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İnce B, Phillips MD, Zenasni Z, Shearer J, Dalton B, Irish M, Mercado D, Webb H, McCombie C, Au K, Kern N, Clark-Stone S, Connan F, Johnston AL, Lazarova S, Zadeh E, Newell C, Pathan T, Wales J, Cashmore R, Marshall S, Arcelus J, Robinson P, Byford S, Landau S, Lawrence V, Himmerich H, Treasure J, Schmidt U. Autopsy of a failed trial part 2: Outcomes, challenges, and lessons learnt from the DAISIES trial. Eur Eat Disord Rev 2024; 32:476-489. [PMID: 38109218 DOI: 10.1002/erv.3058] [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: 07/05/2023] [Revised: 11/03/2023] [Accepted: 11/23/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE The relative merits of inpatient or day-treatment for adults with anorexia nervosa (AN) are unknown. The DAISIES trial aimed to establish the non-inferiority of a stepped-care day patient treatment (DPT) approach versus inpatient treatment as usual (IP-TAU) for improving body mass index (BMI) at 12 months in adults with AN. The trial was terminated due to poor recruitment. This paper presents outcomes and investigates the reasons behind the trial's failure. METHOD Fifteen patients with AN (of 53 approached) participated and were followed-up to 6 or 12 months. Summary statistics were calculated due to low sample size, and qualitative data concerning treatment experiences were analysed using thematic analysis. RESULTS At baseline, participants in both trial arms rated stepped-care DPT as more acceptable. At 12 months, participants' BMIs had increased in both trial arms. Qualitative analysis highlighted valued and challenging aspects of care across settings. Only 6/12 sites opened for recruitment. Among patients approached, the most common reason for declining participation was their treatment preference (n = 12/38). CONCLUSIONS No conclusions can be drawn concerning the effectiveness of IP-TAU and stepped-care DPT, but the latter was perceived more positively. Patient-related, service-related and systemic factors (COVID-19) contributed to the trial's failure. Lessons learnt can inform future studies.
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Affiliation(s)
- Başak İnce
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Matthew D Phillips
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Zohra Zenasni
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - James Shearer
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Bethan Dalton
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Madeleine Irish
- The Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
| | - Daniela Mercado
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Hannah Webb
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Catherine McCombie
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Katie Au
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Nikola Kern
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sam Clark-Stone
- Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
| | - Frances Connan
- Central and North West London NHS Foundation Trust, London, UK
| | | | | | - Ewa Zadeh
- South West London and St George's Mental Health NHS Trust, London, UK
| | - Ciarán Newell
- Dorset HealthCare University NHS Foundation Trust, Poole, UK
| | - Tayeem Pathan
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK
| | - Jackie Wales
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK
| | - Rebecca Cashmore
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK
| | - Sandra Marshall
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet del Llobregat, Barcelona, Spain
| | - Paul Robinson
- Division of Medicine, University College London, London, UK
| | - Sarah Byford
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Vanessa Lawrence
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Hubertus Himmerich
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Hammoud R, Tognin S, Smythe M, Gibbons J, Davidson N, Bakolis I, Mechelli A. Smartphone-based ecological momentary assessment reveals an incremental association between natural diversity and mental wellbeing. Sci Rep 2024; 14:7051. [PMID: 38627422 PMCID: PMC11021539 DOI: 10.1038/s41598-024-55940-7] [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: 12/04/2023] [Accepted: 02/29/2024] [Indexed: 04/19/2024] Open
Abstract
Using smartphone-based ecological momentary assessment, this study investigated an association between natural diversity on mental wellbeing. A sample of 1,998 participants completed 41,448 assessments between April 2018 and September 2023. Environments which included a larger range of natural features, such as trees, plants and birdlife (high natural diversity) were associated with greater mental wellbeing than environments including a smaller range of natural features (low natural diversity). There was evidence of a mediating effect of natural diversity on the association between natural environments and mental wellbeing. These results highlight the importance of policies and practices that support richness of biodiversity for public mental health.
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Affiliation(s)
- Ryan Hammoud
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Michael Smythe
- Nomad Projects, Sunbury Workshops, 24, Swanfield St, London, E2 7LF, UK
| | | | | | - Ioannis Bakolis
- Health Services and Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Andrea Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
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Leggat FJ, Heaton-Shrestha C, Fish J, Siriwardena AN, Domeney A, Rowe C, Patel I, Parsons J, Blair J, Jones F. An exploration of the experiences and self-generated strategies used when navigating everyday life with Long Covid. BMC Public Health 2024; 24:789. [PMID: 38481230 PMCID: PMC10938753 DOI: 10.1186/s12889-024-18267-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Around one in ten people who contract Covid-19 report ongoing symptoms or 'Long Covid'. Without any known interventions to cure the condition, forms of self-management are routinely prescribed by healthcare professionals and described by people with the condition. However, there is limited research exploring what strategies are used to navigate everyday life with Long Covid, and experiences that initiate development of these strategies. Our study aimed to explore the range and influence of self-generated strategies used by people with Long Covid to navigate everyday life within the context of their own condition. METHODS Forming part of the Long Covid Personalised Self-managemenT support co-design and EvaluatioN (LISTEN) project, we conducted a qualitative study using narrative interviews with adults who were not hospitalised with Covid-19. Participants aged over 18 years, who self-identified with Long Covid, were recruited from England and Wales. Data were analysed with patient contributors using a reflexive thematic analysis. RESULTS Eighteen participants (mean age = 44 years, SD = 13 years) took part in interviews held between December 2021 and February 2022. Themes were constructed which depicted 1) the landscape behind the Long Covid experience and 2) the everyday experience of participants' Long Covid. The everyday experience comprised a combination of physical, emotional, and social factors, forming three sub-themes: centrality of physical symptoms, navigating 'experts' and the 'true colour' of personal communities, and a rollercoaster of psychological ambiguity). The third theme, personal strategies to manage everyday life was constructed from participants' unique presentations and self-generated solutions to manage everyday life. This comprised five sub-themes: seeking reassurance and knowledge, developing greater self-awareness through monitoring, trial and error of 'safe' ideas, building in pleasure and comfort, and prioritising 'me'. CONCLUSIONS Among this sample of adults with Long Covid, their experiences highlighted the unpredictable nature of the condition but also the use of creative and wide ranging self-generated strategies. The results offer people with Long Covid, and healthcare professionals supporting them, an overview of the collective evidence relating to individuals' self-management which can enable ways to live 'better' and regain some sense of identity whilst facing the impact of a debilitating, episodic condition. TRIAL REGISTRATION LISTEN ISRCTN36407216.
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Affiliation(s)
- Fiona J Leggat
- Population Health Research Institute, St George's, University of London, London, England, UK
- Centre for Applied Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University, London, England, UK
| | - Celayne Heaton-Shrestha
- Centre for Applied Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University, London, England, UK
| | - Jessica Fish
- Department of Clinical Neuropsychology & Clinical Health Psychology, St George's University Hospitals NHS Foundation Trust, London, England, UK
- Mental Health & Wellbeing, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | | | - Anne Domeney
- LISTEN Lived Experience Advisory Group, London, UK
- Bridges Self-Management, London, England, UK
| | - Carol Rowe
- LISTEN Lived Experience Advisory Group, London, UK
| | - Ian Patel
- LISTEN Lived Experience Advisory Group, London, UK
| | | | - John Blair
- LISTEN Lived Experience Advisory Group, London, UK
| | - Fiona Jones
- Population Health Research Institute, St George's, University of London, London, England, UK.
- Centre for Applied Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University, London, England, UK.
- Bridges Self-Management, London, England, UK.
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Rhead R, Harber-Aschan L, Onwumere J, Polling C, Dorrington S, Ehsan A, Stevelink SAM, Khunti K, Mir G, Morriss R, Wessely S, Woodhead C, Hatch S. Ethnic inequalities among NHS staff in England: workplace experiences during the COVID-19 pandemic. Occup Environ Med 2024; 81:113-121. [PMID: 38378264 PMCID: PMC10958323 DOI: 10.1136/oemed-2023-108976] [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: 05/08/2023] [Accepted: 11/23/2023] [Indexed: 02/22/2024]
Abstract
OBJECTIVES This study aims to determine how workplace experiences of National Health Service (NHS) staff varied by ethnicity during the COVID-19 pandemic and how these experiences are associated with mental and physical health at the time of the study. METHODS An online Inequalities Survey was conducted by the Tackling Inequalities and Discrimination Experiences in Health Services study in collaboration with NHS CHECK. This Inequalities Survey collected measures relating to workplace experiences (such as personal protective equipment (PPE), risk assessments, redeployments and discrimination) as well as mental health (Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder 7 (GAD-7)), and physical health (PHQ-15) from NHS staff working in the 18 trusts participating with the NHS CHECK study between February and October 2021 (N=4622). RESULTS Regression analysis of this cross-sectional data revealed that staff from black and mixed/other ethnic groups had greater odds of experiencing workplace harassment (adjusted OR (AOR) 2.43 (95% CI 1.56 to 3.78) and 2.38 (95% CI 1.12 to 5.07), respectively) and discrimination (AOR 4.36 (95% CI 2.73 to 6.96) and 3.94 (95% CI 1.67 to 9.33), respectively) compared with white British staff. Staff from black ethnic groups also had greater odds than white British staff of reporting PPE unavailability (AOR 2.16 (95% CI 1.16 to 4.00)). Such workplace experiences were associated with negative physical and mental health outcomes, though this association varied by ethnicity. Conversely, understanding employment rights around redeployment, being informed about and having the ability to inform redeployment decisions were associated with lower odds of poor physical and mental health. CONCLUSIONS Structural changes to the way staff from ethnically minoritised groups are supported, and how their complaints are addressed by leaders within the NHS are urgently required.
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Affiliation(s)
- Rebecca Rhead
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Centre for Society and Mental Health, King's College London - Strand Campus, London, UK
| | - Lisa Harber-Aschan
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Demography Unit, Stockholm University, Stockholm, Sweden
| | - Juliana Onwumere
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Catherine Polling
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Dorrington
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Annahita Ehsan
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Sharon A M Stevelink
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, Leicester, UK
- Real World Evidence Unit, University of Leicester, Leicester, UK
| | - Ghazala Mir
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- NIHR ARC East Midlands, University of Nottingham, Nottingham, UK
| | - Simon Wessely
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - Charlotte Woodhead
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Centre for Society and Mental Health, King's College London - Strand Campus, London, UK
| | - Stephani Hatch
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Centre for Society and Mental Health, King's College London - Strand Campus, London, UK
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Hemrage S, Brobbin E, Deluca P, Drummond C. Response to Letter to the Editors regarding 'Efficacy of psychosocial interventions to reduce alcohol use in comorbid alcohol use disorder and alcohol-related liver disease: a systematic review of randomized controlled trials'. Alcohol Alcohol 2024; 59:agae004. [PMID: 38282431 PMCID: PMC10823155 DOI: 10.1093/alcalc/agae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/30/2024] Open
Affiliation(s)
- Sofia Hemrage
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 4 Windsor Walk, London SE5 8BB, United Kingdom
| | - Eileen Brobbin
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 4 Windsor Walk, London SE5 8BB, United Kingdom
| | - Paolo Deluca
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 4 Windsor Walk, London SE5 8BB, United Kingdom
| | - Colin Drummond
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 4 Windsor Walk, London SE5 8BB, United Kingdom
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Donin A, Nightingale CM, Sattar N, Fraser WD, Owen CG, Cook DG, Whincup PH. Cross-sectional study of the associations between circulating vitamin D concentrations and insulin resistance in children aged 9-10 years of South Asian, black African Caribbean and white European origins. J Epidemiol Community Health 2023; 78:jech-2023-220626. [PMID: 38123968 PMCID: PMC11045364 DOI: 10.1136/jech-2023-220626] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Lower circulating vitamin D 25-hydroxyvitamin D (25(OH)D) concentrations are associated with higher type 2 diabetes risk in adults, although causality remains uncertain. However, associations between 25(OH)D and type 2 diabetes risk markers in children have been little studied, particularly in ethnic minority populations. We examined whether 25(OH)D concentrations were associated with insulin resistance in children and whether lower 25(OH)D concentrations in South Asians and black African Caribbeans could contribute to their higher insulin resistance. METHODS Cross-sectional study of 4650 UK primary school children aged 9-10 years of predominantly South Asian, black African Caribbean and white European ethnicity. Children had fasting blood measurements of circulating 25(OH)D metabolite concentrations, insulin and glucose. RESULTS Lower 25(OH)D concentrations were observed in girls, South Asians and black African Caribbeans. In analyses adjusted for age, sex, month, ethnic group and school, circulating 25(OH)D was inversely associated with fasting insulin (-0.38%, 95% CI -0.49% to -0.27%), homoeostasis model assessment (HOMA) insulin resistance (-0.39%, 95% CI -0.50% to -0.28%) and fasting glucose (-0.03%, 95% CI -0.05% to -0.02%) per nmol/L increase in 25(OH)D; associations did not differ between ethnic groups. Ethnic differences in fasting insulin and HOMA insulin resistance (higher among South Asian and black African Caribbeans) were reduced by >40% after adjustment for circulating 25(OH)D concentrations. CONCLUSION Circulating vitamin D was inversely associated with insulin resistance in all ethnic groups; higher insulin resistance in South Asian and black African children were partly explained by their lower vitamin D levels. Whether vitamin D supplementation can reduce emerging type 2 diabetes risk needs further evaluation.
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Affiliation(s)
- Angela Donin
- Population Health Research Institute, St George's University of London, London, UK
| | - Claire M Nightingale
- Population Health Research Institute, St George's University of London, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - William D Fraser
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Chris G Owen
- Population Health Research Institute, St George's University of London, London, UK
| | - Derek G Cook
- Population Health Research Institute, St George's University of London, London, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
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Tildy BE, McNeill A, Robins J, Dregan A, Richardson S, Brose LS. How is nicotine vaping product (e-cigarette) use monitored in primary care electronic health records in the United Kingdom? An exploratory analysis of Clinical Practice Research Datalink (CPRD). BMC Public Health 2023; 23:2263. [PMID: 37974094 PMCID: PMC10655457 DOI: 10.1186/s12889-023-17200-7] [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: 08/31/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) could identify long-term health effects of nicotine vaping. We characterised the extent to which vaping is recorded in primary care EHRs in the UK, on a population level. METHODS We performed descriptive analysis of Clinical Practice Research Datalink (CPRD), primary care electronic health records of 25% of the UK population (~ 16 million patients). Patients aged ≥ 18 years whose vaping status was recorded using medical codes between 2006 and 2022 were identified. We reported the frequency of vaping codes; their distribution by patient age, gender, and ethnicity; trends in vaping recording over time (including interrupted time series analyses); and transitions in patient smoking status. RESULTS Seven medical codes indicated current or former vaping, from 150,114 patients. When their vaping status was first recorded, mean patient age was 50.2 years (standard deviation: 15.0), 52.4% were female, and 82.1% were White. Of those recorded as currently vaping, almost all (98.9%) had records of their prior smoking status: 55.0% had been smoking, 38.3% had stopped smoking, 5.6% had never smoked. Of those who were smoking prior to being recorded as vaping, more than a year after the vaping record, over a third (34.2%) were still smoking, under a quarter (23.7%) quit smoking, 1.7% received a 'never smoked' status, and there was no smoking status for 40.4%. The 'e-cigarette or vaping product use-associated lung injury' (EVALI) outbreak was significantly associated with a declining trend in new records of current vaping between September 2019 and March 2020; and an immediate significant increase in new records of former vaping, followed by a declining trend. CONCLUSIONS Few patients are being asked about vaping. Most who vape had smoked, and many quit smoking after starting vaping. To enable electronic health records to provide stronger evidence on health effects, we recommend improved completeness, accuracy and consistency.
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Affiliation(s)
- Bernadett E Tildy
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, Addiction Sciences Building, 4 Windsor Walk, London, SE5 8BB, UK.
- SPECTRUM Consortium, London, UK.
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, Addiction Sciences Building, 4 Windsor Walk, London, SE5 8BB, UK
- SPECTRUM Consortium, London, UK
- NIHR Applied Research Collaboration South London, London, UK
| | - John Robins
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, Addiction Sciences Building, 4 Windsor Walk, London, SE5 8BB, UK
- NIHR Applied Research Collaboration South London, London, UK
| | - Alexandru Dregan
- Psychological Medicine Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Mingli Building, Haidian District, Beijing, 100083, China
| | - Leonie S Brose
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, Addiction Sciences Building, 4 Windsor Walk, London, SE5 8BB, UK
- SPECTRUM Consortium, London, UK
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Scola G, Chis Ster A, Bean D, Pareek N, Emsley R, Landau S. Implementation of the trial emulation approach in medical research: a scoping review. BMC Med Res Methodol 2023; 23:186. [PMID: 37587484 PMCID: PMC10428565 DOI: 10.1186/s12874-023-02000-9] [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: 11/16/2022] [Accepted: 07/25/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND When conducting randomised controlled trials is impractical, an alternative is to carry out an observational study. However, making valid causal inferences from observational data is challenging because of the risk of several statistical biases. In 2016 Hernán and Robins put forward the 'target trial framework' as a guide to best design and analyse observational studies whilst preventing the most common biases. This framework consists of (1) clearly defining a causal question about an intervention, (2) specifying the protocol of the hypothetical trial, and (3) explaining how the observational data will be used to emulate it. METHODS The aim of this scoping review was to identify and review all explicit attempts of trial emulation studies across all medical fields. Embase, Medline and Web of Science were searched for trial emulation studies published in English from database inception to February 25, 2021. The following information was extracted from studies that were deemed eligible for review: the subject area, the type of observational data that they leveraged, and the statistical methods they used to address the following biases: (A) confounding bias, (B) immortal time bias, and (C) selection bias. RESULTS The search resulted in 617 studies, 38 of which we deemed eligible for review. Of those 38 studies, most focused on cardiology, infectious diseases or oncology and the majority used electronic health records/electronic medical records data and cohort studies data. Different statistical methods were used to address confounding at baseline and selection bias, predominantly conditioning on the confounders (N = 18/49, 37%) and inverse probability of censoring weighting (N = 7/20, 35%) respectively. Different approaches were used to address immortal time bias, assigning individuals to treatment strategies at start of follow-up based on their data available at that specific time (N = 21, 55%), using the sequential trial emulations approach (N = 11, 29%) or the cloning approach (N = 6, 16%). CONCLUSION Different methods can be leveraged to address (A) confounding bias, (B) immortal time bias, and (C) selection bias. When working with observational data, and if possible, the 'target trial' framework should be used as it provides a structured conceptual approach to observational research.
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Affiliation(s)
- Giulio Scola
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Anca Chis Ster
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Bean
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Health Data Research UK London, Institute of Health Informatics, University College London, London, UK
| | - Nilesh Pareek
- King's College Hospital NHS Foundation Trust, London, UK
- School of Cardiovascular and Metabolic Medicine & Sciences, BHF Centre of Excellence, King's College London, London, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Morris AC, Ibrahim Z, Moghraby OS, Stringaris A, Grant IM, Zalewski L, McClellan S, Moriarty G, Simonoff E, Dobson RJB, Downs J. Moving from development to implementation of digital innovations within the NHS: myHealthE, a remote monitoring system for tracking patient outcomes in child and adolescent mental health services. Digit Health 2023; 9:20552076231211551. [PMID: 37954687 PMCID: PMC10638880 DOI: 10.1177/20552076231211551] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023] Open
Abstract
Objective This paper aims to report our experience of developing, implementing, and evaluating myHealthE (MHE), a digital innovation for Child and Adolescents Mental Health Services (CAMHS), which automates the remote collection and reporting of Patient-Reported Outcome Measures (PROMs) into National Health Services (NHS) electronic healthcare records. Methods We describe the logistical and governance issues encountered in developing the MHE interface with patient-identifiable information, and the steps taken to overcome these development barriers. We describe the application's architecture and hosting environment to enable its operability within the NHS, as well as the capabilities needed within the technical team to bridge the gap between academic development and NHS operational teams. Results We present evidence on the feasibility and acceptability of this system within clinical services and the process of iterative development, highlighting additional functions that were incorporated to increase system utility. Conclusion This article provides a framework with which to plan, develop, and implement automated PROM collection from remote devices back to NHS infrastructure. The challenges and solutions described in this paper will be pertinent to other digital health innovation researchers aspiring to deploy interoperable systems within NHS clinical systems.
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Affiliation(s)
- Anna C Morris
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Zina Ibrahim
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Omer S Moghraby
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Argyris Stringaris
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Emotion & Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Ian M Grant
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR South London and Maudsley Biomedical Research Centre, London, UK
| | - Lukasz Zalewski
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR South London and Maudsley Biomedical Research Centre, London, UK
| | | | - Garry Moriarty
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Emily Simonoff
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR South London and Maudsley Biomedical Research Centre, London, UK
| | - Richard JB Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR South London and Maudsley Biomedical Research Centre, London, UK
- Health Data Research UK London, University College London, London, UK
- Institute of Health Informatics, University College London, London, UK
- NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Johnny Downs
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR South London and Maudsley Biomedical Research Centre, London, UK
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10
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Chen S, Price AC, Cardinal RN, Moylett S, Kershenbaum AD, Fitzgerald J, Mueller C, Stewart R, O’Brien JT. Association between antidementia medication use and mortality in people diagnosed with dementia with Lewy bodies in the UK: A retrospective cohort study. PLoS Med 2022; 19:e1004124. [PMID: 36472984 PMCID: PMC9725132 DOI: 10.1371/journal.pmed.1004124] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dementia with Lewy bodies (DLBs) is a common cause of dementia but has higher mortality than Alzheimer's disease (AD). The reasons for this are unclear, but antidementia drugs (including acetylcholinesterase inhibitors [AChEIs] and memantine) symptomatically benefit people with DLB and might improve outcomes. We investigated whether AChEIs and/or memantine were associated with reduced hospital admissions and mortality. METHODS AND FINDINGS We performed a retrospective cohort study of those diagnosed with DLB between 1 January 2005 and 31 December 2019, using data from electronic clinical records of secondary care mental health services in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), United Kingdom (catchment area population approximately 0.86 million), as well as linked records from national Hospital Episode Statistics (HES) data. Eligible patients were those who started AChEIs or memantine within 3 months of their diagnosis (cases) and those who never used AChEIs or memantine (controls). Outcomes included admission, length of stay, and mortality. Cox proportional hazard and linear regression models were used. Of 592 patients with DLB, 219 never took AChEIs or memantine, 100 took AChEIs only, and 273 took both AChEIs and memantine. The cohorts were followed up for an average of 896 days, 981 days, and 1,004 days, respectively. There were no significant differences in the cohorts' baseline characteristics, except for socioeconomic status that was lower in patients who never took AChEIs or memantine (χ2 = 23.34, P = 0.003). After controlling for confounding by sociodemographic factors (age, sex, marital status, ethnicity, socioeconomic status), antipsychotic use, antidepressant use, cognitive status, physical comorbidity, anticholinergic burden, and global health performance, compared with patients who never took AChEIs or memantine, patients taking AChEIs only or taking both had a significantly lower risk of death (adjusted hazard ratio (HR) = 0.67, 95% CI = 0.48 to 0.93, p = 0.02; adjusted HR = 0.64, 95% CI = 0.50 to 0.83, P = 0.001, respectively). Those taking AChEIs or both AChEIs and memantine had significantly shorter periods of unplanned hospital admission for physical disorders (adjusted coefficient -13.48, 95% CI = [-26.87, -0.09], P = 0.049; adjusted coefficient -14.21, 95% CI = [-24.58, -3.85], P = 0.007, respectively), but no difference in length of stay for planned admissions for physical disorders, or for admissions for mental health disorders. No significant additional associations of memantine on admission, length of stay, and mortality were found (all P > 0.05). The main limitation was that this was a naturalistic study and possible confounds cannot be fully controlled, and there may be selection bias resulting from nonrandom prescription behaviour in clinical practice. However, we mimicked the intention-to-treat design of clinical trials, and the majority of baseline characters were balanced between cohorts. In addition, our series of sensitivity analyses confirmed the consistency of our results. CONCLUSION In this study, we observed that use of AChEIs with or without memantine in DLB was associated with shorter duration of hospital admissions and decreased risk of mortality. Although our study was naturalistic, it supports further the use of AChEIs in DLB.
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Affiliation(s)
- Shanquan Chen
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Annabel C. Price
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Rudolf N. Cardinal
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Sinéad Moylett
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Laboratory of Neuroimmunology, KU Leuven, Leuven, Belgium
| | - Anne D. Kershenbaum
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - James Fitzgerald
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Christoph Mueller
- King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Robert Stewart
- King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - John T. O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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Kariyawasam D, Soukup T, Parsons J, Sevdalis N, Baldellou Lopez M, Forde R, Ismail K, Jones M, Ford-Adams M, Yemane N, Pender S, Thomas S, Murrells T, Silverstien A, Forbes A. Protocol for a feasibility study and process evaluation of a psychosocially modelled diabetes education programme for young people with type 1 diabetes: the Youth Empowerment Skills (YES) programme. BMJ Open 2022; 12:e062971. [PMID: 35680254 PMCID: PMC9185576 DOI: 10.1136/bmjopen-2022-062971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Adolescence is a challenging period for young people with type 1 diabetes, associated with worsening glycaemia and care disengagement. Educational interventions in this period tend to focus on diabetes-specific skills, with less emphasis on the psychosocial challenges associated with diabetes experienced by young people. To address this limitation, we codesigned with young people a psychosocially modelled programme of diabetes education, named 'Youth Empowerment Skills' (YES). The programme aims to facilitate a positive adaptation to life with diabetes and engagement with diabetes care through peer-based learning, immersive simulations and support from an outreach youth worker. Here, we present a protocol for a feasibility study of the YES programme. METHODS AND ANALYSIS The study was designed following the Medical Research Council Complex Intervention Evaluation Framework to: test the feasibility (acceptance, implementability, recruitment and completion) of the YES programme; and estimate its efficacy in relation to metabolic and psychosocial outcomes. The study will take place in diabetes centres serving socioculturally diverse populations. We will conduct a feasibility randomised controlled trial (waiting-list design) with integrated process evaluation. Fifty young people with type 1 diabetes (aged 14-19 years) will be randomly allocated to either the YES intervention or a waiting-list control. Randomisation acceptability will be assessed with provision for a preference allocation. Outcomes will be evaluated at 6 months, at which point the waiting list participants will be exposed to the YES programme with further follow-up to 12 months. A simultaneous process evaluation will use a mixed-methods approach collecting qualitative and quantitative data. Study findings will be used to optimise the intervention components, outcome measures and recruitment methods to inform a subsequent definitive trial. ETHICS AND DISSEMINATION The protocol has ethical approval from the UK Health Research Authority (approval IRAS project ID: 279877). Findings will be disseminated in multiple formats for lay and professional audiences. PROTOCOL DATE AND VERSION 7 April 2021, V.1.1. TRIAL REGISTRATION NUMBER NCT04670198.
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Affiliation(s)
- Dulmini Kariyawasam
- Department of Diabetes and Endocrinology, Guy's and St.Thomas 'NHS foundation Trust, London, UK
| | - Tayana Soukup
- Health Service and Population Research Department, King's College London, London, UK
| | - Judith Parsons
- Division of Care Long-term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Nick Sevdalis
- Health Service and Population Research Department, King's College London, London, UK
| | - Maria Baldellou Lopez
- Health Service and Population Research Department, King's College London, London, UK
| | - Rita Forde
- Division of Care Long-term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Khalida Ismail
- Health Service and Population Research Department, King's College London, London, UK
| | - Marie Jones
- Department of Diabetes and Endocrinology, Guy's and St.Thomas 'NHS foundation Trust, London, UK
| | - Martha Ford-Adams
- Paediatric Diabetes Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Nardos Yemane
- Department of Diabetes and Endocrinology, Guy's and St.Thomas 'NHS foundation Trust, London, UK
| | - Siobhan Pender
- Department of Diabetes and Endocrinology, Guy's and St.Thomas 'NHS foundation Trust, London, UK
| | - Stephen Thomas
- Department of Diabetes and Endocrinology, Guy's and St.Thomas 'NHS foundation Trust, London, UK
| | - Trevor Murrells
- National Nursing Research Unit, King's College London, London, UK
| | - Alex Silverstien
- Division of Care Long-term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Angus Forbes
- Division of Care Long-term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
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