript demonstrates the involvement of CYP in the development of an animation that will be integral to a future clinical trial, helping to describe the T2T approach in a comprehensible way to eligible CYP and their families, supporting study recruitment.
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Affiliation(s)
- R S Elliott
- School of Medicine, University of Liverpool, Liverpool, UK
| | - E Taylor
- School of Medicine, University of Liverpool, Liverpool, UK
| | - J Ainsworth
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - J Preston
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - E M D S Smith
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK. .,Department of Paediatric Rheumatology, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
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Sharma V, Augustine T, Ainsworth J, van der Veer SN. The evaluation of digital transformation in renal transplantation in the United Kingdom: A national interview study. Int J Med Inform 2022; 164:104800. [DOI: 10.1016/j.ijmedinf.2022.104800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/28/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
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Bevan A, Hoo ZH, Totton N, Girling C, Davids IR, Whelan P, Antrobus S, Ainsworth J, Buchan I, Anderson A, Bourke S, Doe S, Echevarria C, Taylor J, Bell NJ, Bateman K, Jones C, Moran P, Fitch G, Martin M, McGowan A, Morrow S, Seabridge H, Bush N, Daniels T, Lee K, Robson N, Shiferaw D, Sweis D, Thomas R, Faulkner J, Flight WG, Poole S, Warnock L, Allenby MI, Carroll M, Daniels TV, Dunn H, Nightingale JA, Shepherd E, Ohri C, Gadsby J, Range S, Tature D, Barr HL, Dawson S, Dewar J, Miller B, Saini G, Galey P, Johnson J, Pasteur MC, Derry D, Gledhill H, Lawson A, Thomas M, Waine D, Cunningham J, Damani A, Higton A, Orchard C, Carolan C, Tahir M, Plummer A, Hutchings M, Edenborough FP, Curley R, Wildman MJ. Corrigendum to "Using a learning health system to understand the mismatch between medicines supply and actual medicines use among adults with cystic fibrosis" [J Cyst Fibros (2022), 21/2, 323-331]. J Cyst Fibros 2022; 21:893-897. [PMID: 35907767 DOI: 10.1016/j.jcf.2022.07.011] [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: 11/19/2022]
Affiliation(s)
- Amanda Bevan
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Zhe Hui Hoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK; Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nikki Totton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Carla Girling
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - India R Davids
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Pauline Whelan
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Steven Antrobus
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - John Ainsworth
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Iain Buchan
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Alan Anderson
- Newcastle Adult Cystic Fibrosis Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephen Bourke
- Newcastle Adult Cystic Fibrosis Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Simon Doe
- Newcastle Adult Cystic Fibrosis Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Carlos Echevarria
- Newcastle Adult Cystic Fibrosis Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jill Taylor
- Newcastle Adult Cystic Fibrosis Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicholas J Bell
- Bristol Adult Cystic Fibrosis Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kathryn Bateman
- Bristol Adult Cystic Fibrosis Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Carys Jones
- Bristol Adult Cystic Fibrosis Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Peter Moran
- Bristol Adult Cystic Fibrosis Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Giles Fitch
- North West Midlands Cystic Fibrosis Centre, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Michael Martin
- North West Midlands Cystic Fibrosis Centre, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Angela McGowan
- North West Midlands Cystic Fibrosis Centre, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Stephen Morrow
- North West Midlands Cystic Fibrosis Centre, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Heather Seabridge
- North West Midlands Cystic Fibrosis Centre, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Nicki Bush
- York Hull Adult Cystic Fibrosis Centre, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Tracey Daniels
- York Hull Adult Cystic Fibrosis Centre, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Katy Lee
- York Hull Adult Cystic Fibrosis Centre, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Nicola Robson
- York Hull Adult Cystic Fibrosis Centre, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Dejene Shiferaw
- York Hull Adult Cystic Fibrosis Centre, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Dimah Sweis
- York Hull Adult Cystic Fibrosis Centre, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Rebecca Thomas
- York Hull Adult Cystic Fibrosis Centre, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Jayne Faulkner
- Oxford Adult Cystic Fibrosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - William G Flight
- Oxford Adult Cystic Fibrosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarah Poole
- Oxford Adult Cystic Fibrosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Louise Warnock
- Oxford Adult Cystic Fibrosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mark I Allenby
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mary Carroll
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Respiratory Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Thomas V Daniels
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Respiratory Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Helen Dunn
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Julia A Nightingale
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elizabeth Shepherd
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Chandra Ohri
- Leicester Adult Cystic Fibrosis Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Jessica Gadsby
- Leicester Adult Cystic Fibrosis Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Simon Range
- Leicester Adult Cystic Fibrosis Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Darren Tature
- Leicester Adult Cystic Fibrosis Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Helen L Barr
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sophie Dawson
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jane Dewar
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Bryony Miller
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Gauri Saini
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Penny Galey
- Adult Cystic Fibrosis Clinic, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Jack Johnson
- Adult Cystic Fibrosis Clinic, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Mark C Pasteur
- Adult Cystic Fibrosis Clinic, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - David Derry
- Derriford Hospital Adult Cystic Fibrosis Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Harriet Gledhill
- Derriford Hospital Adult Cystic Fibrosis Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Angharad Lawson
- Derriford Hospital Adult Cystic Fibrosis Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Michelle Thomas
- Derriford Hospital Adult Cystic Fibrosis Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - David Waine
- Derriford Hospital Adult Cystic Fibrosis Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Josie Cunningham
- Cystic Fibrosis Unit, Frimley Health NHS Foundation Trust, Frimley, UK
| | - Annant Damani
- Cystic Fibrosis Unit, Frimley Health NHS Foundation Trust, Frimley, UK
| | - Alexandra Higton
- Cystic Fibrosis Unit, Frimley Health NHS Foundation Trust, Frimley, UK
| | | | - Charlotte Carolan
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Misbah Tahir
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Amanda Plummer
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Marlene Hutchings
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Frank P Edenborough
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rachael Curley
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Martin J Wildman
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK; Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, Stickney Z, Suchy H, Tan R, Yordi S, Ahmed I, Aranha M, El Sabawy D, Garwood P, Harnett M, Holohan R, Howard R, Kayyal Y, Krakoski N, Lupo M, McGilberry W, Nepon H, Scoleri Y, Urbina C, Ahmad Fuad MF, Ahmed O, Jaswantlal D, Kelly E, Khan MHT, Naidu D, Neo WX, O'Neill R, Sugrue M, Abbas JD, Abdul-Fattah S, Azlan A, Barry K, Idris NS, Kaka N, Mc Dermott D, Mohammad Nasir MN, Mozo M, Rehal A, Shaikh Yousef M, Wong RH, Curran E, Gardner M, Hogan A, Julka R, Lasser G, Ní Chorráin N, Ting J, Browne R, George S, Janjua Z, Leung Shing V, Megally M, Murphy S, Ravenscroft L, Vedadi A, Vyas V, Bryan A, Sheikh A, Ubhi J, Vannelli K, Vawda A, Adeusi L, Doherty C, Fitzgerald C, Gallagher H, Gill P, Hamza H, Hogan M, Kelly S, Larry J, Lynch P, Mazeni NA, O'Connell R, O'Loghlin R, Singh K, Abbas Syed R, Ali A, Alkandari B, Arnold A, Arora E, Azam R, Breathnach C, Cheema J, Compton M, Curran S, Elliott JA, Jayasamraj O, Mohammed N, Noone A, Pal A, Pandey S, Quinn P, Sheridan R, Siew L, Tan EP, Tio SW, Toh VTR, Walsh M, Yap C, Yassa J, Young T, Agarwal N, Almoosawy SA, Bowen K, Bruce D, Connachan R, Cook A, Daniell A, Elliott M, Fung HKF, Irving A, Laurie S, Lee YJ, Lim ZX, Maddineni S, McClenaghan RE, Muthuganesan V, Ravichandran P, Roberts N, Shaji S, Solt S, Toshney E, Arnold C, Baker O, Belais F, Bojanic C, Byrne M, Chau CYC, De Soysa S, Eldridge M, Fairey M, Fearnhead N, Guéroult A, Ho JSY, Joshi K, Kadiyala N, Khalid S, Khan F, Kumar K, Lewis E, Magee J, Manetta-Jones D, Mann S, McKeown L, Mitrofan C, Mohamed T, Monnickendam A, Ng AYKC, Ortu A, Patel M, Pope T, Pressling S, Purohit K, Saji S, Shah Foridi J, Shah R, Siddiqui SS, Surman K, Utukuri M, Varghese A, Williams CYK, Yang JJ, Billson E, Cheah E, Holmes P, Hussain S, Murdock D, Nicholls A, Patel P, Ramana G, Saleki M, Spence H, Thomas D, Yu C, Abousamra M, Brown C, Conti I, Donnelly A, Durand M, French N, Goan R, O'Kane E, Rubinchik P, Gardiner H, Kempf B, Lai YL, Matthews H, Minford E, Rafferty C, Reid C, Sheridan N, Al 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Qureshi A, Sawhney R, Sigurdson B, Stephenson L, Vora K, Zacken A, Cope P, Di Traglia R, Ferarrio I, Hackett N, Healicon R, Horseman L, Lam LI, Meerdink M, Menham D, Murphy R, Nimmo I, Ramaesh A, Rees J, Soame R, Dilaver N, Adebambo D, Brown E, Burt J, Foster K, Kaliyappan L, Knight P, Politis A, Richardson E, Townsend J, Abdi M, Ball M, Easby S, Gill N, Ho E, Iqbal H, Matthews M, Nubi S, Nwokocha JO, Okafor I, Perry G, Sinartio B, Vanukuru N, Walkley D, Welch T, Yates J, Yeshitila N, Bryans K, Campbell B, Gray C, Keys R, Macartney M, Chamberlain G, Khatri A, Kucheria A, Lee STP, Reese G, Roy choudhury J, Tan WYR, Teh JJ, Ting A, Kazi S, Kontovounisios C, Vutipongsatorn K, Amarnath T, Balasubramanian N, Bassett E, Gurung P, Lim J, Panjikkaran A, Sanalla A, Alkoot M, Bacigalupo V, Eardley N, Horton M, Hurry A, Isti C, Maskell P, Nursiah K, Punn G, Salih H, Epanomeritakis E, Foulkes A, Henderson R, Johnston E, McCullough H, McLarnon M, Morrison E, Cheung A, Cho SH, Eriksson F, Hedges J, 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Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Sharma V, Foster S, Whelan P, Antrobus S, Augustine T, Ainsworth J, van der Veer SN. KidneyCloud: A Clinically-Codesigned Solution to Support Kidney Services with Assessing Patients for Transplantation. Stud Health Technol Inform 2022; 290:877-881. [PMID: 35673144 DOI: 10.3233/shti220205] [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] [Indexed: 06/15/2023]
Abstract
There is a need for IT systems that support the complex needs of data management in kidney transplantation. The KidneyCloud project aims to inform a transplant-specific digital solution by exploring patient pathways and data journeys. This paper reports on the early prototyping of the KidneyCloud clinician interface using an iterative codesign methodology. User workshops identified that for making clinical decisions and adding patients to the national waiting list transplant teams relied heavily on manual processes to access data across systems and organisations. Based on the requirements gathered, a prototype interface was designed to provide a unified view on the available patient data, which aligned with clinical workflows. Interactive prototype screens allowed users to gain hands-on experience and provide rich real-time feedback. This informed the necessary functionalities of the interface, but also helped us understand the capabilities required of the back-end solution.
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Affiliation(s)
- Videha Sharma
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Department of renal and pancreatic transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Simon Foster
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Pauline Whelan
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Steven Antrobus
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Titus Augustine
- Department of renal and pancreatic transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - John Ainsworth
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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Gumley AI, Bradstreet S, Ainsworth J, Allan S, Alvarez-Jimenez M, Birchwood M, Briggs A, Bucci S, Cotton S, Engel L, French P, Lederman R, Lewis S, Machin M, MacLennan G, McLeod H, McMeekin N, Mihalopoulos C, Morton E, Norrie J, Reilly F, Schwannauer M, Singh SP, Sundram S, Thompson A, Williams C, Yung A, Aucott L, Farhall J, Gleeson J. Digital smartphone intervention to recognise and manage early warning signs in schizophrenia to prevent relapse: the EMPOWER feasibility cluster RCT. Health Technol Assess 2022; 26:1-174. [PMID: 35639493 DOI: 10.3310/hlze0479] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Relapse is a major determinant of outcome for people with a diagnosis of schizophrenia. Early warning signs frequently precede relapse. A recent Cochrane Review found low-quality evidence to suggest a positive effect of early warning signs interventions on hospitalisation and relapse. OBJECTIVE How feasible is a study to investigate the clinical effectiveness and cost-effectiveness of a digital intervention to recognise and promptly manage early warning signs of relapse in schizophrenia with the aim of preventing relapse? DESIGN A multicentre, two-arm, parallel-group cluster randomised controlled trial involving eight community mental health services, with 12-month follow-up. SETTINGS Glasgow, UK, and Melbourne, Australia. PARTICIPANTS Service users were aged > 16 years and had a schizophrenia spectrum disorder with evidence of a relapse within the previous 2 years. Carers were eligible for inclusion if they were nominated by an eligible service user. INTERVENTIONS The Early signs Monitoring to Prevent relapse in psychosis and prOmote Wellbeing, Engagement, and Recovery (EMPOWER) intervention was designed to enable participants to monitor changes in their well-being daily using a mobile phone, blended with peer support. Clinical triage of changes in well-being that were suggestive of early signs of relapse was enabled through an algorithm that triggered a check-in prompt that informed a relapse prevention pathway, if warranted. MAIN OUTCOME MEASURES The main outcomes were feasibility of the trial and feasibility, acceptability and usability of the intervention, as well as safety and performance. Candidate co-primary outcomes were relapse and fear of relapse. RESULTS We recruited 86 service users, of whom 73 were randomised (42 to EMPOWER and 31 to treatment as usual). Primary outcome data were collected for 84% of participants at 12 months. Feasibility data for people using the smartphone application (app) suggested that the app was easy to use and had a positive impact on motivations and intentions in relation to mental health. Actual app usage was high, with 91% of users who completed the baseline period meeting our a priori criterion of acceptable engagement (> 33%). The median time to discontinuation of > 33% app usage was 32 weeks (95% confidence interval 14 weeks to ∞). There were 8 out of 33 (24%) relapses in the EMPOWER arm and 13 out of 28 (46%) in the treatment-as-usual arm. Fewer participants in the EMPOWER arm had a relapse (relative risk 0.50, 95% confidence interval 0.26 to 0.98), and time to first relapse (hazard ratio 0.32, 95% confidence interval 0.14 to 0.74) was longer in the EMPOWER arm than in the treatment-as-usual group. At 12 months, EMPOWER participants were less fearful of having a relapse than those in the treatment-as-usual arm (mean difference -4.29, 95% confidence interval -7.29 to -1.28). EMPOWER was more costly and more effective, resulting in an incremental cost-effectiveness ratio of £3041. This incremental cost-effectiveness ratio would be considered cost-effective when using the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year gained. LIMITATIONS This was a feasibility study and the outcomes detected cannot be taken as evidence of efficacy or effectiveness. CONCLUSIONS A trial of digital technology to monitor early warning signs that blended with peer support and clinical triage to detect and prevent relapse is feasible. FUTURE WORK A main trial with a sample size of 500 (assuming 90% power and 20% dropout) would detect a clinically meaningful reduction in relapse (relative risk 0.7) and improvement in other variables (effect sizes 0.3-0.4). TRIAL REGISTRATION This trial is registered as ISRCTN99559262. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 27. See the NIHR Journals Library website for further project information. Funding in Australia was provided by the National Health and Medical Research Council (APP1095879).
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Affiliation(s)
- Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John Ainsworth
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Maximillian Birchwood
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sue Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Lidia Engel
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Paul French
- Department of Nursing, Manchester Metropolitan University, Manchester, UK
| | - Reeva Lederman
- School of Computing and Information Systems, Melbourne School of Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Matthew Machin
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Hamish McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Cathy Mihalopoulos
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Emma Morton
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Swaran P Singh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Suresh Sundram
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Andrew Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chris Williams
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alison Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia.,NorthWestern Mental Health, Melbourne, VIC, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, VIC, Australia
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16
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Gumley AI, Bradstreet S, Ainsworth J, Allan S, Alvarez-Jimenez M, Aucott L, Birchwood M, Briggs A, Bucci S, Cotton SM, Engel L, French P, Lederman R, Lewis S, Machin M, MacLennan G, McLeod H, McMeekin N, Mihalopoulos C, Morton E, Norrie J, Schwannauer M, Singh SP, Sundram S, Thompson A, Williams C, Yung AR, Farhall J, Gleeson J. The EMPOWER blended digital intervention for relapse prevention in schizophrenia: a feasibility cluster randomised controlled trial in Scotland and Australia. Lancet Psychiatry 2022; 9:477-486. [PMID: 35569503 DOI: 10.1016/s2215-0366(22)00103-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Early warning signs monitoring by service users with schizophrenia has shown promise in preventing relapse but the quality of evidence is low. We aimed to establish the feasibility of undertaking a definitive randomised controlled trial to determine the effectiveness of a blended digital intervention for relapse prevention in schizophrenia. METHODS This multicentre, feasibility, cluster randomised controlled trial aimed to compare Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery (EMPOWER) with treatment as usual in community mental health services (CMHS) in Glasgow and Melbourne. CMHS were the unit of randomisation, selected on the basis of those that probably had five or more care coordinators willing to participate. Participants were eligible if they were older than 16 years, had a schizophrenia or related diagnosis confirmed via case records, were able to provide informed consent, had contact with CMHS, and had had a relapse within the previous 2 years. Participants were randomised within stratified clusters to EMPOWER or to continue their usual approach to care. EMPOWER blended a smartphone for active monitoring of early warning signs with peer support to promote self-management and clinical triage to promote access to relapse prevention. Main outcomes were feasibility, acceptability, usability, and safety, which was assessed through face-to-face interviews. App usage was assessed via the smartphone and self-report. Primary end point was 12 months. Participants, research assistants and other team members involved in delivering the intervention were not masked to treatment conditions. Assessment of relapse was done by an independent adjudication panel masked to randomisation group. The study is registered at ISRCTN (99559262). FINDINGS We identified and randomised eight CMHS (six in Glasgow and two in Melbourne) comprising 47 care coordinators. We recruited 86 service users between Jan 19 and Aug 8, 2018; 73 were randomised (42 [58%] to EMPOWER and 31 [42%] to treatment as usual). There were 37 (51%) men and 36 (49%) women. At 12 months, main outcomes were collected for 32 (76%) of service users in the EMPOWER group and 30 (97%) of service users in the treatment as usual group. Of those randomised to EMPOWER, 30 (71%) met our a priori criterion of more than 33% adherence to daily monitoring that assumed feasibility. Median time to discontinuation of these participants was 31·5 weeks (SD 14·5). There were 29 adverse events in the EMPOWER group and 25 adverse events in the treatment as usual group. There were 13 app-related adverse events, affecting 11 people, one of which was serious. Fear of relapse was lower in the EMPOWER group than in the treatment as usual group at 12 months (mean difference -7·53 (95% CI -14·45 to 0·60; Cohen's d -0·53). INTERPRETATION A trial of digital technology to monitor early warning signs blended with peer support and clinical triage to detect and prevent relapse appears to be feasible, safe, and acceptable. A further main trial is merited. FUNDING UK National Institute for Health Research Health Technology Assessment programme and the Australian National Health and Medical Research Council.
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Affiliation(s)
- Andrew I Gumley
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Simon Bradstreet
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John Ainsworth
- Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Stephanie Allan
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mario Alvarez-Jimenez
- Orygen Melbourne, Melbourne, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lorna Aucott
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Maximillian Birchwood
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Warwick, UK
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sue M Cotton
- Orygen Melbourne, Melbourne, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul French
- Department of Psychiatry, Manchester Metropolitan University, Manchester, UK
| | - Reeva Lederman
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, VIC, Australia
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Matthew Machin
- Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Hamish McLeod
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Cathy Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - John Norrie
- The Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Swaran P Singh
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Warwick, UK
| | - Suresh Sundram
- Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia; Mental Health Program, Monash Health, Melbourne, VIC, Australia
| | - Andrew Thompson
- Orygen Melbourne, Melbourne, VIC, Australia; Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Warwick, UK
| | - Chris Williams
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; School of Medicine, Deakin University, Melbourne, VIC, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia; NorthWestern Mental Health, The Royal Melbourne Hospital, Epping, VIC, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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17
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Cunningham J, Davies N, Devaney S, Holm S, Harding M, Neumann V, Ainsworth J. Non-Fungible Tokens as a Mechanism for Representing Patient Consent. Stud Health Technol Inform 2022; 294:382-386. [PMID: 35612101 DOI: 10.3233/shti220479] [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] [Indexed: 06/15/2023]
Abstract
In recent years we have seen the adoption of distributed ledger technology (DLT), originally the mechanism underpinning the operation of the Bitcoin crypto currency, across a wider range of technology sectors including healthcare. DLT allows for the design of informatics systems with the properties of immutability, security, and decentralization. One recent innovation in the space has been the specification and development of Non-Fungible Tokens (NFTs). NFTs are decentralized DLT-based records that represent ownership of a unique digital asset. The predominant current use case for NFTs has been in the representation and sale of digital artwork, however the features offered by NFTs, unique-ness, immutability, transferability, and verifiability, are directly applicable to the design of health informatics systems. In this paper we explore these properties and describe a reference architecture for using NFTs as a means of representing and transferring records of patient's consent for medical data use.
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Affiliation(s)
- James Cunningham
- Division of Informatics, Imaging and Data Sciences, Health EResearch Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Nigel Davies
- Department of Computing and Communications, Lancaster University, Lancaster, United Kingdom
| | - Sarah Devaney
- CSEP, Department of Law, School of Social Sciences, The University of Manchester, Manchester, United Kingdom
| | - Søren Holm
- CSEP, Department of Law, School of Social Sciences, The University of Manchester, Manchester, United Kingdom
| | - Mike Harding
- Department of Computing and Communications, Lancaster University, Lancaster, United Kingdom
| | - Victoria Neumann
- Department of Computing and Communications, Lancaster University, Lancaster, United Kingdom
| | - John Ainsworth
- Division of Informatics, Imaging and Data Sciences, Health EResearch Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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18
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Green J, Leadbitter K, Ainsworth J, Bucci S. An integrated early care pathway for autism. Lancet Child Adolesc Health 2022; 6:335-344. [PMID: 35303486 DOI: 10.1016/s2352-4642(22)00037-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 01/17/2023]
Abstract
In this Viewpoint, we argue for the need to reconceptualise an integrated early-care provision for autistic children in the light of their enduring support needs and relevant new findings from developmental and intervention research. This model goes beyond short-term reactive care to outline an early proactive, evidenced, developmentally phased, and scalable programme of support for autistic children and their families from the earliest opportunity, with timely access to later step-up care when needed. We also integrate this model with emerging opportunities from data science and digital health technologies as a potential facilitator of such a pathway. Building on this work, we argue that the best current autism intervention evidence can be integrated with concepts and evidence gained in the management of other enduring health conditions to support an autistic child and their family through their early development. The aim is to improve those children's social communication abilities, expand their range and flexibility of interests, and mitigate any negative impacts of sensory difficulties and restricted, repetitive behaviours on the child and their family wellbeing. The pathway solutions described could also be adapted for older adolescents and adults and could be used within the health systems of different countries, including within low-income and middle-income contexts.
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Affiliation(s)
- Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester, UK; Department of Child and Adolescent Mental Health, Manchester Royal Children's Hospital, Manchester, UK.
| | - Kathy Leadbitter
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester, UK
| | - John Ainsworth
- Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine, and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK; Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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19
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Sharma V, Eleftheriou I, van der Veer SN, Brass A, Augustine T, Ainsworth J. Modeling Data Journeys to Inform the Digital Transformation of Kidney Transplant Services: Observational Study. J Med Internet Res 2022; 24:e31825. [PMID: 35451983 PMCID: PMC9073622 DOI: 10.2196/31825] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/27/2021] [Accepted: 02/09/2022] [Indexed: 01/20/2023] Open
Abstract
Background Data journey modeling is a methodology used to establish a high-level overview of information technology (IT) infrastructure in health care systems. It allows a better understanding of sociotechnical barriers and thus informs meaningful digital transformation. Kidney transplantation is a complex clinical service involving multiple specialists and providers. The referral pathway for a transplant requires the centralization of patient data across multiple IT solutions and health care organizations. At present, there is a poor understanding of the role of IT in this process, specifically regarding the management of patient data, clinical communication, and workflow support. Objective To apply data journey modeling to better understand interoperability, data access, and workflow requirements of a regional multicenter kidney transplant service. Methods An incremental methodology was used to develop the data journey model. This included review of service documents, domain expert interviews, and iterative modeling sessions. Results were analyzed based on the LOAD (landscape, organizations, actors, and data) framework to provide a meaningful assessment of current data management challenges and inform ways for IT to overcome these challenges. Results Results were presented as a diagram of the organizations (n=4), IT systems (n>9), actors (n>4), and data journeys (n=0) involved in the transplant referral pathway. The diagram revealed that all movement of data was dependent on actor interaction with IT systems and manual transcription of data into Microsoft Word (Microsoft, Inc) documents. Each actor had between 2 and 5 interactions with IT systems to capture all relevant data, a process that was reported to be time consuming and error prone. There was no interoperability within or across organizations, which led to delays as clinical teams manually transferred data, such as medical history and test results, via post or email. Conclusions Overall, data journey modeling demonstrated that human actors, rather than IT systems, formed the central focus of data movement. The IT landscape did not complement this workflow and exerted a significant administrative burden on clinical teams. Based on this study, future solutions must consider regional interoperability and specialty-specific views of data to support multi-organizational clinical services such as transplantation.
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Affiliation(s)
- Videha Sharma
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, United Kingdom.,Department of Renal and Pancreatic Transplantation, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Iliada Eleftheriou
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, United Kingdom
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, United Kingdom
| | - Andrew Brass
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, United Kingdom
| | - Titus Augustine
- Department of Renal and Pancreatic Transplantation, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom.,Division of Diabetes, Endocrinology and Gastroenterology, The University of Manchester, Manchester, United Kingdom
| | - John Ainsworth
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, United Kingdom
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20
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Wymant C, Bezemer D, Blanquart F, Ferretti L, Gall A, Hall M, Golubchik T, Bakker M, Ong SH, Zhao L, Bonsall D, de Cesare M, MacIntyre-Cockett G, Abeler-Dörner L, Albert J, Bannert N, Fellay J, Grabowski MK, Gunsenheimer-Bartmeyer B, Günthard HF, Kivelä P, Kouyos RD, Laeyendecker O, Meyer L, Porter K, Ristola M, van Sighem A, Berkhout B, Kellam P, Cornelissen M, Reiss P, Fraser C, Aubert V, Battegay M, Bernasconi E, Böni J, Braun DL, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Gorgievski M, Günthard H, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos R, Kovari H, Ledergerber B, Martinetti G, de Tejada BM, Marzolini C, Metzner K, Müller N, Nadal D, Nicca D, Pantaleo G, Rauch A, Regenass S, Rudin C, Schöni-Affolter F, Schmid P, Speck R, Stöckle M, Tarr P, Trkola A, Vernazza P, Weber R, Yerly S, van der Valk M, Geerlings SE, Goorhuis A, Hovius JW, Lempkes B, Nellen FJB, van der Poll T, Prins JM, Reiss P, van Vugt M, Wiersinga WJ, Wit FWMN, van Duinen M, van Eden J, Hazenberg A, van Hes AMH, Rajamanoharan S, Robinson T, Taylor B, Brewer C, Mayr C, Schmidt W, Speidel A, Strohbach F, Arastéh K, Cordes C, Pijnappel FJJ, Stündel M, Claus J, Baumgarten A, Carganico A, Ingiliz P, Dupke S, Freiwald M, Rausch M, Moll A, Schleehauf D, Smalhout SY, Hintsche B, Klausen G, Jessen H, Jessen A, Köppe S, Kreckel P, Schranz D, Fischer K, Schulbin H, Speer M, Weijsenfeld AM, Glaunsinger T, Wicke T, Bieniek B, Hillenbrand H, Schlote F, Lauenroth-Mai E, Schuler C, Schürmann D, Wesselmann H, Brockmeyer N, Jurriaans S, Gehring P, Schmalöer D, Hower M, Spornraft-Ragaller P, Häussinger D, Reuter S, Esser S, Markus R, Kreft B, Berzow D, Back NKT, Christl A, Meyer A, Plettenberg A, Stoehr A, Graefe K, Lorenzen T, Adam A, Schewe K, Weitner L, Fenske S, Zaaijer HL, Hansen S, Stellbrink HJ, Wiemer D, Hertling S, Schmidt R, Arbter P, Claus B, Galle P, Jäger H, Jä Gel-Guedes E, Berkhout B, Postel N, Fröschl M, Spinner C, Bogner J, Salzberger B, Schölmerich J, Audebert F, Marquardt T, Schaffert A, Schnaitmann E, Cornelissen MTE, Trein A, Frietsch B, Müller M, Ulmer A, Detering-Hübner B, Kern P, Schubert F, Dehn G, Schreiber M, Güler C, Schinkel CJ, Gunsenheimer-Bartmeyer B, Schmidt D, Meixenberger K, Bannert N, Wolthers KC, Peters EJG, van Agtmael MA, Autar RS, Bomers M, Sigaloff KCE, Heitmuller M, Laan LM, Ang CW, van Houdt R, Jonges M, Kuijpers TW, Pajkrt D, Scherpbier HJ, de Boer C, van der Plas A, van den Berge M, Stegeman A, Baas S, Hage de Looff L, Buiting A, Reuwer A, Veenemans J, Wintermans B, Pronk MJH, Ammerlaan HSM, van den Bersselaar DNJ, de Munnik ES, Deiman B, Jansz AR, Scharnhorst V, Tjhie J, Wegdam MCA, van Eeden A, Nellen J, Brokking W, Elsenburg LJM, Nobel H, van Kasteren MEE, Berrevoets MAH, Brouwer AE, Adams A, van Erve R, de Kruijf-van de Wiel BAFM, Keelan-Phaf S, van de Ven B, van der Ven B, Buiting AGM, Murck JL, de Vries-Sluijs TEMS, Bax HI, van Gorp ECM, de Jong-Peltenburg NC, de Mendonç A Melo M, van Nood E, Nouwen JL, Rijnders BJA, Rokx C, Schurink CAM, Slobbe L, Verbon A, Bassant N, van Beek JEA, Vriesde M, van Zonneveld LM, de Groot J, Boucher CAB, Koopmans MPG, van Kampen JJA, Fraaij PLA, van Rossum AMC, Vermont CL, van der Knaap LC, Visser E, Branger J, Douma RA, Cents-Bosma AS, Duijf-van de Ven CJHM, Schippers EF, van Nieuwkoop C, van Ijperen JM, Geilings J, van der Hut G, van Burgel ND, Leyten EMS, Gelinck LBS, Mollema F, Davids-Veldhuis S, Tearno C, Wildenbeest GS, Heikens E, Groeneveld PHP, Bouwhuis JW, Lammers AJJ, Kraan S, van Hulzen AGW, Kruiper MSM, van der Bliek GL, Bor PCJ, Debast SB, Wagenvoort GHJ, Kroon FP, de Boer MGJ, Jolink H, Lambregts MMC, Roukens AHE, Scheper H, Dorama W, van Holten N, Claas ECJ, Wessels E, den Hollander JG, El Moussaoui R, Pogany K, Brouwer CJ, Smit JV, Struik-Kalkman D, van Niekerk T, Pontesilli O, Lowe SH, Oude Lashof AML, Posthouwer D, van Wolfswinkel ME, Ackens RP, Burgers K, Schippers J, Weijenberg-Maes B, van Loo IHM, Havenith TRA, van Vonderen MGA, Kampschreur LM, Faber S, Steeman-Bouma R, Al Moujahid A, Kootstra GJ, Delsing CE, van der Burg-van de Plas M, Scheiberlich L, Kortmann W, van Twillert G, Renckens R, Ruiter-Pronk D, van Truijen-Oud FA, Cohen Stuart JWT, Jansen ER, Hoogewerf M, Rozemeijer W, van der Reijden WA, Sinnige JC, Brinkman K, van den Berk GEL, Blok WL, Lettinga KD, de Regt M, Schouten WEM, Stalenhoef JE, Veenstra J, Vrouenraets SME, Blaauw H, Geerders GF, Kleene MJ, Kok M, Knapen M, van der Meché IB, Mulder-Seeleman E, Toonen AJM, Wijnands S, Wttewaal E, Kwa D, van Crevel R, van Aerde K, Dofferhoff ASM, Henriet SSV, Ter Hofstede HJM, Hoogerwerf J, Keuter M, Richel O, Albers M, Grintjes-Huisman KJT, de Haan M, Marneef M, Strik-Albers R, Rahamat-Langendoen J, Stelma FF, Burger D, Gisolf EH, Hassing RJ, Claassen M, Ter Beest G, van Bentum PHM, Langebeek N, Tiemessen R, Swanink CMA, van Lelyveld SFL, Soetekouw R, van der Prijt LMM, van der Swaluw J, Bermon N, van der Reijden WA, Jansen R, Herpers BL, Veenendaal D, Verhagen DWM, Lauw FN, van Broekhuizen MC, van Wijk M, Bierman WFW, Bakker M, Kleinnijenhuis J, Kloeze E, Middel A, Postma DF, Schölvinck EH, Stienstra Y, Verhage AR, Wouthuyzen-Bakker M, Boonstra A, de Groot-de Jonge H, van der Meulen PA, de Weerd DA, Niesters HGM, van Leer-Buter CC, Knoester M, Hoepelman AIM, Arends JE, Barth RE, Bruns AHW, Ellerbroek PM, Mudrikova T, Oosterheert JJ, Schadd EM, van Welzen BJ, Aarsman K, Griffioen-van Santen BMG, de Kroon I, van Berkel M, van Rooijen CSAM, Schuurman R, Verduyn-Lunel F, Wensing AMJ, Bont LJ, Geelen SPM, Loeffen YGT, Wolfs TFW, Nauta N, Rooijakkers EOW, Holtsema H, Voigt R, van de Wetering D, Alberto A, van der Meer I, Rosingh A, Halaby T, Zaheri S, Boyd AC, Bezemer DO, van Sighem AI, Smit C, Hillebregt M, de Jong A, Woudstra T, Bergsma D, Meijering R, van de Sande L, Rutkens T, van der Vliet S, de Groot L, van den Akker M, Bakker Y, El Berkaoui A, Bezemer M, Brétin N, Djoechro E, Groters M, Kruijne E, Lelivelt KJ, Lodewijk C, Lucas E, Munjishvili L, Paling F, Peeck B, Ree C, Regtop R, Ruijs Y, Schoorl M, Schnörr P, Scheigrond A, Tuijn E, Veenenberg L, Visser KM, Witte EC, Ruijs Y, Van Frankenhuijsen M, Allegre T, Makhloufi D, Livrozet JM, Chiarello P, Godinot M, Brunel-Dalmas F, Gibert S, Trepo C, Peyramond D, Miailhes P, Koffi J, Thoirain V, Brochier C, Baudry T, Pailhes S, Lafeuillade A, Philip G, Hittinger G, Assi A, Lambry V, Rosenthal E, Naqvi A, Dunais B, Cua E, Pradier C, Durant J, Joulie A, Quinsat D, Tempesta S, Ravaux I, Martin IP, Faucher O, Cloarec N, Champagne H, Pichancourt G, Morlat P, Pistone T, Bonnet F, Mercie P, Faure I, Hessamfar M, Malvy D, Lacoste D, Pertusa MC, Vandenhende MA, Bernard N, Paccalin F, Martell C, Roger-Schmelz J, Receveur MC, Duffau P, Dondia D, Ribeiro E, Caltado S, Neau D, Dupont M, Dutronc H, Dauchy F, Cazanave C, Vareil MO, Wirth G, Le Puil S, Pellegrin JL, Raymond I, Viallard JF, Chaigne de Lalande S, Garipuy D, Delobel P, Obadia M, Cuzin L, Alvarez M, Biezunski N, Porte L, Massip P, Debard A, Balsarin F, Lagarrigue M, Prevoteau du Clary F, Aquilina C, Reynes J, Baillat V, Merle C, Lemoing V, Atoui N, Makinson A, Jacquet JM, Psomas C, Tramoni C, Aumaitre H, Saada M, Medus M, Malet M, Eden A, Neuville S, Ferreyra M, Sotto A, Barbuat C, Rouanet I, Leureillard D, Mauboussin JM, Lechiche C, Donsesco R, Cabie A, Abel S, Pierre-Francois S, Batala AS, Cerland C, Rangom C, Theresine N, Hoen B, Lamaury I, Fabre I, Schepers K, Curlier E, Ouissa R, Gaud C, Ricaud C, Rodet R, Wartel G, Sautron C, Beck-Wirth G, Michel C, Beck C, Halna JM, Kowalczyk J, Benomar M, Drobacheff-Thiebaut C, Chirouze C, Faucher JF, Parcelier F, Foltzer A, Haffner-Mauvais C, Hustache Mathieu M, Proust A, Piroth L, Chavanet P, Duong M, Buisson M, Waldner A, Mahy S, Gohier S, Croisier D, May T, Delestan M, Andre M, Zadeh MM, Martinot M, Rosolen B, Pachart A, Martha B, Jeunet N, Rey D, Cheneau C, Partisani M, Priester M, Bernard-Henry C, Batard ML, Fischer P, Berger JL, Kmiec I, Robineau O, Huleux T, Ajana F, Alcaraz I, Allienne C, Baclet V, Meybeck A, Valette M, Viget N, Aissi E, Biekre R, Cornavin P, Merrien D, Seghezzi JC, Machado M, Diab G, Raffi F, Bonnet B, Allavena C, Grossi O, Reliquet V, Billaud E, Brunet C, Bouchez S, Morineau-Le Houssine P, Sauser F, Boutoille D, Besnier M, Hue H, Hall N, Brosseau D, Souala F, Michelet C, Tattevin P, Arvieux C, Revest M, Leroy H, Chapplain JM, Dupont M, Fily F, Patra-Delo S, Lefeuvre C, Bernard L, Bastides F, Nau P, Verdon R, de la Blanchardiere A, Martin A, Feret P, Geffray L, Daniel C, Rohan J, Fialaire P, Chennebault JM, Rabier V, Abgueguen P, Rehaiem S, Luycx O, Niault M, Moreau P, Poinsignon Y, Goussef M, Mouton-Rioux V, Houlbert D, Alvarez-Huve S, Barbe F, Haret S, Perre P, Leantez-Nainville S, Esnault JL, Guimard T, Suaud I, Girard JJ, Simonet V, Debab Y, Schmit JL, Jacomet C, Weinberck P, Genet C, Pinet P, Ducroix S, Durox H, Denes É, Abraham B, Gourdon F, Antoniotti O, Molina JM, Ferret S, Lascoux-Combe C, Lafaurie M, Colin de Verdiere N, Ponscarme D, De Castro N, Aslan A, Rozenbaum W, Pintado C, Clavel F, Taulera O, Gatey C, Munier AL, Gazaigne S, Penot P, Conort G, Lerolle N, Leplatois A, Balausine S, Delgado J, Timsit J, Tabet M, Gerard L, Girard PM, Picard O, Tredup J, Bollens D, Valin N, Campa P, Bottero J, Lefebvre B, Tourneur M, Fonquernie L, Wemmert C, Lagneau JL, Yazdanpanah Y, Phung B, Pinto A, Vallois D, Cabras O, Louni F, Pialoux G, Lyavanc T, Berrebi V, Chas J, Lenagat S, Rami A, Diemer M, Parrinello M, Depond A, Salmon D, Guillevin L, Tahi T, Belarbi L, Loulergue P, Zak Dit Zbar O, Launay O, Silbermann B, Leport C, Alagna L, Pietri MP, Simon A, Bonmarchand M, Amirat N, Pichon F, Kirstetter M, Katlama C, Valantin MA, Tubiana R, Caby F, Schneider L, Ktorza N, Calin R, Merlet A, Ben Abdallah S, Weiss L, Buisson M, Batisse D, Karmochine M, Pavie J, Minozzi C, Jayle D, 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Summerfield H, Evans M, White C, Robertson R, Lean C, Morris S, Winter A, Faulkner S, Goorney B, Howard L, Fairley I, Stemp C, Short L, Gomez M, Young F, Roberts M, Green S, Sivakumar K, Minton J, Siminoni A, Calderwood J, Greenhough D, DeSouza C, Muthern L, Orkin C, Murphy S, Truvedi M, McLean K, Hawkins D, Higgs C, Moyes A, Antonucci S, McCormack S, Lynn W, Bevan M, Fox J, Teague A, Anderson J, Mguni S, Post F, Campbell L, Mazhude C, Russell H, Gilson R, Carrick G, Ainsworth J, Waters A, Byrne P, Johnson M, Fidler S, Kuldanek K, Mullaney S, Lawlor V, Melville R, Sukthankar A, Thorpe S, Murphy C, Wilkins E, Ahmad S, Green P, Tayal S, Ong E, Meaden J, Riddell L, Loay D, Peacock K, Blackman H, Harindra V, Saeed AM, Allen S, Natarajan U, Williams O, Lacey H, Care C, Bowman C, Herman S, Devendra SV, Wither J, Bridgwood A, Singh G, Bushby S, Kellock D, Young S, Rooney G, Snart B, Currie J, Fitzgerald M, Arumainayyagam J, Chandramani S. A highly virulent variant of HIV-1 circulating in the Netherlands. Science 2022; 375:540-545. [PMID: 35113714 DOI: 10.1126/science.abk1688] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.
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Affiliation(s)
- Chris Wymant
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - François Blanquart
- Centre for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, PSL Research University, Paris, France.,IAME, UMR 1137, INSERM, Université de Paris, Paris, France
| | - Luca Ferretti
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Astrid Gall
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Matthew Hall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tanya Golubchik
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Margreet Bakker
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Swee Hoe Ong
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Lele Zhao
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David Bonsall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mariateresa de Cesare
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - George MacIntyre-Cockett
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lucie Abeler-Dörner
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Norbert Bannert
- Division for HIV and Other Retroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Jacques Fellay
- School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M Kate Grabowski
- Department of Pathology, John Hopkins University, Baltimore, MD, USA
| | | | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Pia Kivelä
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | - Laurence Meyer
- INSERM CESP U1018, Université Paris Saclay, APHP, Service de Santé Publique, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Kholoud Porter
- Institute for Global Health, University College London, London, UK
| | - Matti Ristola
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | | | - Ben Berkhout
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Kellam
- Kymab Ltd., Cambridge, UK.,Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Marion Cornelissen
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Molecular Diagnostic Unit, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, Netherlands.,Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Christophe Fraser
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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21
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Hu K, Zatyka M, Astuti D, Beer N, Dias RP, Kulkarni A, Ainsworth J, Wright B, Majander A, Yu-Wai-Man P, Williams D, Barrett T. WFS1 protein expression correlates with clinical progression of optic atrophy in patients with Wolfram syndrome. J Med Genet 2022; 59:65-74. [PMID: 34006618 PMCID: PMC8685651 DOI: 10.1136/jmedgenet-2020-107257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/10/2020] [Revised: 09/15/2020] [Accepted: 10/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Wolfram syndrome (WFS) is a rare disorder characterised by childhood-onset diabetes mellitus and progressive optic atrophy. Most patients have variants in the WFS1 gene. We undertook functional studies of WFS1 variants and correlated these with WFS1 protein expression and phenotype. METHODS 9 patients with a clinical diagnosis of WFS were studied with quantitative PCR for markers of endoplasmic reticulum (ER) stress and immunoblotting of fibroblast protein extracts for WFS1 protein expression. Luciferase reporter assay was used to assess ATF-6 dependent unfolded protein response (UPR) activation. RESULTS 6 patients with compound heterozygous nonsense mutations in WFS1 had no detectable WFS1 protein expression; 3 patients with missense variants had 4%, 45% and 48% WFS1 protein expression. One of these also had an OPA1 mutation and was reclassified as autosomal dominant optic atrophy-plus syndrome. There were no correlations between ER stress marker mRNA and WFS1 protein expression. ERSE-luciferase reporter indicated activation of the ATF6 branch of UPR in two patients tested. Patients with partial WFS1 expression showed milder visual acuity impairment (asymptomatic or colour blind only), compared with those with absent expression (registered severe vision impaired) (p=0.04). These differences remained after adjusting for duration of optic atrophy. CONCLUSIONS Patients with WFS who have partial WFS1 protein expression present with milder visual impairment. This suggests a protective effect of partial WFS1 protein expression on the severity and perhaps progression of vision impairment and that therapies to increase residual WFS1 protein expression may be beneficial.
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Affiliation(s)
- Kun Hu
- Institute of Cancer and Genomic Sciences, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Malgorzata Zatyka
- Institute of Cancer and Genomic Sciences, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Dewi Astuti
- Institute of Cancer and Genomic Sciences, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Nicola Beer
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University, Oxford, Oxfordshire, UK
| | - Renuka P Dias
- Institute of Metabolism and Systems Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Archana Kulkarni
- Department of Ophthalmology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - John Ainsworth
- Department of Ophthalmology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Benjamin Wright
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Anna Majander
- Department of Ophthalmology, Helsinki University Hospital, University of Helsinki Faculty of Medicine, Helsinki, Uusimaa, Finland
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, Greater London, UK
| | - Patrick Yu-Wai-Man
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, Greater London, UK
- Cambridge Centre for Brain Repair, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Denise Williams
- Department of Clinical Genetics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Timothy Barrett
- Institute of Cancer and Genomic Sciences, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Department of Endocrinology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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22
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Mifsud M, Picton S, Ainsworth J. Bilateral retinal involvement in juvenile xanthogranuloma-Successful treatment with clofarabine. Pediatr Blood Cancer 2021; 68:e29222. [PMID: 34245213 DOI: 10.1002/pbc.29222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Maria Mifsud
- Department of Paediatric Oncology and Haematology, Royal Marsden Hospital, London, UK
| | - Susan Picton
- Department of Paediatric Oncology, Leeds Children's Hospital, Leeds, UK
| | - John Ainsworth
- Department of Paediatric Ophthalmology, Birmingham Children's Hospital, Birmingham, UK
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23
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Cunningham J, Davidge G, Davies N, Devaney S, Holm S, Harding M, Leeming G, Neumann V, Ainsworth J. Blockchain Native Data Linkage. Front Blockchain 2021. [DOI: 10.3389/fbloc.2021.667388] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Data providers holding sensitive medical data often need to exchange data pertaining to patients for whom they hold particular data. This involves requesting information from other providers to augment the data they hold. However, revealing the superset of identifiers for which a provider requires information can, in itself, leak sensitive private data. Data linkage services exist to facilitate the exchange of anonymized identifiers between data providers. Reliance on third parties to provide these services still raises issues around the trust, privacy and security of such implementations. The rise and use of blockchain and distributed ledger technologies over the last decade has, alongside innovation and disruption in the financial sphere, also brought to the fore and refined the use of associated privacy-preserving cryptographic protocols and techniques. These techniques are now being adopted and used in fields removed from the original financial use cases. In this paper we present a combination of a blockchain-native auditing and trust-enabling environment alongside a query exchange protocol. This allows the exchange of sets of patient identifiers between data providers in such a way that only identifiers lying in the intersection of sets of identifiers are revealed and shared, allowing further secure and privacy-preserving exchange of medical information to be carried out between the two parties. We present the design and implementation of a system demonstrating the effectiveness of these exchange protocols giving a reference architecture for the implementation of such a system.
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24
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Sharma V, Davies A, Ainsworth J. Clinical risk prediction models: the canary in the coalmine for artificial intelligence in healthcare? BMJ Health Care Inform 2021; 28:bmjhci-2021-100421. [PMID: 34607819 PMCID: PMC8491286 DOI: 10.1136/bmjhci-2021-100421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/03/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Videha Sharma
- Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Angela Davies
- Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, UK
| | - John Ainsworth
- Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, UK
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25
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Wildman MJ, O’Cathain A, Hind D, Maguire C, Arden MA, Hutchings M, Bradley J, Walters SJ, Whelan P, Ainsworth J, Tappenden P, Buchan I, Elliott R, Nicholl J, Elborn S, Michie S, Mandefield L, Sutton L, Hoo ZH, Drabble SJ, Lumley E, Beever D, Navega Biz A, Scott A, Waterhouse S, Robinson L, Hernández Alava M, Sasso A. An intervention to support adherence to inhaled medication in adults with cystic fibrosis: the ACtiF research programme including RCT. Programme Grants Appl Res 2021. [DOI: 10.3310/pgfar09110] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background
People with cystic fibrosis frequently have low levels of adherence to inhaled medications.
Objectives
The objectives were to develop and evaluate an intervention for adults with cystic fibrosis to improve adherence to their inhaled medication.
Design
We used agile software methods to develop an online platform. We used mixed methods to develop a behaviour change intervention for delivery by an interventionist. These were integrated to become the CFHealthHub intervention. We undertook a feasibility study consisting of a pilot randomised controlled trial and process evaluation in two cystic fibrosis centres. We evaluated the intervention using an open-label, parallel-group randomised controlled trial with usual care as the control. Participants were randomised in a 1 : 1 ratio to intervention or usual care. Usual care consisted of clinic visits every 3 months. We undertook a process evaluation alongside the randomised controlled trial, including a fidelity study, a qualitative interview study and a mediation analysis. We undertook a health economic analysis using both a within-trial and model-based analysis.
Setting
The randomised controlled trial took place in 19 UK cystic fibrosis centres.
Participants
Participants were people aged ≥ 16 years with cystic fibrosis, on the cystic fibrosis registry, not post lung transplant or on the active transplant list, who were able to consent and not using dry-powder inhalers.
Intervention
People with cystic fibrosis used a nebuliser with electronic monitoring capabilities. This transferred data automatically to a digital platform. People with cystic fibrosis and clinicians could monitor adherence using these data, including through a mobile application (app). CFHealthHub displayed graphs of adherence data as well as educational and problem-solving information. A trained interventionist helped people with cystic fibrosis to address their adherence.
Main outcome measures
Randomised controlled trial – adjusted incidence rate ratio of pulmonary exacerbations meeting the modified Fuchs criteria over a 12-month follow-up period (primary outcome); change in percentage adherence; and per cent predicted forced expiratory volume in 1 second (key secondary outcomes). Process evaluation – percentage fidelity to intervention delivery, and participant and interventionist perceptions of the intervention. Economic modelling – incremental cost per quality-adjusted life-year gained.
Results
Randomised controlled trial – 608 participants were randomised to the intervention (n = 305) or usual care (n = 303). To our knowledge, this was the largest randomised controlled trial in cystic fibrosis undertaken in the UK. The adjusted rate of exacerbations per year (primary outcome) was 1.63 in the intervention and 1.77 in the usual-care arm (incidence rate ratio 0.96, 95% confidence interval 0.83 to 1.12; p = 0.638) after adjustment for covariates. The adjusted difference in mean weekly normative adherence was 9.5% (95% confidence interval 8.6% to 10.4%) across 1 year, favouring the intervention. Adjusted mean difference in forced expiratory volume in 1 second (per cent) predicted at 12 months was 1.4% (95% confidence interval –0.2% to 3.0%). No adverse events were related to the intervention. Process evaluation – fidelity of intervention delivery was high, the intervention was acceptable to people with cystic fibrosis, participants engaged with the intervention [287/305 (94%) attended the first intervention visit], expected mechanisms of action were identified and contextual factors varied between randomised controlled trial sites. Qualitative interviews with 22 people with cystic fibrosis and 26 interventionists identified that people with cystic fibrosis welcomed the objective adherence data as proof of actions to self and others, and valued the relationship that they built with the interventionists. Economic modelling – the within-trial analysis suggests that the intervention generated 0.01 additional quality-adjusted life-years at an additional cost of £865.91 per patient, leading to an incremental cost-effectiveness ratio of £71,136 per quality-adjusted life-year gained. This should be interpreted with caution owing to the short time horizon. The health economic model suggests that the intervention is expected to generate 0.17 additional quality-adjusted life-years and cost savings of £1790 over a lifetime (70-year) horizon; hence, the intervention is expected to dominate usual care. Assuming a willingness-to-pay threshold of £20,000 per quality-adjusted life-year gained, the probability that the intervention generates more net benefit than usual care is 0.89. The model results are dependent on assumptions regarding the duration over which costs and effects of the intervention apply, the impact of the intervention on forced expiratory volume in 1 second (per cent) predicted and the relationship between increased adherence and drug-prescribing levels.
Limitations
Number of exacerbations is a sensitive and valid measure of clinical change used in many trials. However, data collection of this outcome in this context was challenging and could have been subject to bias. It was not possible to measure baseline adherence accurately. It was not possible to quantify the impact of the intervention on the number of packs of medicines prescribed.
Conclusions
We developed a feasible and acceptable intervention that was delivered to fidelity in the randomised controlled trial. We observed no statistically significant difference in the primary outcome of exacerbation rates over 12 months. We observed an increase in normative adherence levels in a disease where adherence levels are low. The magnitude of the increase in adherence may not have been large enough to affect exacerbations.
Future work
Given the non-significant difference in the primary outcome, further research is required to explore why an increase in objective normative adherence did not reduce exacerbations and to develop interventions that reduce exacerbations.
Trial registration
Work package 3.1: Current Controlled Trials ISRCTN13076797. Work packages 3.2 and 3.3: Current Controlled Trials ISRCTN55504164.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin J Wildman
- Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Hind
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Chin Maguire
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Madelynne A Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | - Marlene Hutchings
- Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Judy Bradley
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Stephen J Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Pauline Whelan
- Health eResearch Centre, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - John Ainsworth
- Health eResearch Centre, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Paul Tappenden
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Iain Buchan
- Health eResearch Centre, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Department of Public Health and Policy, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Rachel Elliott
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jon Nicholl
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Stuart Elborn
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - Laura Mandefield
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Laura Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Zhe Hui Hoo
- Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah J Drabble
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Lumley
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Beever
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Aline Navega Biz
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anne Scott
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Simon Waterhouse
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Louisa Robinson
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | - Alessandro Sasso
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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26
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Bevan A, Hoo ZH, Totton N, Girling C, Davids IR, Whelan P, Antrobus S, Ainsworth J, Buchan I, Anderson A, Bourke S, Doe S, Echevarria C, Taylor J, Bell NJ, Bateman K, Jones C, Moran P, Fitch G, Martin M, McGowan A, Morrow S, Seabridge H, Bush N, Daniels T, Lee K, Robson N, Shiferaw D, Sweis D, Thomas R, Faulkner J, Flight WG, Poole S, Warnock L, Allenby MI, Carroll M, Daniels TV, Dunn H, Nightingale JA, Shepherd E, Ohri C, Gadsby J, Range S, Tature D, Barr HL, Dawson S, Dewar J, Miller B, Saini G, Galey P, Johnson J, Pasteur MC, Derry D, Gledhill H, Lawson A, Thomas M, Waine D, Cunningham J, Damani A, Higton A, Orchard C, Carolan C, Tahir M, Plummer A, Hutchings M, Edenborough FP, Curley R, Wildman MJ. Using a learning health system to understand the mismatch between medicines supply and actual medicines use among adults with cystic fibrosis. J Cyst Fibros 2021; 21:323-331. [PMID: 34565705 DOI: 10.1016/j.jcf.2021.09.007] [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] [Received: 04/22/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Studies in separate cohorts suggest possible discrepancies between inhaled medicines supplied (median 50-60%) and medicines used (median 30-40%). We performed the first study that directly compares CF medicine supply against use to identify the cost of excess medicines supply. METHODS This cross-sectional study included participants from 12 UK adult centres with ≥1 year of continuous adherence data from data-logging nebulisers. Medicine supply was measured as medication possession ratio (MPR) for a 1-year period from the first suitable supply date. Medicine use was measured as electronic data capture (EDC) adherence over the same period. The cost of excess medicines was calculated as whole excess box(es) supplied after accounting for the discrepancy between EDC adherence and MPR with 20% contingency. RESULTS Among 275 participants, 133 (48.4%) were females and mean age was 30 years (95% CI 29-31 years). Median EDC adherence was 57% (IQR 23-86%), median MPR was 74% (IQR 46-96%) and the discrepancy between measures was median 14% (IQR 2-29%). Even with 20% contingency, mean potential cost of excess medicines was £1,124 (95% CI £855-1,394), ranging from £183 (95% CI £29-338) for EDC adherence ≥80% to £2,017 (95% CI £1,507-2,526) for EDC adherence <50%. CONCLUSIONS This study provides a conservative estimate of excess inhaled medicines supply cost among adults with CF in the UK. The excess supply cost was highest among those with lowest EDC adherence, highlighting the importance of adherence support and supplying medicine according to actual use. MPR provides information about medicine supply but over-estimates actual medicine use.
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Affiliation(s)
- Amanda Bevan
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Zhe Hui Hoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK; Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nikki Totton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Carla Girling
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - India R Davids
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Pauline Whelan
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Steven Antrobus
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - John Ainsworth
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Iain Buchan
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Alan Anderson
- Newcastle Adult Cystic Fibrosis Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephen Bourke
- Newcastle Adult Cystic Fibrosis Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Simon Doe
- Newcastle Adult Cystic Fibrosis Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Carlos Echevarria
- Newcastle Adult Cystic Fibrosis Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jill Taylor
- Newcastle Adult Cystic Fibrosis Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicholas J Bell
- Bristol Adult Cystic Fibrosis Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kathryn Bateman
- Bristol Adult Cystic Fibrosis Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Carys Jones
- Bristol Adult Cystic Fibrosis Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Peter Moran
- Bristol Adult Cystic Fibrosis Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Giles Fitch
- North West Midlands Cystic Fibrosis Centre, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Michael Martin
- North West Midlands Cystic Fibrosis Centre, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Angela McGowan
- North West Midlands Cystic Fibrosis Centre, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Stephen Morrow
- North West Midlands Cystic Fibrosis Centre, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Heather Seabridge
- North West Midlands Cystic Fibrosis Centre, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Nicki Bush
- York Hull Adult Cystic Fibrosis Centre, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Tracey Daniels
- York Hull Adult Cystic Fibrosis Centre, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Katy Lee
- York Hull Adult Cystic Fibrosis Centre, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Nicola Robson
- York Hull Adult Cystic Fibrosis Centre, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Dejene Shiferaw
- York Hull Adult Cystic Fibrosis Centre, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Dimah Sweis
- York Hull Adult Cystic Fibrosis Centre, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Rebecca Thomas
- York Hull Adult Cystic Fibrosis Centre, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Jayne Faulkner
- Oxford Adult Cystic Fibrosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - William G Flight
- Oxford Adult Cystic Fibrosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarah Poole
- Oxford Adult Cystic Fibrosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Louise Warnock
- Oxford Adult Cystic Fibrosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mark I Allenby
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mary Carroll
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Respiratory Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Thomas V Daniels
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Respiratory Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Helen Dunn
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Julia A Nightingale
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elizabeth Shepherd
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Chandra Ohri
- Leicester Adult Cystic Fibrosis Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Jessica Gadsby
- Leicester Adult Cystic Fibrosis Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Simon Range
- Leicester Adult Cystic Fibrosis Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Darren Tature
- Leicester Adult Cystic Fibrosis Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Helen L Barr
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sophie Dawson
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jane Dewar
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Bryony Miller
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Gauri Saini
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Penny Galey
- Adult Cystic Fibrosis Clinic, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Jack Johnson
- Adult Cystic Fibrosis Clinic, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Mark C Pasteur
- Adult Cystic Fibrosis Clinic, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - David Derry
- Derriford Hospital Adult Cystic Fibrosis Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Harriet Gledhill
- Derriford Hospital Adult Cystic Fibrosis Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Angharad Lawson
- Derriford Hospital Adult Cystic Fibrosis Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Michelle Thomas
- Derriford Hospital Adult Cystic Fibrosis Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - David Waine
- Derriford Hospital Adult Cystic Fibrosis Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Josie Cunningham
- Cystic Fibrosis Unit, Frimley Health NHS Foundation Trust, Frimley, UK
| | - Annant Damani
- Cystic Fibrosis Unit, Frimley Health NHS Foundation Trust, Frimley, UK
| | - Alexandra Higton
- Cystic Fibrosis Unit, Frimley Health NHS Foundation Trust, Frimley, UK
| | | | - Charlotte Carolan
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Misbah Tahir
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Amanda Plummer
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Marlene Hutchings
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Frank P Edenborough
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rachael Curley
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Martin J Wildman
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK; Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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27
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Wildman MJ, O'Cathain A, Maguire C, Arden MA, Hutchings M, Bradley J, Walters SJ, Whelan P, Ainsworth J, Buchan I, Mandefield L, Sutton L, Tappenden P, Elliott RA, Hoo ZH, Drabble SJ, Beever D. Self-management intervention to reduce pulmonary exacerbations by supporting treatment adherence in adults with cystic fibrosis: a randomised controlled trial. Thorax 2021; 77:461-469. [PMID: 34556552 PMCID: PMC9016257 DOI: 10.1136/thoraxjnl-2021-217594] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 05/07/2021] [Accepted: 08/15/2021] [Indexed: 12/02/2022]
Abstract
Introduction Recurrent pulmonary exacerbations lead to progressive lung damage in cystic fibrosis (CF). Inhaled medications (mucoactive agents and antibiotics) help prevent exacerbations, but objectively measured adherence is low. We investigated whether a multi-component (complex) self-management intervention to support adherence would reduce exacerbation rates over 12 months. Methods Between October 2017 and May 2018, adults with CF (aged ≥16 years; 19 UK centres) were randomised to the intervention (data-logging nebulisers, a digital platform and behavioural change sessions with trained clinical interventionists) or usual care (data-logging nebulisers). Outcomes included pulmonary exacerbations (primary outcome), objectively measured adherence, body mass index (BMI), lung function (FEV1) and Cystic Fibrosis Questionnaire-Revised (CFQ-R). Analyses were by intent to treat over 12 months. Results Among intervention (n=304) and usual care (n=303) participants (51% female, median age 31 years), 88% completed 12-month follow-up. Mean exacerbation rate was 1.63/year with intervention and 1.77/year with usual care (adjusted ratio 0.96; 95% CI 0.83 to 1.12; p=0.64). Adjusted mean differences (95% CI) were in favour of the intervention versus usual care for objectively measured adherence (9.5% (8.6% to 10.4%)) and BMI (0.3 (0.1 to 0.6) kg/m2), with no difference for %FEV1 (1.4 (−0.2 to 3.0)). Seven CFQ-R subscales showed no between-group difference, but treatment burden reduced for the intervention (3.9 (1.2 to 6.7) points). No intervention-related serious adverse events occurred. Conclusions While pulmonary exacerbations and FEV1 did not show statistically significant differences, the intervention achieved higher objectively measured adherence versus usual care. The adherence difference might be inadequate to influence exacerbations, though higher BMI and lower perceived CF treatment burden were observed.
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Affiliation(s)
- Martin J Wildman
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK .,School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alicia O'Cathain
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Chin Maguire
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Madelynne A Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | - Marlene Hutchings
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Judy Bradley
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Stephen J Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Pauline Whelan
- Health eResearch Centre - Division of Imaging, Informatics and Data Sciences, Faculty of Biology, Medicine and Health, The University of Manchester School of Health Sciences, Manchester, UK
| | - John Ainsworth
- Health eResearch Centre - Division of Imaging, Informatics and Data Sciences, Faculty of Biology, Medicine and Health, The University of Manchester School of Health Sciences, Manchester, UK
| | - Iain Buchan
- Health eResearch Centre - Division of Imaging, Informatics and Data Sciences, Faculty of Biology, Medicine and Health, The University of Manchester School of Health Sciences, Manchester, UK.,Department of Public Health and Policy, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Laura Mandefield
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Laura Sutton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Paul Tappenden
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rachel A Elliott
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, The University of Manchester School of Health Sciences, Manchester, UK
| | - Zhe Hui Hoo
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sarah J Drabble
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Daniel Beever
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
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28
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Hoo ZH, Totton N, Waterhouse S, Lewis J, Girling C, Bradburn M, Arden MA, Whelan P, Ainsworth J, Dawson S, Millward S, Barnett K, Dewar J, Barr HL, Saini G, Shepherd E, Carroll M, Allenby MI, Daniels TV, Nightingale JA, Lowther M, Carolan C, Clarke C, Szczepanski R, Hutchings M, Edenborough FP, Curley R, Wildman MJ. Real-World Adherence Among Adults With Cystic Fibrosis Is Low: A Retrospective Analysis of the CFHealthHub Digital Learning Health System. Chest 2021; 160:2061-2065. [PMID: 34186037 DOI: 10.1016/j.chest.2021.06.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- Zhe Hui Hoo
- School of Health and Related Research, University of Sheffield, Sheffield, UK; Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - Nikki Totton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Simon Waterhouse
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jen Lewis
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Carla Girling
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael Bradburn
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Madelynne A Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | - Pauline Whelan
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - John Ainsworth
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Sophie Dawson
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sarah Millward
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kate Barnett
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jane Dewar
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Helen L Barr
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Gauri Saini
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Elizabeth Shepherd
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mary Carroll
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Respiratory Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Mark I Allenby
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Thomas V Daniels
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Respiratory Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Julia A Nightingale
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Michelle Lowther
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Charlotte Carolan
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Charlotte Clarke
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rachel Szczepanski
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Marlene Hutchings
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Frank P Edenborough
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rachael Curley
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Martin J Wildman
- School of Health and Related Research, University of Sheffield, Sheffield, UK; Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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29
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Leung J, Ainsworth J, Peters R, Mehr S, Smart J, Rose E. Increased Rates of Peanut and Tree Nut Aspiration as a Possible Consequence of Allergy Prevention by Early Introduction. J Allergy Clin Immunol Pract 2021; 9:3140-3146.e2. [PMID: 33862267 DOI: 10.1016/j.jaip.2021.03.052] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pediatric airway foreign bodies (FBs) are a surgical emergency, and peanuts and tree nuts (PN/TNs) can pose a significant aspiration risk in young children. In 2015, the Learning Early About Peanut allergy (LEAP) trial established that early introduction of peanuts in high-risk infants reduced the risk of developing a peanut allergy. Infant feeding guidelines were subsequently modified to actively encourage the introduction of allergenic foods for all infants. The impact of this shift in feeding advice on the incidence of PN/TN inhalation has not been previously studied. OBJECTIVE To determine the incidence of PN/TN inhalation presentations to a quaternary pediatric hospital between 2008 and 2018. METHODS A retrospective cohort study of children who were diagnosed with an airway FB by rigid bronchoscopy. RESULTS There were 200 cases of FB inhalation (35% PN/TN, 34% other foods, and 31% inorganic material). There was a rise in the total incidence of FB inhalation over the study period (incidence ratio rate [IRR], 1.09; P < .001). The rise was due to PN/TN (IRR, 1.16; P < .002) and other food inhalation (IRR, 1.12; P = .01), with no significant increase in inorganic FB aspiration (IRR, 1; P = .94). Between pre-LEAP (2008-2014) and post-LEAP (2015-2018) periods, there was a trebling, doubling, and no increase in the rate of PN/TN, other food, and inorganic FB inhalation, respectively. CONCLUSIONS Since the publication of the LEAP study, there has been a rise in PN/TN and other hard solid food inhalation at our institution. This study highlights the urgent need to engage the public to promote safe introduction of hard foods in young children.
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Affiliation(s)
- James Leung
- Paediatric Otolaryngology Head and Neck Surgery Unit, The Royal Children's Hospital, Parkville, Melbourne, VIC, Australia.
| | - John Ainsworth
- Paediatric Allergy and Immunology Unit, The Royal Children's Hospital, Parkville, Melbourne, VIC, Australia; Epworth Allergy Specialists & Centre for Paediatric Allergies, Epworth Hospital, Richmond, VIC, Australia
| | - Rachel Peters
- Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Sam Mehr
- Paediatric Allergy and Immunology Unit, The Royal Children's Hospital, Parkville, Melbourne, VIC, Australia; Epworth Allergy Specialists & Centre for Paediatric Allergies, Epworth Hospital, Richmond, VIC, Australia; Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia
| | - Joanne Smart
- Paediatric Allergy and Immunology Unit, The Royal Children's Hospital, Parkville, Melbourne, VIC, Australia; Epworth Allergy Specialists & Centre for Paediatric Allergies, Epworth Hospital, Richmond, VIC, Australia; Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia
| | - Elizabeth Rose
- Paediatric Otolaryngology Head and Neck Surgery Unit, The Royal Children's Hospital, Parkville, Melbourne, VIC, Australia
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30
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Steels S, Ainsworth J, van Staa TP. Implementation of a "real-world" learning health system: Results from the evaluation of the Connected Health Cities programme. Learn Health Syst 2021; 5:e10224. [PMID: 33889733 PMCID: PMC8051340 DOI: 10.1002/lrh2.10224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/26/2019] [Revised: 12/18/2019] [Accepted: 01/22/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The "learning health system" has been proposed to deliver better outcomes for patients and communities by analyzing routinely captured health information and feeding back results to clinical staff. This approach has been piloted in the Connected Health Cities (CHC) programme in four regions in the North of England. This paper presents the results of the evaluation of this program conducted between February and December 2018. METHODS Fifty nine semistructured interviews were completed with a mix of CHC programme staff and external partners who had contributed to the delivery of the CHC programme. Interviews were audio recorded and transcribed verbatim. This also included the review of project documentation including project reports and minutes of project group meetings, in addition to a short online survey that was completed by 31 members of CHC programme staff. Data were analyzed thematically. RESULTS Two overarching themes emerged through the thematic analysis of participant interview: (a) challenges in the implementation of learning health system pathways, and (b) benefits to the CHC approach for both staff and patients. In particular, time constraints in delivering an ambitious program of work, data quality, and accessibility, as well as the long-term sustainability of the CHC programme were noted as key challenges in implementing a LHS at scale. CONCLUSIONS The findings from this evaluation provide valuable insight into creating learning health system at scale, including the potential benefits and likely challenges.
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Affiliation(s)
- Stephanie Steels
- Health e‐Research Centre, School of Health Sciences, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
- Faculty of Health, Psychology and Social CareManchester Metropolitan UniversityManchesterUK
| | - John Ainsworth
- Health e‐Research Centre, School of Health Sciences, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Tjeerd P. van Staa
- Health e‐Research Centre, School of Health Sciences, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
- Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
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31
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Affiliation(s)
- Videha Sharma
- Centre for Health Informatics, University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
- Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, UK
| | - Georgina Moulton
- Centre for Health Informatics, University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
| | - John Ainsworth
- Centre for Health Informatics, University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
| | - Titus Augustine
- Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, UK
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32
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Mogharbel A, Dowding D, Ainsworth J. Physicians' Use of the Computerized Physician Order Entry System for Medication Prescribing: Systematic Review. JMIR Med Inform 2021; 9:e22923. [PMID: 33661126 PMCID: PMC7974763 DOI: 10.2196/22923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/30/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Computerized physician order entry (CPOE) systems in health care settings have many benefits for prescribing medication, such as improved quality of patient care and patient safety. However, to achieve their full potential, the factors influencing the usage of CPOE systems by physicians must be identified and understood. OBJECTIVE The aim of this study is to identify the factors influencing the usage of CPOE systems by physicians for medication prescribing in their clinical practice. METHODS We conducted a systematic search of the literature on this topic using four databases: PubMed, CINAHL, Ovid MEDLINE, and Embase. Searches were performed from September 2019 to December 2019. The retrieved papers were screened by examining the titles and abstracts of relevant studies; two reviewers screened the full text of potentially relevant papers for inclusion in the review. Qualitative, quantitative, and mixed methods studies with the aim of conducting assessments or investigations of factors influencing the use of CPOE for medication prescribing among physicians were included. The identified factors were grouped based on constructs from two models: the unified theory of acceptance and use of technology model and the Delone and McLean Information System Success Model. We used the Mixed Method Appraisal Tool to assess the quality of the included studies and narrative synthesis to report the results. RESULTS A total of 11 articles were included in the review, and 37 factors related to the usage of CPOE systems were identified as the factors influencing how physicians used CPOE for medication prescribing. These factors represented three main themes: individual, technological, and organizational. CONCLUSIONS This study identified the common factors that influenced the usage of CPOE systems by physicians for medication prescribing regardless of the type of setting or the duration of the use of a system by participants. Our findings can be used to inform implementation and support the usage of the CPOE system by physicians.
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Affiliation(s)
- Asra Mogharbel
- Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Centre for Health Informatics, The University of Manchester, Manchester, United Kingdom
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - John Ainsworth
- Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Centre for Health Informatics, The University of Manchester, Manchester, United Kingdom
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33
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Sharma V, Ali I, van der Veer S, Martin G, Ainsworth J, Augustine T. Adoption of clinical risk prediction tools is limited by a lack of integration with electronic health records. BMJ Health Care Inform 2021; 28:bmjhci-2020-100253. [PMID: 33608259 PMCID: PMC7898839 DOI: 10.1136/bmjhci-2020-100253] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/03/2021] [Indexed: 01/06/2023] Open
Affiliation(s)
- Videha Sharma
- Centre for Health Informatics, The University of Manchester, Manchester, UK .,Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Ibrahim Ali
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Glen Martin
- Centre for Health Informatics, The University of Manchester, Manchester, UK
| | - John Ainsworth
- Centre for Health Informatics, The University of Manchester, Manchester, UK
| | - Titus Augustine
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
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34
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Sharma V, Piscoran O, Summers A, Woywodt A, van der Veer SN, Ainsworth J, Augustine T. The use of health information technology in renal transplantation: A systematic review. Transplant Rev (Orlando) 2021; 35:100607. [PMID: 33607425 DOI: 10.1016/j.trre.2021.100607] [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] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
Renal transplantation is a complex, multi-disciplinary and cross-center service. Clinical pathways naturally traverse specialty and organizational boundaries as patients transition from chronic kidney disease to renal failure and ultimately transplantation. Health information technology (IT) has the potential to support transplant care by improving access to data, information sharing and communication. This novel review aimed to identify and characterize health IT solutions in renal transplantation, and where possible evaluate any intended benefits. A systematic literature review was conducted of studies covering any part of the clinical pathway, with end-users being clinical staff or patients. Interventions were characterized and evaluated for achieved benefits using the World Health Organization (WHO) Classification of Digital Health Interventions and the mixed methods assessment tool (MMAT) was used to determine the quality of experimental studies. Of 4498 articles, 12 descriptive and 6 experimental studies met the inclusion criteria. Median MMAT percentage score of experimental studies was 64 (i.q.r. 57 to 74.8). The most frequent functionality of technology involved overcoming communication roadblocks and improving access to data. Intended benefits included improving information management and supporting workflow, however only one study reported evaluated results. Six patient-facing applications that primarily addressed adherence-to-treatment were identified, five of which were evaluated for intended benefits, showing overall positive results. Overall, despite transplantation being well suited to health IT interventions, this review demonstrates a scarcity of literature in this field. A small number of clinician- and patient-facing IT solutions have been reported, albeit mostly in non-experimental studies. Due to this lack of formal evaluation, the effectiveness of solutions remains unclear. High-quality evaluative studies are required to develop effective IT solutions that improve clinical care.
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Affiliation(s)
- Videha Sharma
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester Faculty of Biology, Medicine and Health, Manchester, Greater Manchester, M13 9PT, UK.
| | - Oana Piscoran
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK
| | - Angela Summers
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; University of Manchester Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, Greater Manchester, M13 9PT, UK
| | - Alexander Woywodt
- Lancashire Teaching Hospitals NHS Foundation Trust, Department of Nephrology, Royal Preston Hospital, Preston, Lancashire, PR2 9HT, UK
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester Faculty of Biology, Medicine and Health, Manchester, Greater Manchester, M13 9PT, UK
| | - John Ainsworth
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester Faculty of Biology, Medicine and Health, Manchester, Greater Manchester, M13 9PT, UK
| | - Titus Augustine
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; University of Manchester Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, Greater Manchester, M13 9PT, UK
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Arden MA, Hutchings M, Whelan P, Drabble SJ, Beever D, Bradley JM, Hind D, Ainsworth J, Maguire C, Cantrill H, O'Cathain A, Wildman M. Development of an intervention to increase adherence to nebuliser treatment in adults with cystic fibrosis: CFHealthHub. Pilot Feasibility Stud 2021; 7:1. [PMID: 33390191 PMCID: PMC7780635 DOI: 10.1186/s40814-020-00739-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 11/30/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is a life-limiting genetic condition in which daily therapies to maintain lung health are critical, yet treatment adherence is low. Previous interventions to increase adherence have been largely unsuccessful and this is likely due to a lack of focus on behavioural evidence and theory alongside input from people with CF. This intervention is based on a digital platform that collects and displays objective nebuliser adherence data. The purpose of this paper is to identify the specific components of an intervention to increase and maintain adherence to nebuliser treatments in adults with CF with a focus on reducing effort and treatment burden. METHODS Intervention development was informed by the Behaviour Change Wheel (BCW) and person-based approach (PBA). A multidisciplinary team conducted qualitative research to inform a needs analysis, selected, and refined intervention components and methods of delivery, mapped adherence-related barriers and facilitators, associated intervention functions and behaviour change techniques, and utilised iterative feedback to develop and refine content and processes. RESULTS Results indicated that people with CF need to understand their treatment, be able to monitor adherence, have treatment goals and feedback and confidence in their ability to adhere, have a treatment plan to develop habits for treatment, and be able to solve problems around treatment adherence. Behaviour change techniques were selected to address each of these needs and were incorporated into the digital intervention developed iteratively, alongside a manual and training for health professionals. Feedback from people with CF and clinicians helped to refine the intervention which could be tailored to individual patient needs. CONCLUSIONS The intervention development process is underpinned by a strong theoretical framework and evidence base and was developed by a multidisciplinary team with a range of skills and expertise integrated with substantial input from patients and clinicians. This multifaceted development strategy has ensured that the intervention is usable and acceptable to people with CF and clinicians, providing the best chance of success in supporting people with CF with different needs to increase and maintain their adherence. The intervention is being tested in a randomised controlled trial across 19 UK sites.
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Affiliation(s)
- M A Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, 2.03a Heart of the Campus, Collegiate Crescent Campus, Sheffield, S10 2BQ, UK.
| | - M Hutchings
- Sheffield Adult Cystic Fibrosis Unit Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
| | - P Whelan
- Health eResearch Centre-Farr Institute, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9GB, UK
| | - S J Drabble
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - D Beever
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - J M Bradley
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - D Hind
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - J Ainsworth
- Health eResearch Centre-Farr Institute, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9GB, UK
| | - C Maguire
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - H Cantrill
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - A O'Cathain
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - M Wildman
- Sheffield Adult Cystic Fibrosis Unit Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
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Berry N, Machin M, Ainsworth J, Berry K, Edge D, Haddock G, Lewis S, Morris R, Bucci S. Developing a Theory-Informed Smartphone App for Early Psychosis: Learning Points From a Multidisciplinary Collaboration. Front Psychiatry 2020; 11:602861. [PMID: 33362612 PMCID: PMC7758439 DOI: 10.3389/fpsyt.2020.602861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Actissist is a smartphone app designed to deliver an intervention grounded in cognitive behavior therapy for early psychosis. Actissist was developed by a multidisciplinary team of academics, clinicians, experts by experience and software engineers. Actissist has been tested in two trials, the first a proof-of-concept trial where Actissist was safe, acceptable and feasible, the second, a powered randomized controlled trial. Objective: This article describes how our multidisciplinary team designed and developed Actissist. This article describes: (i) how Actissist was informed by initial qualitative interviews and focus groups and an expert reference group; (ii) refinements made to the app based on ongoing user feedback; (iii) successes and challenges encountered; and (iv) learning points and recommendations for involving stakeholders in digital health interventions. Methods: Expert reference group meetings informed the development of Actissist and design of subsequent trials, which included individuals with lived experience of psychosis, clinicians, academics, computer scientists and software engineers. Person-centered stakeholder involvement was promoted using focus groups and qualitative interviews prior to the development of the app, which informed version one of Actissist. Interviews were carried out with participants who had used Actissist. Two further versions of Actissist were developed following additional rounds of testing. Results: Multidisciplinary working throughout the Actissist project led to the development, inclusion and improvement of the app design and content. These changes and features included non-directive and compassionate content, co-designed recovery videos, relaxation exercises, psychoeducation material, ability to "favorite" areas of the app that users found helpful, and goal-setting. Challenges to collaborative working included discrepancies between what stakeholders want and what is technically possible to deliver, resource pressures, trying to deliver desired features within the boundaries of fundamental trial design considerations, and power imbalances associated with multidisciplinary working. Conclusions: The involvement of stakeholders in the design and development and delivery of Actissist has been fundamental to our development approach. Through this collaborative process, we have identified different perspectives and ideas that would have not been generated by the research team alone. Clinical Trial Registrations: Proof-of-concept trial: http://www.isrctn.com/ISRCTN34966555 Fully-powered randomized controlled trial: https://www.isrctn.com/ISRCTN76986679.
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Affiliation(s)
- Natalie Berry
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Matthew Machin
- Division of Informatics Imaging and Data Sciences, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - John Ainsworth
- Division of Informatics Imaging and Data Sciences, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Katherine Berry
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Dawn Edge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Shon Lewis
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Rohan Morris
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Hind D, Drabble SJ, Arden MA, Mandefield L, Waterhouse S, Maguire C, Cantrill H, Robinson L, Beever D, Scott A, Keating S, Hutchings M, Bradley J, Nightingale J, Allenby MI, Dewar J, Whelan P, Ainsworth J, Walters SJ, Wildman MJ, O'Cathain A. Feasibility study for supporting medication adherence for adults with cystic fibrosis: mixed-methods process evaluation. BMJ Open 2020; 10:e039089. [PMID: 33109661 PMCID: PMC7592300 DOI: 10.1136/bmjopen-2020-039089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/27/2020] [Accepted: 09/29/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To undertake a process evaluation of an adherence support intervention for people with cystic fibrosis (PWCF), to assess its feasibility and acceptability. SETTING Two UK cystic fibrosis (CF) units. PARTICIPANTS Fourteen adult PWCF; three professionals delivering adherence support ('interventionists'); five multi-disciplinary CF team members. INTERVENTIONS Nebuliser with data recording and transfer capability, linked to a software platform, and strategies to support adherence to nebulised treatments facilitated by interventionists over 5 months (± 1 month). PRIMARY AND SECONDARY MEASURES Feasibility and acceptability of the intervention, assessed through semistructured interviews, questionnaires, fidelity assessments and click analytics. RESULTS Interventionists were complimentary about the intervention and training. Key barriers to intervention feasibility and acceptability were identified. Interventionists had difficulty finding clinic space and time in normal working hours to conduct review visits. As a result, fewer than expected intervention visits were conducted and interviews indicated this may explain low adherence in some intervention arm participants. Adherence levels appeared to be >100% for some patients, due to inaccurate prescription data, particularly in patients with complex treatment regimens. Flatlines in adherence data at the start of the study were linked to device connectivity problems. Content and delivery quality fidelity were 100% and 60%-92%, respectively, indicating that interventionists needed to focus more on intervention 'active ingredients' during sessions. CONCLUSIONS The process evaluation led to 14 key changes to intervention procedures to overcome barriers to intervention success. With the identified changes, it is feasible and acceptable to support medication adherence with this intervention. TRIAL REGISTRATION NUMBER ISRCTN13076797; Results.
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Affiliation(s)
- Daniel Hind
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Sarah J Drabble
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Madelynne A Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | | | - Simon Waterhouse
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Chin Maguire
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Hannah Cantrill
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Louisa Robinson
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Daniel Beever
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Alex Scott
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Sam Keating
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Marlene Hutchings
- Sheffield Adult Cystic Fibrosis Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, Sheffield, UK
| | - Judy Bradley
- Wellcome-Wolfson Institute For Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Julia Nightingale
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark I Allenby
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jane Dewar
- Wolfson Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Pauline Whelan
- Health eResearch Centre - Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - John Ainsworth
- Health eResearch Centre - Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen J Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Martin J Wildman
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Sheffield Adult Cystic Fibrosis Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, Sheffield, UK
| | - Alicia O'Cathain
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Leeming G, Thew S, Ainsworth J. Designing a Solution to Manage Electronic Consent for Children. Stud Health Technol Inform 2020; 270:1103-1107. [PMID: 32570552 DOI: 10.3233/shti200333] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Electronic systems for managing consent do exist but are generally only able to record consent from the research subject directly. Consent for research is also challenging to integrate into many electronic patient record systems. The Born In Bradford study is a large, from birth cohort study in the North of England which requires consent to be recorded by the pregnant mother of a child who will be included in the study from birth. This creates a complex challenge for consent management that has previously been achieved through paper-based processes. As the study begins a new phase with the objective of inviting all new parents within the Bradford region to participate in the study the solution also needs to work with existing maternity systems. This paper considers the specific challenges of converting the often grey rules around consent of children into an electronic system that is transparent and supports the trust of both the family and the clinical and care teams recruiting research subjects into a large cohort study, and describes the user centred design and technical approach taken to resolve it.
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Affiliation(s)
- Gary Leeming
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Sarah Thew
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Storybook UX Ltd
| | - John Ainsworth
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Lewis S, Ainsworth J, Sanders C, Stockton-Powdrell C, Machin M, Whelan P, Hopkins R, He Z, Applegate E, Drake R, Bamford C, Roberts C, Wykes T. Smartphone-Enhanced Symptom Management In Psychosis: Open, Randomized Controlled Trial. J Med Internet Res 2020; 22:e17019. [PMID: 32788150 PMCID: PMC7453320 DOI: 10.2196/17019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 11/13/2019] [Revised: 02/04/2020] [Accepted: 02/16/2020] [Indexed: 11/19/2022] Open
Abstract
Background Improving recovery from acute symptoms and preventing relapse are two significant challenges in severe mental illness. We developed a personalized smartphone-based app to monitor symptoms in real time and validated its acceptance, reliability, and validity. Objective To assess (i) acceptability of continuous monitoring to SMI patients and health professionals over 3 months; (ii) impact of active self-monitoring on positive psychotic symptoms assessed at 6 and 12 weeks; and (iii) the feasibility of detecting early warning signs of relapse. Methods The active symptom monitoring smartphone app was built into an end-to-end system in two NHS Trusts to enable real-time symptom self-monitoring and detection by the clinical team of early signs of relapse in people with severe mental illness. We conducted an open randomized controlled trial of active symptom monitoring compared to usual management to assess: (i) acceptability and safety of continuous monitoring over 3 months; (ii) impact of active self-monitoring on positive psychotic symptoms assessed at 6 and 12 weeks; (iii) feasibility of detecting early warning signs of relapse communicated to the healthcare staff via an app streaming data to the electronic health record. Eligible participants with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) diagnosis of schizophrenia and related disorders, and a history of relapse within the previous two years were enrolled from an early intervention team and a community mental health team. Results Of 181 eligible patients, 81 (45%) consented and were randomized to either active symptom monitoring or management as usual. At 12 weeks, 90% (33/36) of those in the active monitoring group continued to use the system and exhibited an adherence rate (defined as responding to >33% of alerts) of 84% (30/36}. Active symptom monitoring was associated with no difference on the empowerment scale in comparison to the usual management group at 12 weeks. The pre-planned intent-to-treat analysis of the primary outcome, a positive score on the Positive and Negative Syndrome Scale (PANSS) scale, showed a significant reduction in the active symptom monitoring group over 12 weeks in the early intervention center. Alerts for personalized early warning signs of relapse were built into the workflows of both NHS Trusts, and 100% of health professional staff used the system in a new digital workflow. Qualitative analyses supported the acceptability of the system to participants and staff. Conclusions The active smartphone monitoring system is feasible and was accepted by users in a 3-month study of people with severe mental illness, with surprisingly high levels of adherence. App use was associated with psychotic symptom improvement in recent-onset participants, but not those with longstanding illness, supporting the notion of improved self-management. When built into clinical management workflows to enable personalized alerts of symptom deterioration, the app has demonstrated utility in promoting earlier intervention for relapse. Trial Registration ISRCTN Registry ISRCTN88145142; http://www.isrctn.com/ISRCTN88145142
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Affiliation(s)
- Shon Lewis
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - John Ainsworth
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Caroline Sanders
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Charlotte Stockton-Powdrell
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Matthew Machin
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Pauline Whelan
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Richard Hopkins
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Zhimin He
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
| | - Eve Applegate
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Richard Drake
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Charlie Bamford
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Chris Roberts
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Austin L, Sharp CA, van der Veer SN, Machin M, Humphreys J, Mellor P, McCarthy J, Ainsworth J, Sanders C, Dixon WG. Providing 'the bigger picture': benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record. Rheumatology (Oxford) 2020; 59:367-378. [PMID: 31335942 PMCID: PMC7223265 DOI: 10.1093/rheumatology/kez207] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [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: 10/22/2018] [Accepted: 03/29/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives To establish the acceptability and feasibility of collecting daily patient-generated health data (PGHD) using smartphones and integrating PGHD into the electronic health record, using the example of RA. Methods The Remote Monitoring of RA smartphone app was co-designed with patients, clinicians and researchers using qualitative semi-structured interviews and focus groups, including selection of question sets for symptoms and disease impact. PGHD were integrated into the electronic health record of one hospital and available in graphical form during consultations. Acceptability and feasibility were assessed with 20 RA patients and two clinicians over 3 months. A qualitative evaluation included semi-structured interviews with patients and clinicians before and after using the app, and audio-recordings of consultations to explore impact on the consultation. PGHD completeness was summarized descriptively, and qualitative data were analysed thematically. Results Patients submitted data on a median of 91% days over 3 months. Qualitative analysis generated three themes: RA as an invisible disease; providing the bigger picture of RA; and enabling person-centred consultations. The themes demonstrated that the system helped render patients’ RA more visible by providing the ‘bigger picture’, identifying real-time changes in disease activity and capturing symptoms that would otherwise have been missed. Graphical summaries during consultations enabled a more person-centred approach whereby patients felt better able to participate in consultations and treatment plans. Conclusion Remote Monitoring of RA has uniquely integrated daily PGHD from smartphones into the electronic health record. It has delivered proof-of-concept that such integrated remote monitoring systems are feasible and can transform consultations for clinician and patient benefit.
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Affiliation(s)
- Lynn Austin
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, Greater Manchester, Salford Royal NHS Foundation Trust, Salford.,National Institute for Health Research School for Primary Care Research, The University of Manchester
| | - Charlotte A Sharp
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, Greater Manchester, Salford Royal NHS Foundation Trust, Salford.,Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, The University of Manchester.,NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre.,Alliance Manchester Business School, The University of Manchester
| | - Sabine N van der Veer
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, The University of Manchester.,Centre for Health Informatics, Division of Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, Imaging and Data Sciences, Manchester Academic Health Science Centre, The University of Manchester
| | - Matthew Machin
- Centre for Health Informatics, Division of Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, Imaging and Data Sciences, Manchester Academic Health Science Centre, The University of Manchester
| | - John Humphreys
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, Greater Manchester, Salford Royal NHS Foundation Trust, Salford
| | - Peter Mellor
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, Greater Manchester, Salford Royal NHS Foundation Trust, Salford
| | - Jill McCarthy
- Alliance Manchester Business School, The University of Manchester
| | - John Ainsworth
- Centre for Health Informatics, Division of Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, Imaging and Data Sciences, Manchester Academic Health Science Centre, The University of Manchester
| | - Caroline Sanders
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, Greater Manchester, Salford Royal NHS Foundation Trust, Salford.,National Institute for Health Research School for Primary Care Research, The University of Manchester.,National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester
| | - William G Dixon
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, Greater Manchester, Salford Royal NHS Foundation Trust, Salford.,Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, The University of Manchester.,NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre.,Rheumatology Department, Salford Royal NHS Foundation Trust, Salford, UK
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41
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Sanders C, Nahar P, Small N, Hodgson D, Ong BN, Dehghan A, Sharp CA, Dixon WG, Lewis S, Kontopantelis E, Daker-White G, Bower P, Davies L, Kayesh H, Spencer R, McAvoy A, Boaden R, Lovell K, Ainsworth J, Nowakowska M, Shepherd A, Cahoon P, Hopkins R, Allen D, Lewis A, Nenadic G. Digital methods to enhance the usefulness of patient experience data in services for long-term conditions: the DEPEND mixed-methods study. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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
Background
Collecting NHS patient experience data is critical to ensure the delivery of high-quality services. Data are obtained from multiple sources, including service-specific surveys and widely used generic surveys. There are concerns about the timeliness of feedback, that some groups of patients and carers do not give feedback and that free-text feedback may be useful but is difficult to analyse.
Objective
To understand how to improve the collection and usefulness of patient experience data in services for people with long-term conditions using digital data capture and improved analysis of comments.
Design
The DEPEND study is a mixed-methods study with four parts: qualitative research to explore the perspectives of patients, carers and staff; use of computer science text-analytics methods to analyse comments; co-design of new tools to improve data collection and usefulness; and implementation and process evaluation to assess use of the tools and any impacts.
Setting
Services for people with severe mental illness and musculoskeletal conditions at four sites as exemplars to reflect both mental health and physical long-terms conditions: an acute trust (site A), a mental health trust (site B) and two general practices (sites C1 and C2).
Participants
A total of 100 staff members with diverse roles in patient experience management, clinical practice and information technology; 59 patients and 21 carers participated in the qualitative research components.
Interventions
The tools comprised a digital survey completed using a tablet device (kiosk) or a pen and paper/online version; guidance and information for patients, carers and staff; text-mining programs; reporting templates; and a process for eliciting and recording verbal feedback in community mental health services.
Results
We found a lack of understanding and experience of the process of giving feedback. People wanted more meaningful and informal feedback to suit local contexts. Text mining enabled systematic analysis, although challenges remained, and qualitative analysis provided additional insights. All sites managed to collect feedback digitally; however, there was a perceived need for additional resources, and engagement varied. Observation indicated that patients were apprehensive about using kiosks but often would participate with support. The process for collecting and recording verbal feedback in mental health services made sense to participants, but was not successfully adopted, with staff workload and technical problems often highlighted as barriers. Staff thought that new methods were insightful, but observation did not reveal changes in services during the testing period.
Conclusions
The use of digital methods can produce some improvements in the collection and usefulness of feedback. Context and flexibility are important, and digital methods need to be complemented with alternative methods. Text mining can provide useful analysis for reporting on large data sets within large organisations, but qualitative analysis may be more useful for small data sets and in small organisations.
Limitations
New practices need time and support to be adopted and this study had limited resources and a limited testing time.
Future work
Further research is needed to improve text-analysis methods for routine use in services and to evaluate the impact of methods (digital and non-digital) on service improvement in varied contexts and among diverse patients and carers.
Funding
This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 28. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Caroline Sanders
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Papreen Nahar
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Nicola Small
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Damian Hodgson
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Bie Nio Ong
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Azad Dehghan
- Department of Computer Science, University of Manchester, Manchester, UK
| | - Charlotte A Sharp
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Shôn Lewis
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Gavin Daker-White
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Linda Davies
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Humayun Kayesh
- Department of Computer Science, University of Manchester, Manchester, UK
| | - Rebecca Spencer
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK
| | - Aneela McAvoy
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK
| | - Ruth Boaden
- Alliance Manchester Business School, University of Manchester, Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK
| | - Karina Lovell
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - John Ainsworth
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Magdalena Nowakowska
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Andrew Shepherd
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Patrick Cahoon
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Richard Hopkins
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | | | - Goran Nenadic
- Department of Computer Science, University of Manchester, Manchester, UK
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Hemingway H, Lyons R, Li Q, Buchan I, Ainsworth J, Pell J, Morris A. A national initiative in data science for health: an evaluation of the UK Farr Institute. Int J Popul Data Sci 2020; 5:1128. [PMID: 32935051 PMCID: PMC7480324 DOI: 10.23889/ijpds.v5i1.1128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the extent to which the inter-institutional, inter-disciplinary mobilisation of data and skills in the Farr Institute contributed to establishing the emerging field of data science for health in the UK. DESIGN AND OUTCOME MEASURES We evaluated evidence of six domains characterising a new field of science:defining central scientific challenges,demonstrating how the central challenges might be solved,creating novel interactions among groups of scientists,training new types of experts,re-organising universities,demonstrating impacts in society.We carried out citation, network and time trend analyses of publications, and a narrative review of infrastructure, methods and tools. SETTING Four UK centres in London, North England, Scotland and Wales (23 university partners), 2013-2018. RESULTS 1. The Farr Institute helped define a central scientific challenge publishing a research corpus, demonstrating insights from electronic health record (EHR) and administrative data at each stage of the translational cycle in 593 papers with at least one Farr Institute author affiliation on PubMed. 2. The Farr Institute offered some demonstrations of how these scientific challenges might be solved: it established the first four ISO27001 certified trusted research environments in the UK, and approved more than 1000 research users, published on 102 unique EHR and administrative data sources, although there was no clear evidence of an increase in novel, sustained record linkages. The Farr Institute established open platforms for the EHR phenotyping algorithms and validations (>70 diseases, CALIBER). Sample sizes showed some evidence of increase but remained less than 10% of the UK population in primary care-hospital care linked studies. 3.The Farr Institute created novel interactions among researchers: the co-author publication network expanded from 944 unique co-authors (based on 67 publications in the first 30 months) to 3839 unique co-authors (545 papers in the final 30 months). 4. Training expanded substantially with 3 new masters courses, training >400 people at masters, short-course and leadership level and 48 PhD students. 5. Universities reorganised with 4/5 Centres established 27 new faculty (tenured) positions, 3 new university institutes. 6. Emerging evidence of impacts included: > 3200 citations for the 10 most cited papers and Farr research informed eight practice-changing clinical guidelines and policies relevant to the health of millions of UK citizens. CONCLUSION The Farr Institute played a major role in establishing and growing the field of data science for health in the UK, with some initial evidence of benefits for health and healthcare. The Farr Institute has now expanded into Health Data Research (HDR) UK but key challenges remain including, how to network such activities internationally.
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Affiliation(s)
- H Hemingway
- HDR UK London
- UCL Institute of Health Informatics, 222 Euston Road, London NW1 2DA
| | - R Lyons
- HDRUK Wales/Northern Ireland
- Swansea University Medical School, Fourth Floor, Data Science Building, Singleton Campus, Swansea, SA2 8PP
| | - Q Li
- UCL Institute of Health Informatics, 222 Euston Road, London NW1 2DA
- West China Hospital, Chengdu, China
| | - I Buchan
- University of Liverpool, Liverpool L69 3BX
| | - J Ainsworth
- Division of Informatics, Imaging & Data Sciences, The University of Manchester, Oxford Rd, Manchester M13 9PL
| | - J Pell
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ
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Gumley A, Bradstreet S, Ainsworth J, Allan S, Alvarez-Jimenez M, Beattie L, Bell I, Birchwood M, Briggs A, Bucci S, Castagnini E, Clark A, Cotton SM, Engel L, French P, Lederman R, Lewis S, Machin M, MacLennan G, Matrunola C, McLeod H, McMeekin N, Mihalopoulos C, Morton E, Norrie J, Reilly F, Schwannauer M, Singh SP, Smith L, Sundram S, Thomson D, Thompson A, Whitehill H, Wilson-Kay A, Williams C, Yung A, Farhall J, Gleeson J. Early Signs Monitoring to Prevent Relapse in Psychosis and Promote Well-Being, Engagement, and Recovery: Protocol for a Feasibility Cluster Randomized Controlled Trial Harnessing Mobile Phone Technology Blended With Peer Support. JMIR Res Protoc 2020; 9:e15058. [PMID: 31917372 PMCID: PMC6996736 DOI: 10.2196/15058] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 06/17/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022] Open
Abstract
Background Relapse in schizophrenia is a major cause of distress and disability and is predicted by changes in symptoms such as anxiety, depression, and suspiciousness (early warning signs [EWSs]). These can be used as the basis for timely interventions to prevent relapse. However, there is considerable uncertainty regarding the implementation of EWS interventions. Objective This study was designed to establish the feasibility of conducting a definitive cluster randomized controlled trial comparing Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery (EMPOWER) against treatment as usual (TAU). Our primary outcomes are establishing parameters of feasibility, acceptability, usability, safety, and outcome signals of a digital health intervention as an adjunct to usual care that is deliverable in the UK National Health Service and Australian community mental health service (CMHS) settings. We will assess the feasibility of candidate primary outcomes, candidate secondary outcomes, and candidate mechanisms for a definitive trial. Methods We will randomize CMHSs to EMPOWER or TAU. We aim to recruit up to 120 service user participants from 8 CMHSs and follow them for 12 months. Eligible service users will (1) be aged 16 years and above, (2) be in contact with local CMHSs, (3) have either been admitted to a psychiatric inpatient service or received crisis intervention at least once in the previous 2 years for a relapse, and (4) have an International Classification of Diseases-10 diagnosis of a schizophrenia-related disorder. Service users will also be invited to nominate a carer to participate. We will identify the feasibility of the main trial in terms of recruitment and retention to the study and the acceptability, usability, safety, and outcome signals of the EMPOWER intervention. EMPOWER is a mobile phone app that enables the monitoring of well-being and possible EWSs of relapse on a daily basis. An algorithm calculates changes in well-being based on participants’ own baseline to enable tailoring of well-being messaging and clinical triage of possible EWSs. Use of the app is blended with ongoing peer support. Results Recruitment to the trial began September 2018, and follow-up of participants was completed in July 2019. Data collection is continuing. The database was locked in July 2019, followed by analysis and disclosing of group allocation. Conclusions The knowledge gained from the study will inform the design of a definitive trial including finalizing the delivery of our digital health intervention, sample size estimation, methods to ensure successful identification, consent, randomization, and follow-up of participants, and the primary and secondary outcomes. The trial will also inform the final health economic model to be applied in the main trial. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 99559262; http://isrctn.com/ISRCTN99559262 International Registered Report Identifier (IRRID) DERR1-10.2196/15058
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Affiliation(s)
- Andrew Gumley
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Simon Bradstreet
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom
| | - John Ainsworth
- Division of Informatics, Imaging, and Data Sciences, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Stephanie Allan
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Louise Beattie
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom
| | - Imogen Bell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Max Birchwood
- Division of Mental Health and Wellbeing, University of Warwick, Warwick, United Kingdom
| | - Andrew Briggs
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Emily Castagnini
- La Trobe University, Melbourne, Australia.,NorthWestern Mental Health, Melbourne, Australia
| | - Andrea Clark
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Research Scotland Mental Health Network, Glasgow, United Kingdom
| | - Sue M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | | | - Paul French
- Manchester Metropolitan University, Manchester, United Kingdom
| | - Reeva Lederman
- School of Computing and Information Systems, Melbourne School of Engineering, University of Melbourne, Melbourne, Australia
| | - Shon Lewis
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Matthew Machin
- Division of Informatics, Imaging, and Data Sciences, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Graeme MacLennan
- The Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, United Kingdom
| | - Claire Matrunola
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Research Scotland Mental Health Network, Glasgow, United Kingdom
| | - Hamish McLeod
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Nicola McMeekin
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | - Emma Morton
- Australian Catholic University, Melbourne, Australia
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Frank Reilly
- Scottish Recovery Network, Glasgow, United Kingdom
| | - Matthias Schwannauer
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Swaran P Singh
- Division of Mental Health and Wellbeing, University of Warwick, Warwick, United Kingdom
| | - Lesley Smith
- Scottish Recovery Network, Glasgow, United Kingdom
| | | | - David Thomson
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Andrew Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Division of Mental Health and Wellbeing, University of Warwick, Warwick, United Kingdom
| | - Helen Whitehill
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,Scottish Recovery Network, Glasgow, United Kingdom
| | - Alison Wilson-Kay
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Christopher Williams
- Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom
| | - Alison Yung
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - John Farhall
- La Trobe University, Melbourne, Australia.,NorthWestern Mental Health, Melbourne, Australia
| | - John Gleeson
- Australian Catholic University, Melbourne, Australia
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Tully MP, Hassan L, Oswald M, Ainsworth J. Commercial use of health data-A public "trial" by citizens' jury. Learn Health Syst 2019; 3:e10200. [PMID: 31641688 PMCID: PMC6802529 DOI: 10.1002/lrh2.10200] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 11/07/2018] [Revised: 04/26/2019] [Accepted: 07/25/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Surveys suggest a dichotomy in how citizens view research for public benefit and research for commercial gain. Therefore, a research initiative, such as a learning health system, which works for both public and commercial benefit, may be controversial and lower public trust. METHODS This study aimed to investigate what informed citizens considered to be appropriate uses of health data in a learning health system and why they made those decisions. Two-paired 4-day juries were run, with different jurors but the same purpose, expert witnesses, and facilitators. Overall, 694 people applied; 36 jurors were selected to match criteria based on demographics and privacy views. Jurors considered whether and why eight exemplars of anonymised patient data were acceptable. The exemplars were either planned initiatives to improve care pathways (Planned Examples) or possible commercial data uses (Potential Examples). RESULTS These citizens' juries found that all Planned and two of the Potential Examples were considered appropriate by most, but not all, jurors because they could deliver public benefit. In general, positive health outcomes for patients were more acceptable than improved efficiency of services for the NHS, although they recognised that the latter also improved health. Jurors had concerns about whether improving efficiency would lead to inequitable distribution or closure of services, based on their existing understanding from media reports. Commercial gain that accrued secondary to this benefit was acceptable, with some jurors becoming more accepting of commercial uses as they understood them better. Prioritising profit, however, was unacceptable, regardless of any governance arrangements. CONCLUSIONS Jurors tended to be more accepting of data sharing to both private and public sectors after the jury process. Many jurors accept commercial gain if public benefit is achieved. Some were suspicious of data sharing for efficiency gains. Juries elicited more informed and nuanced judgement from citizens than surveys.
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Affiliation(s)
- Mary P. Tully
- Health E‐Research Centre, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
| | - Lamiece Hassan
- Health E‐Research Centre, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
| | - Malcolm Oswald
- School of Law, Faculty of HumanitiesUniversity of ManchesterManchesterUK
- Citizens Juries c.i.cManchesterUK
| | - John Ainsworth
- Health E‐Research Centre, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
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45
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Bucci S, Ainsworth J, Barrowclough C, Lewis S, Haddock G, Berry K, Emsley R, Edge D, Machin M. A Theory-Informed Digital Health Intervention in People with Severe Mental Health Problems. Stud Health Technol Inform 2019; 264:526-530. [PMID: 31437979 DOI: 10.3233/shti190278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is an important gap in scaling up psychosocial interventions for people with severe mental health problems so that these interventions are not only widely available but also delivered in a timely manner. We examined the feasability of adapting a psychological intervention traditionally delivered face-to-face onto a digital platform. We report both the clinical and technical processes used to adapt and develop the digital platform in a group of people in the early phase of psychosis. The digital platform prompts people to engage with the intervention multiple times a day over a 12-week period. Participants are also able to access a repository of multi-media content to support their mental health. The digital platform has been successfully validated by participants registered with early intervention for psychosis services in the Northwest of England, UK and is currently being tested in a powered efficacy trial.
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Affiliation(s)
- Sandra Bucci
- Division of Psychology and Mental Health, Manchester Academic Health Sciences, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust
| | - John Ainsworth
- Division of Informatics, Imaging & Data Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Christine Barrowclough
- Division of Psychology and Mental Health, Manchester Academic Health Sciences, University of Manchester, Manchester, UK
| | - Shon Lewis
- Division of Psychology and Mental Health, Manchester Academic Health Sciences, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust
| | - Gillian Haddock
- Division of Psychology and Mental Health, Manchester Academic Health Sciences, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust
| | - Katherine Berry
- Division of Psychology and Mental Health, Manchester Academic Health Sciences, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, Manchester Academic Health Sciences, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust
| | - Matthew Machin
- Division of Informatics, Imaging & Data Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Leeming G, Cunningham J, Ainsworth J. A Ledger of Me: Personalizing Healthcare Using Blockchain Technology. Front Med (Lausanne) 2019; 6:171. [PMID: 31396516 PMCID: PMC6668357 DOI: 10.3389/fmed.2019.00171] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 11/03/2018] [Accepted: 07/08/2019] [Indexed: 11/13/2022] Open
Abstract
Personal Health Records (PHRs) have the potential to give patients fine-grained, personalized and secure access to their own medical data and to enable self-management of care. Emergent trends around the use of Blockchain, or Distributed Ledger Technology, seem to offer solutions to some of the problems faced in enabling these technologies, especially to support issues consent, data exchange, and data access. We present an analysis of existing blockchain-based health record solutions and a reference architecture for a "Ledger of Me" system that extends PHR to create a new platform combining the collection and access of medical data and digital interventions with smart contracts. Our intention is to enable patient use of the data in order to support their care and to provide a strong consent mechanisms for sharing of data between different organizations and apps. Ledger of Me is based on around the principle that this combination of event-driven smart contracts, medical record data, and patient control is important for the adoption of blockchain-based solutions for the PHR. The reference architecture we present can serve as the basis of a range of future blockchain-based medical application architectures.
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Affiliation(s)
- Gary Leeming
- Division of Informatics, Imaging and Data Sciences, Health eResearch Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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47
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Affiliation(s)
- Gary Leeming
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - John Ainsworth
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - David A Clifton
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK.
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Hind D, Drabble SJ, Arden MA, Mandefield L, Waterhouse S, Maguire C, Cantrill H, Robinson L, Beever D, Scott AJ, Keating S, Hutchings M, Bradley J, Nightingale J, Allenby MI, Dewar J, Whelan P, Ainsworth J, Walters SJ, O’Cathain A, Wildman MJ. Supporting medication adherence for adults with cystic fibrosis: a randomised feasibility study. BMC Pulm Med 2019; 19:77. [PMID: 30975206 PMCID: PMC6458785 DOI: 10.1186/s12890-019-0834-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 03/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preventative medication reduces hospitalisations in people with cystic fibrosis (PWCF) but adherence is poor. We assessed the feasibility of a randomised controlled trial of a complex intervention, which combines display of real time adherence data and behaviour change techniques. METHODS Design: Pilot, open-label, parallel-group RCT with concurrent semi-structured interviews. PARTICIPANTS PWCF at two Cystic Fibrosis (CF) units. Eligible: aged 16 or older; on the CF registry. Ineligible: post-lung transplant or on the active list; unable to consent; using dry powder inhalers. INTERVENTIONS Central randomisation on a 1:1 allocation to: (1) intervention, linking nebuliser use with data recording and transfer capability to a software platform, and behavioural strategies to support self-management delivered by trained interventionists (n = 32); or, (2) control, typically face-to-face meetings every 3 months with CF team (n = 32). OUTCOMES RCT feasibility defined as: recruitment of ≥ 48 participants (75% of target) in four months (pilot primary outcome); valid exacerbation data available for ≥ 85% of those randomised (future RCT primary outcome); change in % medication adherence; FEV1 percent predicted (key secondaries in future RCT); and perceptions of trial procedures, in semi-structured interviews with intervention (n = 14) and control (n = 5) participants, interventionists (n = 3) and CF team members (n = 5). RESULTS The pilot trial recruited to target, randomising 33 to intervention and 31 to control in the four-month period, June-September 2016. At study completion (30th April 2017), 60 (94%; Intervention = 32, Control =28) participants contributed good quality exacerbation data (intervention: 35 exacerbations; control: 25 exacerbation). The mean change in adherence and baseline-adjusted FEV1 percent predicted were higher in the intervention arm by 10% (95% CI: -5.2 to 25.2) and 5% (95% CI -2 to 12%) respectively. Five serious adverse events occurred, none related to the intervention. The mean change in adherence was 10% (95% CI: -5.2 to 25.2), greater in the intervention arm. Interventionists delivered insufficient numbers of review sessions due to concentration on participant recruitment. This left interventionists insufficient time for key intervention procedures. A total of 10 key changes that were made to RCT procedures are summarised. CONCLUSIONS With improved research processes and lower monthly participant recruitment targets, a full-scale trial is feasible. TRIAL REGISTRATION ISRCTN13076797 . Prospectively registered on 07/06/2016.
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Affiliation(s)
- Daniel Hind
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Sarah J. Drabble
- School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Madelynne A. Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BQ UK
| | - Laura Mandefield
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Simon Waterhouse
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Chin Maguire
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Hannah Cantrill
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Louisa Robinson
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Daniel Beever
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Alexander J. Scott
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Sam Keating
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Marlene Hutchings
- Sheffield Adult Cystic Fibrosis Unit Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU UK
| | - Judy Bradley
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, 97 Lisburn Road, Belfast, BT9 7BL UK
| | - Julia Nightingale
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - Mark I. Allenby
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - Jane Dewar
- Wolfson Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, City Hospital, Hucknall Road, Nottingham, NG5 1PB UK
| | - Pauline Whelan
- Health eResearch Centre - Farr Institute, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - John Ainsworth
- Health eResearch Centre - Farr Institute, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen J. Walters
- School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Alicia O’Cathain
- School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Martin J. Wildman
- Sheffield Adult Cystic Fibrosis Unit Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU UK
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Tully M, Hassan L, Oswald M, Ainsworth J. Commercial use of health data in the dock – results of a public “trial”. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.598] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionSurveys suggest that there is a dichotomy in how citizens view research for public good and research for commercial gain. As a consequence, the idea that a research initiative, such as a learning health system, for both public and commercial benefit may be controversial and reduce public trust.
Objectives and ApproachThis study aims to investigate what informed citizens considered to be appropriate uses of health data in a learning health system. Two paired four-day juries were run, with different jurors but the same purpose, expert witnesses and facilitators. Overall, 694 people applied to be jurors; 36 were selected to match criteria based on national demographics and their prior privacy views. Jurors considered whether and why eight exemplar data uses of depersonalised patient data were acceptable. The exemplars were data uses planned by the learning health system initiative to improve care pathways (planned uses), and possible unplanned data uses.
ResultsAll planned uses were considered appropriate by most, but not all, jurors, as they had the potential of benefitting the public through improving care. Positive health outcomes were more acceptable than improved efficiency of services, given jurors prior beliefs about how the NHS operates raising concerns about whether improving efficiency would lead to inequitable distribution or closure of services. The potential uses were considered appropriate where there were improvements in drugs, treatments, or lower NHS costs. Some jurors became more accepting of commercial uses as they understood them better. Commercial uses that prioritised generating profit and did not produce health benefits for the public were unacceptable, regardless of any safeguards for the data. Commercial gain that occurred secondary to achieving public benefit were generally accepted.
Conclusion/ImplicationsJuries elicit more informed and nuanced judgement from citizens than surveys. Jurors tended to be more accepting of data sharing to both private and public sector after the jury process. Many jurors accept commercial gain if public benefit is achieved. Some were suspicious of data sharing for efficiency gains.
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Bower P, Reeves D, Sutton M, Lovell K, Blakemore A, Hann M, Howells K, Meacock R, Munford L, Panagioti M, Parkinson B, Riste L, Sidaway M, Lau YS, Warwick-Giles L, Ainsworth J, Blakeman T, Boaden R, Buchan I, Campbell S, Coventry P, Reilly S, Sanders C, Skevington S, Waheed W, Checkland K. Improving care for older people with long-term conditions and social care needs in Salford: the CLASSIC mixed-methods study, including RCT. Health Serv Deliv Res 2018. [DOI: 10.3310/hsdr06310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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
BackgroundThe Salford Integrated Care Programme (SICP) was a large-scale transformation project to improve care for older people with long-term conditions and social care needs. We report an evaluation of the ability of the SICP to deliver an enhanced experience of care, improved quality of life, reduced costs of care and improved cost-effectiveness.ObjectivesTo explore the process of implementation of the SICP and the impact on patient outcomes and costs.DesignQualitative methods (interviews and observations) to explore implementation, a cohort multiple randomised controlled trial to assess patient outcomes through quasi-experiments and a formal trial, and an analysis of routine data sets and appropriate comparators using non-randomised methodologies.SettingSalford in the north-west of England.ParticipantsOlder people aged ≥ 65 years, carers, and health and social care professionals.InterventionsA large-scale integrated care project with three core mechanisms of integration (community assets, multidisciplinary groups and an ‘integrated contact centre’).Main outcome measuresPatient self-management, care experience and quality of life, and health-care utilisation and costs.Data sourcesProfessional and patient interviews, patient self-report measures, and routine quantitative data on service utilisation.ResultsThe SICP and subsequent developments have been sustained by strong partnerships between organisations. The SICP achieved ‘functional integration’ through the pooling of health and social care budgets, the development of the Alliance Agreement between four organisations and the development of the shared care record. ‘Service-level’ integration was slow and engagement with general practice was a challenge. We saw only minor changes in patient experience measures over the period of the evaluation (both improvements and reductions), with some increase in the use of community assets and care plans. Compared with other sites, the difference in the rates of admissions showed an increase in emergency admissions. Patient experience of health coaching was largely positive, although the effects of health coaching on activation and depression were not statistically significant. Economic analyses suggested that coaching was likely to be cost-effective, generating improvements in quality of life [mean incremental quality-adjusted life-year gain of 0.019, 95% confidence interval (CI) –0.006 to 0.043] at increased cost (mean incremental total cost increase of £150.58, 95% CI –£470.611 to £711.776).LimitationsThe Comprehensive Longitudinal Assessment of Salford Integrated Care study represents a single site evaluation, with consequent limits on external validity. Patient response rates to the cohort survey were < 40%.ConclusionsThe SICP has been implemented in a way that is consistent with the original vision. However, there has been more rapid success in establishing new integrated structures (such as a formal integrated care organisation), rather than in delivering mechanisms of integration at sufficient scale to have a large impact on patient outcomes.Future workFurther research could focus on each of the mechanisms of integration. The multidisciplinary groups may require improved targeting of patients or disease subgroups to demonstrate effectiveness. Development of a proven model of health coaching that can be implemented at scale is required, especially one that would provide cost savings for commissioners or providers. Similarly, further exploration is required to assess the longer-term benefits of community assets and whether or not health impacts translate to reductions in care use.Trial registrationCurrent Controlled Trials ISRCTN12286422.FundingThis project was funded by the NIHR Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 31. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peter Bower
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - David Reeves
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Matt Sutton
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Amy Blakemore
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mark Hann
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Kelly Howells
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Rachel Meacock
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Luke Munford
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Beth Parkinson
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Lisa Riste
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | | | - Yiu-Shing Lau
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Lynsey Warwick-Giles
- Policy Research Unit in Commissioning and the Healthcare System, Centre for Primary Care, University of Manchester, Manchester, UK
| | - John Ainsworth
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Thomas Blakeman
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Ruth Boaden
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care for Greater Manchester, Alliance Business School Manchester, University of Manchester, Manchester, UK
| | - Iain Buchan
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Stephen Campbell
- National Institute for Health Research Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, University of Manchester, Manchester, UK
| | | | | | - Caroline Sanders
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Suzanne Skevington
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Waquas Waheed
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Katherine Checkland
- Policy Research Unit in Commissioning and the Healthcare System, Centre for Primary Care, University of Manchester, Manchester, UK
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