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Wray J, Ridout D, Jones A, Davis P, Wellman P, Rodrigues W, Hudson E, Tsang V, Pagel C, Brown KL. The Impact of Morbidities Following Pediatric Cardiac Surgery on Family Functioning and Parent Quality of Life. Pediatr Cardiol 2024; 45:14-23. [PMID: 37914854 DOI: 10.1007/s00246-023-03312-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023]
Abstract
We previously selected and defined nine important post-operative morbidities linked to paediatric cardiac surgery, and prospectively measured their incidence following 3090 consecutive operations. Our aim was to study the impact of these morbidities on family functioning and parental quality of life over 6 months in a subset of cases. As part of a prospective case matched study in five of the ten children's cardiac centers in the UK, we compared outcomes for parents of children who had a 'single morbidity', 'multiple morbidities', 'extracorporeal life support (ECLS)' or 'no morbidity'. Outcomes were evaluated using the PedsQL Family impact module (FIM) at 6 weeks and 6 months post-surgery. Outcomes were modelled using mixed effects regression, with adjustment for case mix and clustering within centers. We recruited 340 patients with morbidity (60% of eligible patients) and 326 with no morbidity over 21 months. In comparison to the reference group of 'no morbidity', after adjustment for case mix, at 6 weeks parent health-related quality of life (HRQoL) and total FIM sores were lower (worse) only for ECLS (p < 0.005), although a higher proportion of parents in both the ECLS and multi-morbidity groups had low/very low scores (p < .05). At 6 months, parent outcomes had improved for all groups but parent HRQoL and total score for ECLS remained lower than the 'no morbidity' group (p < .05) and a higher proportion of families had low or very low scores in the ECLS (70%) group (p < .01). Post-operative morbidities impact parent HRQoL and aspects of family functioning early after surgery, with this impact lessening by 6 months. Families of children who experience post-operative morbidities should be offered timely psychological support.
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Affiliation(s)
- Jo Wray
- Heart and Lung Division and NIHR GOSH BRC, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Deborah Ridout
- Population, Policy and Practice Programme and NIHR GOSH BRC, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alison Jones
- Department of Intensive Care and Paediatric Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Peter Davis
- Paediatric Intensive Care Unit and Department of Paediatric Cardiac Surgery, Bristol Royal Children's Hospital, Bristol, UK
| | - Paul Wellman
- Department of Paediatric Cardiology and Cardiac Surgery, Evelina Children's Hospital, London, UK
| | - Warren Rodrigues
- Heart and Lung Division and NIHR GOSH BRC, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Emma Hudson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Victor Tsang
- Heart and Lung Division and NIHR GOSH BRC, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - Katherine L Brown
- Heart and Lung Division and NIHR GOSH BRC, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
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Affiliation(s)
| | - Christina Pagel
- Clinical Operational Research Unit, University College London
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Affiliation(s)
| | - Christina Pagel
- Clinical Operational Research Unit, University College London
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Huang Q, Ridout D, Tsang V, Drury NE, Jones TJ, Bellsham-Revell H, Hadjicosta E, Seale AN, Mehta C, Pagel C, Crowe S, Espuny-Pujol F, Franklin RC, Brown KL. Risk Factors for Reintervention With Functionally Single-Ventricle Disease Undergoing Staged Palliation in England and Wales: A Retrospective Cohort Study. Circulation 2023; 148:1343-1345. [PMID: 37871240 PMCID: PMC10589421 DOI: 10.1161/circulationaha.123.065647] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Affiliation(s)
- Qi Huang
- Clinical Operational Research Unit, Department of Mathematics (Q.H., E.H., C.P., S.C., F.E.-P
| | - Deborah Ridout
- Population, Policy and Practice Programme, Great Ormond Street Institute of Child Health (D.R.), University College London
| | - Victor Tsang
- Institute of Cardiovascular Science (V.T., K.L.B.), University College London
- Great Ormond Street Hospital Biomedical Research Centre, London (V.T., K.L,B,)
| | - Nigel E. Drury
- Paediatric Cardiology and Cardiac Surgery, Birmingham Children’s Hospital, Birmingham (N.E.D., T.J.J., A.N.S., C.M.)
- Institute of Cardiovascular Sciences, University of Birmingham (N.E.D., T.J.J., A.N.S.)
| | - Timothy J. Jones
- Paediatric Cardiology and Cardiac Surgery, Birmingham Children’s Hospital, Birmingham (N.E.D., T.J.J., A.N.S., C.M.)
- Institute of Cardiovascular Sciences, University of Birmingham (N.E.D., T.J.J., A.N.S.)
| | | | - Elena Hadjicosta
- Clinical Operational Research Unit, Department of Mathematics (Q.H., E.H., C.P., S.C., F.E.-P
| | - Anna N. Seale
- Paediatric Cardiology and Cardiac Surgery, Birmingham Children’s Hospital, Birmingham (N.E.D., T.J.J., A.N.S., C.M.)
- Institute of Cardiovascular Sciences, University of Birmingham (N.E.D., T.J.J., A.N.S.)
| | - Chetan Mehta
- Paediatric Cardiology and Cardiac Surgery, Birmingham Children’s Hospital, Birmingham (N.E.D., T.J.J., A.N.S., C.M.)
| | - Christina Pagel
- Clinical Operational Research Unit, Department of Mathematics (Q.H., E.H., C.P., S.C., F.E.-P
| | - Sonya Crowe
- Clinical Operational Research Unit, Department of Mathematics (Q.H., E.H., C.P., S.C., F.E.-P
| | - Ferran Espuny-Pujol
- Clinical Operational Research Unit, Department of Mathematics (Q.H., E.H., C.P., S.C., F.E.-P
| | - Rodney C.G. Franklin
- Paediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London (R.C.G.F.)
| | - Kate L. Brown
- Institute of Cardiovascular Science (V.T., K.L.B.), University College London
- Great Ormond Street Hospital Biomedical Research Centre, London (V.T., K.L,B,)
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Affiliation(s)
- Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
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Wilde H, Tomlinson C, Mateen BA, Selby D, Kanthimathinathan HK, Ramnarayan P, Du Pre P, Johnson M, Pathan N, Gonzalez-Izquierdo A, Lai AG, Gurdasani D, Pagel C, Denaxas S, Vollmer S, Brown K. Hospital admissions linked to SARS-CoV-2 infection in children and adolescents: cohort study of 3.2 million first ascertained infections in England. BMJ 2023; 382:e073639. [PMID: 37407076 PMCID: PMC10318942 DOI: 10.1136/bmj-2022-073639] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To describe hospital admissions associated with SARS-CoV-2 infection in children and adolescents. DESIGN Cohort study of 3.2 million first ascertained SARS-CoV-2 infections using electronic health care record data. SETTING England, July 2020 to February 2022. PARTICIPANTS About 12 million children and adolescents (age <18 years) who were resident in England. MAIN OUTCOME MEASURES Ascertainment of a first SARS-CoV-2 associated hospital admissions: due to SARS-CoV-2, with SARS-CoV-2 as a contributory factor, incidental to SARS-CoV-2 infection, and hospital acquired SARS-CoV-2. RESULTS 3 226 535 children and adolescents had a recorded first SARS-CoV-2 infection during the observation period, and 29 230 (0.9%) infections involved a SARS-CoV-2 associated hospital admission. The median length of stay was 2 (interquartile range 1-4) days) and 1710 of 29 230 (5.9%) SARS-CoV-2 associated admissions involved paediatric critical care. 70 deaths occurred in which covid-19 or paediatric inflammatory multisystem syndrome was listed as a cause, of which 55 (78.6%) were in participants with a SARS-CoV-2 associated hospital admission. SARS-CoV-2 was the cause or a contributory factor in 21 000 of 29 230 (71.8%) participants who were admitted to hospital and only 380 (1.3%) participants acquired infection as an inpatient and 7855 (26.9%) participants were admitted with incidental SARS-CoV-2 infection. Boys, younger children (<5 years), and those from ethnic minority groups or areas of high deprivation were more likely to be admitted to hospital (all P<0.001). The covid-19 vaccination programme in England has identified certain conditions as representing a higher risk of admission to hospital with SARS-CoV-2: 11 085 (37.9%) of participants admitted to hospital had evidence of such a condition, and a further 4765 (16.3%) of participants admitted to hospital had a medical or developmental health condition not included in the vaccination programme's list. CONCLUSIONS Most SARS-CoV-2 associated hospital admissions in children and adolescents in England were due to SARS-CoV-2 or SARS-CoV-2 was a contributory factor. These results should inform future public health initiatives and research.
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Affiliation(s)
- Harrison Wilde
- Department of Statistics, University of Warwick, Warwick, UK
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
| | - Christopher Tomlinson
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
- UCL UK Research and Innovation Centre for Doctoral Training in AI-enabled Healthcare Systems, UCL, London, UK
- University College London Hospitals Biomedical Research Centre, UCL, London, UK
| | - Bilal A Mateen
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
- University College London Hospitals Biomedical Research Centre, UCL, London, UK
- Wellcome Trust, London, UK
| | - David Selby
- Department for Data Science and its Applications, German Research Centre for Artificial Intelligence (DFKI), Kaiserslautern, Germany
- Department of Computer Science, TU Kaiserslautern, Kaiserslautern, Germany
| | | | - Padmanabhan Ramnarayan
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London UK Imperial College London, London, UK
| | - Pascale Du Pre
- Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK
| | - Mae Johnson
- Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK
| | - Nazima Pathan
- University Department of Paediatrics, Cambridge University, Cambridge, UK
| | | | - Alvina G Lai
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
| | - Deepti Gurdasani
- William Harvey Institute, Queen Mary University of London, London, UK
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Spiros Denaxas
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
- University College London Hospitals Biomedical Research Centre, UCL, London, UK
| | - Sebastian Vollmer
- Department for Data Science and its Applications, German Research Centre for Artificial Intelligence (DFKI), Kaiserslautern, Germany
- Department of Computer Science, TU Kaiserslautern, Kaiserslautern, Germany
| | - Katherine Brown
- Institute of Cardiovascular Science, UCL, London, UK
- Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK
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Dorobantu DM, Huang Q, Espuny Pujol F, Brown KL, Franklin RC, Pufulete M, Lawlor DA, Crowe S, Pagel C, Stoica SC. Hospital resource utilization in a national cohort of functionally single ventricle patients undergoing surgical treatment. JTCVS Open 2023; 14:441-461. [PMID: 37425480 PMCID: PMC10329026 DOI: 10.1016/j.xjon.2023.03.014] [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] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/22/2023] [Accepted: 03/27/2023] [Indexed: 07/11/2023]
Abstract
Objective The study objective was to provide a detailed overview of health resource use from birth to 18 years old for patients with functionally single ventricles and identify associated risk factors. Methods All patients with functionally single ventricles treated between 2000 and 2017 in England and Wales were linked to hospital and outpatient records using data from the Linking AUdit and National datasets in Congenital HEart Services project. Hospital stay was described in yearly age intervals, and associated risk factors were explored using quantile regression. Results A total of 3037 patients with functionally single ventricles were included, 1409 (46.3%) undergoing a Fontan procedure. During the first year of life, the median days spent in hospital was 60 (interquartile range, 37-102), mostly inpatient days, mirroring a mortality of 22.8%. This decreases to between 2 and 9 in-hospital days/year afterward. Between 2 and 18 years, most hospital days were outpatient, with a median of 1 to 5 days/year. Lower age at the first procedure, hypoplastic left heart syndrome/mitral atresia, unbalanced atrioventricular septal defect, preterm birth, congenital/acquired comorbidities, additional cardiac risk factors, and severity of illness markers were associated with fewer days at home and more intensive care unit days in the first year of life. Only markers of early severe illness were associated with fewer days at home in the first 6 months after the Fontan procedure. Conclusions Hospital resource use in functionally single ventricle cases is not uniform, decreasing 10-fold during adolescence compared with the first year of life. There are subsets of patients with worse outcomes during their first year of life or with persistently high hospital use throughout their childhood, which could be the target of future research.
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Affiliation(s)
- Dan-Mihai Dorobantu
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
| | - Qi Huang
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, United Kingdom
| | - Ferran Espuny Pujol
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, United Kingdom
| | - Katherine L. Brown
- Cardiac and Critical Care Division, Great Ormond Street Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Rodney C. Franklin
- Department of Paediatric Cardiology, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Maria Pufulete
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Deborah A. Lawlor
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Bristol National Institute for Health Research Biomedical Research Centre, Bristol, United Kingdom
| | - Sonya Crowe
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, United Kingdom
| | - Christina Pagel
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, United Kingdom
| | - Serban C. Stoica
- University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
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Pagel C, Wilde H, Tomlinson C, Mateen B, Brown K. A Methodological Framework for Assessing the Benefit of SARS-CoV-2 Vaccination following Previous Infection: Case Study of Five- to Eleven-Year-Olds. Vaccines (Basel) 2023; 11:vaccines11050988. [PMID: 37243092 DOI: 10.3390/vaccines11050988] [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: 04/15/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Vaccination rates against SARS-CoV-2 in children aged five to eleven years remain low in many countries. The current benefit of vaccination in this age group has been questioned given that the large majority of children have now experienced at least one SARS-CoV-2 infection. However, protection from infection, vaccination or both wanes over time. National decisions on offering vaccines to this age group have tended to be made without considering time since infection. There is an urgent need to evaluate the additional benefits of vaccination in previously infected children and under what circumstances those benefits accrue. We present a novel methodological framework for estimating the potential benefits of COVID-19 vaccination in previously infected children aged five to eleven, accounting for waning. We apply this framework to the UK context and for two adverse outcomes: hospitalisation related to SARS-CoV-2 infection and Long Covid. We show that the most important drivers of benefit are: the degree of protection provided by previous infection; the protection provided by vaccination; the time since previous infection; and future attack rates. Vaccination can be very beneficial for previously infected children if future attack rates are high and several months have elapsed since the previous major wave in this group. Benefits are generally larger for Long Covid than hospitalisation, because Long Covid is both more common than hospitalisation and previous infection offers less protection against it. Our framework provides a structure for policy makers to explore the additional benefit of vaccination across a range of adverse outcomes and different parameter assumptions. It can be easily updated as new evidence emerges.
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Affiliation(s)
- Christina Pagel
- Clinical Operational Research Unit, Department of Mathematics, University College London (UCL), London WC1E 6BT, UK
| | - Harrison Wilde
- Department of Statistics, University of Warwick, Coventry CV4 7AL, UK
- UCL Institute of Health Informatics, University College London (UCL), London NW1 2DA, UK
| | - Christopher Tomlinson
- UCL Institute of Health Informatics, University College London (UCL), London NW1 2DA, UK
- UK Research and Innovation Centre for Doctoral Training in AI-enabled Healthcare Systems, University College London (UCL), London WC1E 6BT, UK
- University College London Hospitals Biomedical Research Centre, University College London (UCL), London W1T 7DN, UK
| | - Bilal Mateen
- UCL Institute of Health Informatics, University College London (UCL), London NW1 2DA, UK
- University College London Hospitals Biomedical Research Centre, University College London (UCL), London W1T 7DN, UK
- Wellcome Trust, London NW1 2BE, UK
| | - Katherine Brown
- Biomedical Research Centre, Great Ormond Street Hospital for Children, London WC1N 3JH, UK
- Institute of Cardiovascular Science, University College London (UCL), London WC1E 6DD, UK
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Affiliation(s)
- Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
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Brown KL, Huang Q, Hadjicosta E, Seale AN, Tsang V, Anderson D, Barron D, Bellsham-Revell H, Pagel C, Crowe S, Espuny-Pujol F, Franklin R, Ridout D. Long-term survival and center volume for functionally single-ventricle congenital heart disease in England and Wales. J Thorac Cardiovasc Surg 2022:S0022-5223(22)01259-4. [PMID: 36535820 DOI: 10.1016/j.jtcvs.2022.11.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Long-term survival is an important metric for health care evaluation, especially in functionally single-ventricle (f-SV) congenital heart disease (CHD). This study's aim was to evaluate the relationship between center volume and long-term survival in f-SV CHD within the centralized health care service of England and Wales. METHODS This was a retrospective cohort study of children born with f-SV CHD between 2000 and 2018, using the national CHD procedure registry, with survival ascertained in 2020. RESULTS Of 56,039 patients, 3293 (5.9%) had f-SV CHD. Median age at first intervention was 7 days (interquartile range [IQR], 4, 27), and median follow-up time was 7.6 years (IQR, 1.0, 13.3). The largest diagnostic subcategories were hypoplastic left heart syndrome, 1276 (38.8%); tricuspid atresia, 440 (13.4%); and double-inlet left ventricle, 322 (9.8%). The survival rate at 1 year and 5 years was 76.8% (95% confidence interval [CI], 75.3%-78.2%) and 72.1% (95% CI, 70.6%-73.7%), respectively. The unadjusted hazard ratio for each 5 additional patients with f-SV starting treatment per center per year was 1.04 (95% CI, 1.02-1.06), P < .001. However, after adjustment for significant risk factors (diagnostic subcategory; antenatal diagnosis; younger age, low weight, acquired comorbidity, increased severity of illness at first procedure), the hazard ratio for f-SV center volume was 1.01 (95% CI, 0.99-1.04) P = .28. There was strong evidence that patients with more complex f-SV (hypoplastic left heart syndrome, Norwood pathway) were treated at centers with greater f-SV case volume (P < .001). CONCLUSIONS After adjustment for case mix, there was no evidence that f-SV center volume was linked to longer-term survival in the centralized health service provided by the 10 children's cardiac centers in England and Wales.
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Affiliation(s)
- Kate L Brown
- Great Ormond Street Hospital Biomedical Research Centre and Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Qi Huang
- Clinical Operational Research Unit, University College London, London, United Kingdom.
| | - Elena Hadjicosta
- Clinical Operational Research Unit, University College London, London, United Kingdom
| | - Anna N Seale
- Paediatric Cardiology and Cardiothoracic Surgery, Birmingham Women's and Children's Hospital National Health Service Foundation Trust and Institute of Cardiovascular Science, University of Birmingham, Birmingham, United Kingdom
| | - Victor Tsang
- Great Ormond Street Hospital Biomedical Research Centre and Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - David Anderson
- Paediatric Cardiology, Evelina London Hospital, London, United Kingdom
| | - David Barron
- Paediatric Cardiology and Cardiothoracic Surgery, Birmingham Women's and Children's Hospital National Health Service Foundation Trust and Institute of Cardiovascular Science, University of Birmingham, Birmingham, United Kingdom
| | | | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, United Kingdom
| | - Sonya Crowe
- Clinical Operational Research Unit, University College London, London, United Kingdom
| | - Ferran Espuny-Pujol
- Clinical Operational Research Unit, University College London, London, United Kingdom
| | - Rodney Franklin
- Paediatric Cardiology, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Deborah Ridout
- Population, Policy and Practice Programme, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Affiliation(s)
- Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
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Affiliation(s)
- Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
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Pierce CA, Herold KC, Herold BC, Chou J, Randolph A, Kane B, McFarland S, Gurdasani D, Pagel C, Hotez P, Cobey S, Hensley SE. COVID-19 and children. Science 2022; 377:1144-1149. [PMID: 36074833 PMCID: PMC10324476 DOI: 10.1126/science.ade1675] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
There has been substantial research on adult COVID-19 and how to treat it. But how do severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections afflict children? The COVID-19 pandemic has yielded many surprises, not least that children generally develop less severe disease than older adults, which is unusual for a respiratory disease. However, some children can develop serious complications from COVID-19, such as multisystem inflammatory syndrome in children (MIS-C) and Long Covid, even after mild or asymptomatic COVID-19. Why this occurs in some and not others is an important question. Moreover, when children do contract COVID-19, understanding their role in transmission, especially in schools and at home, is crucial to ensuring effective mitigation measures. Therefore, in addition to nonpharmaceutical interventions, such as improved ventilation, there is a strong case to vaccinate children so as to reduce possible long-term effects from infection and to decrease transmission. But questions remain about whether vaccination might skew immune responses to variants in the long term. As the experts discuss below, more is being learned about these important issues, but much more research is needed to understand the long-term effects of COVID-19 in children.
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Affiliation(s)
- Carl A Pierce
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kevan C Herold
- Departments of Immunobiology and of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Betsy C Herold
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Janet Chou
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Adrienne Randolph
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
| | - Binita Kane
- Manchester University Foundation Trust and School of Biological Sciences, University of Manchester, Manchester, UK
| | | | - Deepti Gurdasani
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - Peter Hotez
- Texas Children's Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Biology, Baylor University, Waco, TX, USA
- Hagler Institute for Advanced Study, Texas A&M University, College Station, TX, USA
- Scowcroft Institute of International Affairs, Texas A&M University, College Station, TX, USA
- James A. Baker III Institute for Public Policy, Rice University, Houston, TX, USA
- School of Public Health, University of Texas, Houston, TX, USA
| | - Sarah Cobey
- Department of Ecology and Evolution, University of Chicago, Illinois, USA
| | - Scott E Hensley
- Department of Microbiology, University of Pennsylvania, Philadelphia, PA, USA
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Gurdasani D, Pagel C, McKee M, Michie S, Greenhalgh T, Yates C, Scally G, Ziauddeen H. Covid-19 in the UK: policy on children and schools. BMJ 2022. [DOI: 10.1136/bmj-2022-071234] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Espuny Pujol F, Franklin RC, Crowe S, Brown KL, Swan L, Pagel C, English KM. Transfer of congenital heart patients from paediatric to adult services in England. Heart 2022; 108:1964-1971. [PMID: 35794015 DOI: 10.1136/heartjnl-2022-321085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/16/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study assessed the transfer of patients from paediatric cardiac to adult congenital heart disease (ACHD) services in England and the factors impacting on this process. METHODS This retrospective cohort study used a population-based linked data set (LAUNCHES QI data set: 'Linking Audit and National datasets in Congenital Heart Services for Quality Improvement') including all patients born between 1987 and 2000, recorded as having a congenital heart disease (CHD) procedure in childhood. Hospital Episode Statistics data identified transfer from paediatric to ACHD services between the ages of 16 and 22 years. RESULTS Overall, 63.8% of a cohort of 10 298 patients transferred by their 22nd birthday. The estimated probability of transfer by age 22 was 96.5% (95% CI 95.3 to 97.7), 86.7% (95% CI 85.6 to 87.9) and 41.0% (95% CI 39.4 to 42.6) for severe, moderate and mild CHD, respectively. 166 patients (1.6%) died between 16 and 22 years; 42 of these (0.4%) died after age 16 but prior to transfer. Multivariable ORs in the moderate and severe CHD groups up to age 20 showed significantly lower likelihood of transfer among female patients (0.87, 95% CI 0.78 to 0.97), those with missing ethnicity data (0.31, 95% CI 0.18 to 0.52), those from deprived areas (0.84, 95% CI 0.72 to 0.98) and those with moderate (compared with severe) CHD (0.30, 95% CI 0.26 to 0.35). The odds of transfer were lower for the horizontal compared with the vertical care model (0.44, 95% CI 0.27 to 0.72). Patients who did not transfer had a lower probability of a further National Congenital Heart Disease Audit procedure between ages 20 and 30 compared with those who did transfer: 12.3% (95% CI 5.1 to 19.6) vs 32.5% (95% CI 28.7 to 36.3). CONCLUSIONS Majority of patients with moderate or severe CHD in England transfer to adult services. Patients who do not transfer undergo fewer elective CHD procedures over the following decade.
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Affiliation(s)
| | - Rodney C Franklin
- Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
| | - Sonya Crowe
- Clinical Operational Research Unit, UCL, London, UK
| | - Kate L Brown
- Cardiorespiratory, GOSH, London, UK.,Heart and Lung Division, Great Ormond Street Hospital NIHR Biomedical Research Centre', London, UK
| | - Lorna Swan
- Adult Congenital Heart Disease, Golden Jubilee National Hospital, Glasgow, UK
| | | | - Kate M English
- Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Thygesen JH, Tomlinson C, Hollings S, Mizani MA, Handy A, Akbari A, Banerjee A, Cooper J, Lai AG, Li K, Mateen BA, Sattar N, Sofat R, Torralbo A, Wu H, Wood A, Sterne JAC, Pagel C, Whiteley WN, Sudlow C, Hemingway H, Denaxas S. COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records. Lancet Digit Health 2022; 4:e542-e557. [PMID: 35690576 PMCID: PMC9179175 DOI: 10.1016/s2589-7500(22)00091-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 11/11/2021] [Revised: 03/15/2022] [Accepted: 04/13/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. METHODS In this cohort study, we used eight linked National Health Service (NHS) datasets for people in England alive on Jan 23, 2020. Data on COVID-19 testing, vaccination, primary and secondary care records, and death registrations were collected until Nov 30, 2021. We defined ten COVID-19 phenotypes reflecting clinically relevant stages of disease severity and encompassing five categories: positive SARS-CoV-2 test, primary care diagnosis, hospital admission, ventilation modality (four phenotypes), and death (three phenotypes). We constructed patient trajectories illustrating transition frequency and duration between phenotypes. Analyses were stratified by pandemic waves and vaccination status. FINDINGS Among 57 032 174 individuals included in the cohort, 13 990 423 COVID-19 events were identified in 7 244 925 individuals, equating to an infection rate of 12·7% during the study period. Of 7 244 925 individuals, 460 737 (6·4%) were admitted to hospital and 158 020 (2·2%) died. Of 460 737 individuals who were admitted to hospital, 48 847 (10·6%) were admitted to the intensive care unit (ICU), 69 090 (15·0%) received non-invasive ventilation, and 25 928 (5·6%) received invasive ventilation. Among 384 135 patients who were admitted to hospital but did not require ventilation, mortality was higher in wave 1 (23 485 [30·4%] of 77 202 patients) than wave 2 (44 220 [23·1%] of 191 528 patients), but remained unchanged for patients admitted to the ICU. Mortality was highest among patients who received ventilatory support outside of the ICU in wave 1 (2569 [50·7%] of 5063 patients). 15 486 (9·8%) of 158 020 COVID-19-related deaths occurred within 28 days of the first COVID-19 event without a COVID-19 diagnoses on the death certificate. 10 884 (6·9%) of 158 020 deaths were identified exclusively from mortality data with no previous COVID-19 phenotype recorded. We observed longer patient trajectories in wave 2 than wave 1. INTERPRETATION Our analyses illustrate the wide spectrum of disease trajectories as shown by differences in incidence, survival, and clinical pathways. We have provided a modular analytical framework that can be used to monitor the impact of the pandemic and generate evidence of clinical and policy relevance using multiple EHR sources. FUNDING British Heart Foundation Data Science Centre, led by Health Data Research UK.
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Affiliation(s)
- Johan H Thygesen
- Institute of Health Informatics, University College London, London, UK
| | - Christopher Tomlinson
- Institute of Health Informatics, University College London, London, UK; UK Research and Innovation Centre for Doctoral Training in AI-enabled Healthcare Systems, University College London, London, UK; University College London Hospitals Biomedical Research Centre, University College London, London, UK
| | | | - Mehrdad A Mizani
- Institute of Health Informatics, University College London, London, UK
| | - Alex Handy
- Institute of Health Informatics, University College London, London, UK
| | - Ashley Akbari
- Population Data Science, Swansea University, Swansea, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
| | - Jennifer Cooper
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alvina G Lai
- Institute of Health Informatics, University College London, London, UK
| | - Kezhi Li
- Institute of Health Informatics, University College London, London, UK; UK Research and Innovation Centre for Doctoral Training in AI-enabled Healthcare Systems, University College London, London, UK
| | - Bilal A Mateen
- Institute of Health Informatics, University College London, London, UK; The Wellcome Trust, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Reecha Sofat
- Institute of Health Informatics, University College London, London, UK; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Ana Torralbo
- Institute of Health Informatics, University College London, London, UK
| | - Honghan Wu
- Institute of Health Informatics, University College London, London, UK
| | - Angela Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, and Cambridge Centre for AI in Medicine, University of Cambridge, Cambridge, UK
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - William N Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Cathie Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; British Heart Foundation Data Science Centre, Health Data Research UK, London, UK; Health Data Research UK, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK; University College London Hospitals Biomedical Research Centre, University College London, London, UK; Health Data Research UK, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK; British Heart Foundation Research Accelerator, University College London, London, UK; University College London Hospitals Biomedical Research Centre, University College London, London, UK; British Heart Foundation Data Science Centre, Health Data Research UK, London, UK; Health Data Research UK, London, UK.
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Espuny Pujol F, Pagel C, Brown KL, Doidge JC, Feltbower RG, Franklin RC, Gonzalez-Izquierdo A, Gould DW, Norman LJ, Stickley J, Taylor JA, Crowe S. Linkage of National Congenital Heart Disease Audit data to hospital, critical care and mortality national data sets to enable research focused on quality improvement. BMJ Open 2022; 12:e057343. [PMID: 35589356 PMCID: PMC9121475 DOI: 10.1136/bmjopen-2021-057343] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To link five national data sets (three registries, two administrative) and create longitudinal healthcare trajectories for patients with congenital heart disease (CHD), describing the quality and the summary statistics of the linked data set. DESIGN Bespoke linkage of record-level patient identifiers across five national data sets. Generation of spells of care defined as periods of time-overlapping events across the data sets. SETTING National Congenital Heart Disease Audit (NCHDA) procedures in public (National Health Service; NHS) hospitals in England and Wales, paediatric and adult intensive care data sets (Paediatric Intensive Care Audit Network; PICANet and the Case Mix Programme from the Intensive Care National Audit & Research Centre; ICNARC-CMP), administrative hospital episodes (hospital episode statistics; HES inpatient, outpatient, accident and emergency; A&E) and mortality registry data. PARTICIPANTS Patients with any CHD procedure recorded in NCHDA between April 2000 and March 2017 from public hospitals. PRIMARY AND SECONDARY OUTCOME MEASURES Primary: number of linked records, number of unique patients and number of generated spells of care. Secondary: quality and completeness of linkage. RESULTS There were 143 862 records in NCHDA relating to 96 041 unique patients. We identified 65 797 linked PICANet patient admissions, 4664 linked ICNARC-CMP admissions and over 6 million linked HES episodes of care (1.1M inpatient, 4.7M outpatient). The linked data set had 4 908 153 spells of care after quality checks, with a median (IQR) of 3.4 (1.8-6.3) spells per patient-year. Where linkage was feasible (in terms of year and centre), 95.6% surgical procedure records were linked to a corresponding HES record, 93.9% paediatric (cardiac) surgery procedure records to a corresponding PICANet admission and 76.8% adult surgery procedure records to a corresponding ICNARC-CMP record. CONCLUSIONS We successfully linked four national data sets to the core data set of all CHD procedures performed between 2000 and 2017. This will enable a much richer analysis of longitudinal patient journeys and outcomes. We hope that our detailed description of the linkage process will be useful to others looking to link national data sets to address important research priorities.
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Affiliation(s)
- Ferran Espuny Pujol
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Katherine L Brown
- Cardiorespiratory Division, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - James C Doidge
- Intensive Care National Audit and Research Centre, London, UK
| | - Richard G Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - Rodney C Franklin
- Department of Paediatric Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
| | - Doug W Gould
- Intensive Care National Audit and Research Centre, London, UK
| | - Lee J Norman
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - John Stickley
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Julie A Taylor
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Sonya Crowe
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
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Abstract
As the world reflects on 2 years of the COVID-19 pandemic, we need to change how to tackle the enormous challenges of the future. The good news is that the past 2 years of the COVID-19 pandemic have shown that change is possible.
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Affiliation(s)
- Christina Pagel
- Christina Pagel is a professor of Operational Research and director of the Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
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20
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Affiliation(s)
- Simon Williams
- School of Psychology, Swansea University
- School of Psychology, University of Sussex
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McKee M, Altmann D, Costello A, Friston K, Haque Z, Khunti K, Michie S, Oni T, Pagel C, Pillay D, Reicher S, Salisbury H, Scally G, Yates K, Bauld L, Bear L, Drury J, Parker M, Phoenix A, Stokoe E, West R. Open science communication: the first year of the UK's Independent Scientific Advisory Group for Emergencies. Health Policy 2022; 126:234-244. [PMID: 35140018 PMCID: PMC8760632 DOI: 10.1016/j.healthpol.2022.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/30/2021] [Accepted: 01/13/2022] [Indexed: 12/19/2022]
Abstract
The COVID-19 pandemic has shone a light on the complex relationship between science and policy. Policymakers have had to make decisions at speed in conditions of uncertainty, implementing policies that have had profound consequences for people's lives. Yet this process has sometimes been characterised by fragmentation, opacity and a disconnect between evidence and policy. In the United Kingdom, concerns about the secrecy that initially surrounded this process led to the creation of Independent SAGE, an unofficial group of scientists from different disciplines that came together to ask policy-relevant questions, review the evolving evidence, and make evidence-based recommendations. The group took a public health approach with a population perspective, worked in a holistic transdisciplinary way, and were committed to public engagement. In this paper, we review the lessons learned during its first year. These include the importance of learning from local expertise, the value of learning from other countries, the role of civil society as a critical friend to government, finding appropriate relationships between science and policy, and recognising the necessity of viewing issues through an equity lens.
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Gurdasani D, Akrami A, Bradley VC, Costello A, Greenhalgh T, Flaxman S, McKee M, Michie S, Pagel C, Rasmussen S, Scally G, Yates C, Ziauddeen H. Long COVID in children. Lancet Child Adolesc Health 2022; 6:e2. [PMID: 34921807 PMCID: PMC8673872 DOI: 10.1016/s2352-4642(21)00342-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/23/2021] [Accepted: 10/22/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Deepti Gurdasani
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK.
| | - Athena Akrami
- Sainsbury Wellcome Centre, University College London, London, UK
| | | | - Anthony Costello
- Institute for Global Health, University College London, London, UK
| | - Trisha Greenhalgh
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seth Flaxman
- Department of Computer Science, University of Oxford, Oxford, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Sarah Rasmussen
- Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, UK
| | - Gabriel Scally
- Population Health Sciences, Bristol Medical Schoo l, University of Bristol, Bristol, UK
| | - Christian Yates
- Department of Mathematical Sciences, University of Bath, Bath, UK
| | - Hisham Ziauddeen
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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24
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Affiliation(s)
- Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - Deepti Gurdasani
- William Harvey Research Institute, Queen Mary University of London, London, UK
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25
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Gurdasani D, Bhatt S, Costello A, Denaxas S, Flaxman S, Greenhalgh T, Griffin S, Hyde Z, Katzourakis A, McKee M, Michie S, Ratmann O, Reicher S, Scally G, Tomlinson C, Yates C, Ziauddeen H, Pagel C. Vaccinating adolescents against SARS-CoV-2 in England: a risk-benefit analysis. J R Soc Med 2021; 114:513-524. [PMID: 34723680 PMCID: PMC8649477 DOI: 10.1177/01410768211052589] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/24/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To offer a quantitative risk-benefit analysis of two doses of SARS-CoV-2 vaccination among adolescents in England. SETTING England. DESIGN Following the risk-benefit analysis methodology carried out by the US Centers for Disease Control, we calculated historical rates of hospital admission, Intensive Care Unit admission and death for ascertained SARS-CoV-2 cases in children aged 12-17 in England. We then used these rates alongside a range of estimates for incidence of long COVID, vaccine efficacy and vaccine-induced myocarditis, to estimate hospital and Intensive Care Unit admissions, deaths and cases of long COVID over a period of 16 weeks under assumptions of high and low case incidence. PARTICIPANTS All 12-17 year olds with a record of confirmed SARS-CoV-2 infection in England between 1 July 2020 and 31 March 2021 using national linked electronic health records, accessed through the British Heart Foundation Data Science Centre. MAIN OUTCOME MEASURES Hospitalisations, Intensive Care Unit admissions, deaths and cases of long COVID averted by vaccinating all 12-17 year olds in England over a 16-week period under different estimates of future case incidence. RESULTS At high future case incidence of 1000/100,000 population/week over 16 weeks, vaccination could avert 4430 hospital admissions and 36 deaths over 16 weeks. At the low incidence of 50/100,000/week, vaccination could avert 70 hospital admissions and two deaths over 16 weeks. The benefit of vaccination in terms of hospitalisations in adolescents outweighs risks unless case rates are sustainably very low (below 30/100,000 teenagers/week). Benefit of vaccination exists at any case rate for the outcomes of death and long COVID, since neither have been associated with vaccination to date. CONCLUSIONS Given the current (as at 15 September 2021) high case rates (680/100,000 population/week in 10-19 year olds) in England, our findings support vaccination of adolescents against SARS-CoV2.
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Affiliation(s)
| | | | | | | | | | | | | | - Zoë Hyde
- University of Western Australia,
Crawley WA 6009, Australia
| | | | - Martin McKee
- London School of Hygiene and Tropical
Medicine, London WC1E 7HT, UK
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26
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Bar-Yam Y, Gurdasani D, Baker MG, Scally G, George S, Kvalsvig A, Fhaoláin SN, Chiou ST, Drury J, Duckett S, Ding EL, Gershenson C, Gibson C, Greenhalgh T, Hamdy A, Hyde Z, James T, Jimenez JL, McKee M, Michie S, Pagel C, Philippe C, Prather K, Raina SK, Ricciardi W, Rubin M, Ryan T, Schneider MF, Staines A, West R, Ziauddeen H. The World Health Network: a global citizens' initiative. Lancet 2021; 398:1567-1568. [PMID: 34755625 PMCID: PMC8553262 DOI: 10.1016/s0140-6736(21)02246-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Yaneer Bar-Yam
- New England Complex Systems Institute, Boston, MA 02139, USA.
| | - Deepti Gurdasani
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Michael G Baker
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Gabriel Scally
- Department of Public Health, University of Bristol, Bristol, UK
| | | | - Amanda Kvalsvig
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | | | - Shu-Ti Chiou
- Health and Sustainable Development Foundation, Yilan, Taiwan; College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - John Drury
- School of Psychology, University of Sussex, Brighton, UK
| | - Stephen Duckett
- Health and Aged Care program, Grattan Institute, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Eric L Ding
- New England Complex Systems Institute, Boston, MA 02139, USA; Federation of American Scientists, Washington, DC, USA
| | - Carlos Gershenson
- Instituto de Investigaciones en Matemáticas Aplicadas y Sistemas and Centro de Ciencias de la Complejidad, Universidad Nacional Autonóma de México, Mexico City, Mexico
| | - Christine Gibson
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Zoë Hyde
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, WA, Australia
| | | | - Jose L Jimenez
- Department of Chemistry and Cooperative Institute for Research in Environmental Sciences, University of Colorado, Boulder, CO, USA
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | | | - Kim Prather
- Department of Chemistry and Biochemistry, University of California, San Diego, CA, USA
| | - Sunil K Raina
- Community Medicine, Dr Rajendra Prasad Government Medical College, Himachal Pradesh, India
| | - Walter Ricciardi
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Tomás Ryan
- School of Biochemistry and Immunology and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | | | - Anthony Staines
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Robert West
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Hisham Ziauddeen
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Hadjicosta E, Franklin R, Seale A, Stumper O, Tsang V, Anderson DR, Pagel C, Crowe S, Espuny Pujol F, Ridout D, Brown KL. Cohort study of intervened functionally univentricular heart in England and Wales (2000-2018). Heart 2021; 108:1046-1054. [PMID: 34706904 PMCID: PMC9209673 DOI: 10.1136/heartjnl-2021-319677] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/17/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Given the paucity of long-term outcome data for complex congenital heart disease (CHD), we aimed to describe the treatment pathways and survival for patients who started interventions for functionally univentricular heart (FUH) conditions, excluding hypoplastic left heart syndrome. Methods We performed a retrospective cohort study using all procedure records from the National Congenital Heart Diseases Audit for children born in 2000–2018. The primary outcome was mortality, ascertained from the Office for National Statistics in 2020. Results Of 53 615 patients, 1557 had FUH: 55.9% were boys and 67.4% were of White ethnic groups. The largest diagnostic categories were tricuspid atresia (28.9%), double inlet left ventricle (21.0%) and unbalanced atrioventricular septal defect (AVSD) (15.2%). The ages at staged surgery were: initial palliation 11.5 (IQR 5.5–43.5) days, cavopulmonary shunt 9.2 (IQR 6.0–17.1) months and Fontan 56.2 (IQR 45.5–70.3) months. The median follow-up time was 10.8 (IQR 7.0–14.9) years and the 1, 5 and 10-year survival rates after initial palliation were 83.6% (95% CI 81.7% to 85.4%), 79.4% (95% CI 77.3% to 81.4%) and 77.2% (95% CI 75.0% to 79.2%), respectively. Higher hazards were present for unbalanced AVSD HR 2.75 (95% CI 1.82 to 4.17), atrial isomerism HR 1.75 (95% CI 1.14 to 2.70) and low weight HR 1.65 (95% CI 1.13 to 2.41), critical illness HR 2.30 (95% CI 1.67 to 3.18) or acquired comorbidities HR 2.71 (95% CI 1.82 to 4.04) at initial palliation. Conclusion Although treatment pathways for FUH are complex and variable, nearly 8 out of 10 children survived to 10 years. Longer-term analyses of outcome based on diagnosis (rather than procedure) can inform parents, patients and clinicians, driving practice improvements for complex CHD.
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Affiliation(s)
- Elena Hadjicosta
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Rodney Franklin
- Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
| | - Anna Seale
- Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
| | - Oliver Stumper
- Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
| | - Victor Tsang
- Heart and Lung Division, Great Ormond Street Hospital, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - David R Anderson
- Paediatric Cardiac Surgery, Evelina London Children's Healthcare, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Sonya Crowe
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Ferran Espuny Pujol
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Deborah Ridout
- University College London Institute of Child Health, London, UK
| | - Kate L Brown
- Institute of Cardiovascular Science, University College London, London, UK .,NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
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28
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Abstract
[Figure: see text].
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Wray J, Pagel C, Chester AH, Kennedy F, Crowe S. What was the impact of the first wave of COVID-19 on the delivery of care to children and adults with congenital heart disease? A qualitative study using online forums. BMJ Open 2021; 11:e049006. [PMID: 34593493 PMCID: PMC8487016 DOI: 10.1136/bmjopen-2021-049006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/23/2022] Open
Abstract
OBJECTIVES Globally, healthcare systems have been stretched to the limit by the COVID-19 pandemic. Significant changes have had to be made to the way in which non-COVID-19-related care has been delivered. Our objective was to understand, from the perspective of patients with a chronic, life-long condition (congenital heart disease, CHD) and their parents/carers, the impact of COVID-19 on the delivery of care, how changes were communicated and whether healthcare providers should do anything differently in a subsequent wave of COVID-19 infections. DESIGN AND SETTING Qualitative study involving a series of asynchronous discussion forums set up and moderated by three patient charities via their Facebook pages. PARTICIPANTS Patients with CHD and parents/carers of patients with CHD. MAIN OUTCOME MEASURES Qualitative responses to questions posted on the discussion forums. RESULTS The forums ran over a 6-week period and involved 109 participants. Following thematic analysis, we identified three themes and 10 subthemes related to individual condition-related factors, patient-related factors and health professional/centre factors that may have influenced how patients and parents/carers experienced changes to service delivery as a result of COVID-19. Specifically, respondents reported high levels of disruption to the delivery of care, inconsistent advice and messaging and variable communication from health professionals, with examples of both excellent and very poor experiences of care reported. Uncertainty about follow-up and factors related to the complexity and stability of their condition contributed to anxiety and stress. CONCLUSIONS The importance of clear, consistent communication cannot be over-estimated. Our findings, while collected in relation to patients with CHD, are not necessarily specific to this population and we believe that they reflect the experiences of many thousands of people with life-long conditions in the UK. Recommendations related to communication, service delivery and support during the pandemic may improve patients' experience of care and, potentially, their outcomes.
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Affiliation(s)
- Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Research Department of Children's Cardiovascular Diseases, Institute of Cardiovascular Science, University College London, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Adrian H Chester
- Heart Valve Research Group, The Magdi Yacoub Institute, Heart Science Centre, Harefield, UK
- Myocardial Function, National Heart and Lung Institute, Imperial College London, London, UK
| | - Fiona Kennedy
- Adult Congenital Heart Disease Department, Barts Health NHS Trust, London, UK
| | - Sonya Crowe
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
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Wilde H, Mellan T, Hawryluk I, Dennis JM, Denaxas S, Pagel C, Duncan A, Bhatt S, Flaxman S, Mateen BA, Vollmer SJ. The association between mechanical ventilator compatible bed occupancy and mortality risk in intensive care patients with COVID-19: a national retrospective cohort study. BMC Med 2021; 19:213. [PMID: 34461893 PMCID: PMC8404408 DOI: 10.1186/s12916-021-02096-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Received: 04/26/2021] [Accepted: 08/16/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The literature paints a complex picture of the association between mortality risk and ICU strain. In this study, we sought to determine if there is an association between mortality risk in intensive care units (ICU) and occupancy of beds compatible with mechanical ventilation, as a proxy for strain. METHODS A national retrospective observational cohort study of 89 English hospital trusts (i.e. groups of hospitals functioning as single operational units). Seven thousand one hundred thirty-three adults admitted to an ICU in England between 2 April and 1 December, 2020 (inclusive), with presumed or confirmed COVID-19, for whom data was submitted to the national surveillance programme and met study inclusion criteria. A Bayesian hierarchical approach was used to model the association between hospital trust level (mechanical ventilation compatible), bed occupancy, and in-hospital all-cause mortality. Results were adjusted for unit characteristics (pre-pandemic size), individual patient-level demographic characteristics (age, sex, ethnicity, deprivation index, time-to-ICU admission), and recorded chronic comorbidities (obesity, diabetes, respiratory disease, liver disease, heart disease, hypertension, immunosuppression, neurological disease, renal disease). RESULTS One hundred thirty-five thousand six hundred patient days were observed, with a mortality rate of 19.4 per 1000 patient days. Adjusting for patient-level factors, mortality was higher for admissions during periods of high occupancy (> 85% occupancy versus the baseline of 45 to 85%) [OR 1.23 (95% posterior credible interval (PCI): 1.08 to 1.39)]. In contrast, mortality was decreased for admissions during periods of low occupancy (< 45% relative to the baseline) [OR 0.83 (95% PCI 0.75 to 0.94)]. CONCLUSION Increasing occupancy of beds compatible with mechanical ventilation, a proxy for operational strain, is associated with a higher mortality risk for individuals admitted to ICU. Further research is required to establish if this is a causal relationship or whether it reflects strain on other operational factors such as staff. If causal, the result highlights the importance of strategies to keep ICU occupancy low to mitigate the impact of this type of resource saturation.
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Affiliation(s)
- Harrison Wilde
- Department of Statistics, University of Warwick, Coventry, CV4 7AL, UK
| | - Thomas Mellan
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, UK
| | - Iwona Hawryluk
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, UK
| | - John M Dennis
- Institute of Biomedical & Clinical Science, RILD Building, Royal Devon & Exeter Hospital, University of Exeter Medical School, Barrack Road, Exeter, EX2 5DW, UK
| | - Spiros Denaxas
- The Alan Turing Institute, British Library, 96 Euston Road, London, NW1 2DB, UK
- Institute of Health Informatics, University College London, 222 Euston Rd, London, London, NW1 2DA, UK
- Health Data Research UK, Gibbs Building, 215 Euston Road, London, NW1 2BE, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, 222 Euston Rd, London, London, NW1 2DA, UK
| | - Andrew Duncan
- The Alan Turing Institute, British Library, 96 Euston Road, London, NW1 2DB, UK
- Department of Mathematics, Imperial College, London, London, UK
| | - Samir Bhatt
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, UK
| | - Seth Flaxman
- Department of Mathematics, Imperial College, London, London, UK
| | - Bilal A Mateen
- The Alan Turing Institute, British Library, 96 Euston Road, London, NW1 2DB, UK.
- Institute of Health Informatics, University College London, 222 Euston Rd, London, London, NW1 2DA, UK.
- The Wellcome Trust, Gibbs Building, 215 Euston Road, London, NW1 2BE, UK.
| | - Sebastian J Vollmer
- Department of Statistics, University of Warwick, Coventry, CV4 7AL, UK
- The Alan Turing Institute, British Library, 96 Euston Road, London, NW1 2DB, UK
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Taylor JA, Crowe S, Espuny Pujol F, Franklin RC, Feltbower RG, Norman LJ, Doidge J, Gould DW, Pagel C. The road to hell is paved with good intentions: the experience of applying for national data for linkage and suggestions for improvement. BMJ Open 2021; 11:e047575. [PMID: 34413101 PMCID: PMC8378388 DOI: 10.1136/bmjopen-2020-047575] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 11/04/2022] Open
Abstract
BACKGROUND We can improve healthcare services by better understanding current provision. One way to understand this is by linking data sets from clinical and national audits, national registries and other National Health Service (NHS) encounter data. However, getting to the point of having linked national data sets is challenging. OBJECTIVE We describe our experience of the data application and linkage process for our study 'LAUNCHES QI', and the time, processes and resource requirements involved. To help others planning similar projects, we highlight challenges encountered and advice for applications in the current system as well as suggestions for system improvements. FINDINGS The study set up for LAUNCHES QI began in March 2018, and the process through to data acquisition took 2.5 years. Several challenges were encountered, including the amount of information required (often duplicate information in different formats across applications), lack of clarity on processes, resource constraints that limit an audit's capacity to fulfil requests and the unexpected amount of time required from the study team. It is incredibly difficult to estimate the resources needed ahead of time, and yet necessary to do so as early on as funding applications. Early decisions can have a significant impact during latter stages and be hard to change, yet it is difficult to get specific information at the beginning of the process. CONCLUSIONS The current system is incredibly complex, arduous and slow, stifling innovation and delaying scientific progress. NHS data can inform and improve health services and we believe there is an ethical responsibility to use it to do so. Streamlining the number of applications required for accessing data for health services research and providing clarity to data controllers could facilitate the maintenance of stringent governance, while accelerating scientific studies and progress, leading to swifter application of findings and improvements in healthcare.
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Affiliation(s)
- Julie A Taylor
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Sonya Crowe
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Ferran Espuny Pujol
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Rodney C Franklin
- Paediatric Cardiology Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Lee J Norman
- Paediatric Intensive Care Audit Network, University of Leeds, Leeds, UK
| | - James Doidge
- Intensive Care National Audit and Research Centre, London, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Christina Pagel
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
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Gurdasani D, Drury J, Greenhalgh T, Griffin S, Haque Z, Hyde Z, Katzourakis A, McKee M, Michie S, Pagel C, Reicher S, Roberts A, West R, Yates C, Ziauddeen H. Mass infection is not an option: we must do more to protect our young. Lancet 2021; 398:297-298. [PMID: 34245669 PMCID: PMC8262842 DOI: 10.1016/s0140-6736(21)01589-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Deepti Gurdasani
- William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK.
| | | | | | | | | | - Zoë Hyde
- University of Western Australia, Crawley, WA, Australia
| | | | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
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Evans REC, Barber V, Seaton S, Draper ES, Rajah F, Pagel C, Polke E, Ramnarayan P, Wray J. Development of a parent experience measure for paediatric critical care transport teams. Nurs Crit Care 2021; 27:367-374. [PMID: 34028143 DOI: 10.1111/nicc.12648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/16/2021] [Accepted: 04/20/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND A third of children admitted to paediatric intensive care units (PICUs) in the United Kingdom (UK) are transported by paediatric critical care transport services (PCCTs). Parents have described the transfer journey as particularly stressful. Critical care nurses have a key role in mitigating the impact of the journey on parents. Evaluating parents' experiences is important to inform service improvements. AIM AND OBJECTIVES Our aim was to describe the development of a new measure of parents' experiences of PCCTs, derived from data collected in the Differences in access to Emergency Paediatric Intensive Care and care during Transport (DEPICT) study. DESIGN A descriptive cross-sectional survey was used. METHODS As part of the DEPICT study, a 17-item transport experience questionnaire was developed and given to parents of children transported by PCCTs to 24 UK PICUs during a 12-month period. Analyses included exploratory factor analysis and a validation review by a PCCT stakeholder group. RESULTS Families of 1722 children (1798 journeys) completed questionnaires. Five items were excluded from further analysis as correlation coefficients were <0.3. Two factors explained 53% of the variance and all 12 items loaded on one of these factors. Factor 1 (8 items) explained 47% of the variance, had excellent internal reliability and the clustered items were conceptually coherent with a specific relevance to PCCTs; these were offered for consideration, with other items possibly discarded. Twenty-eight PCCT clinicians reviewed the questions. Using a 70% agreement threshold, one additional, previously discarded, item was identified for inclusion, resulting in a nine-item experience measure. CONCLUSION Our brief measure of parents' experience of critical care transport provides a standardized measure that can be used across all PCCTs, enabling national benchmarking of services and potentially increasing the collection and use of parent experience data to improve services. RELEVANCE TO CLINICAL PRACTICE Being able to measure experience provides an opportunity to understand how to make services better to improve experience.
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Affiliation(s)
- Ruth E C Evans
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Victoria Barber
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sarah Seaton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Fatemah Rajah
- Yorkshire and Humber Infant and Children's Transport Service (Embrace), Barnsley, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College, London, UK
| | - Eithne Polke
- Children's Acute Transport Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Padmanabhan Ramnarayan
- Children's Acute Transport Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Respiratory, Critical Care and Anaesthesia Section, Infection, Immunity and Inflammation Research and Teaching Department, UCL GOS Institute of Child Health, London, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Institute of Cardiovascular Science, University College, London, UK
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Seaton SE, Draper ES, Pagel C, Rajah F, Wray J, Ramnarayan P. The effect of care provided by paediatric critical care transport teams on mortality of children transported to paediatric intensive care units in England and Wales: a retrospective cohort study. BMC Pediatr 2021; 21:217. [PMID: 33941116 PMCID: PMC8089132 DOI: 10.1186/s12887-021-02689-x] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background Centralisation of paediatric intensive care units (PICUs) has the increased the need for specialist paediatric critical care transport teams (PCCT) to transport critically ill children to PICU. We investigated the impact of care provided by PCCTs for children on mortality and other clinically important outcomes. Methods We analysed linked national data from the Paediatric Intensive Care Audit Network (PICANet) from children admitted to PICUs in England and Wales (2014–2016) to assess the impact of who led the child’s transport, whether prolonged stabilisation by the PCCT was detrimental and the impact of critical incidents during transport on patient outcome. We used logistic regression models to estimate the adjusted odds and probability of mortality within 30 days of admission to PICU (primary outcome) and negative binomial models to investigate length of stay (LOS) and length of invasive ventilation (LOV). Results The study included 9112 children transported to PICU. The most common diagnosis was respiratory problems; junior doctors led the PCCT in just over half of all transports; and the 30-day mortality was 7.1%. Transports led by Advanced Nurse Practitioners and Junior Doctors had similar outcomes (adjusted mortality ANP: 0.035 versus Junior Doctor: 0.038). Prolonged stabilisation by the PCCT was possibly associated with increased mortality (0.059, 95% CI: 0.040 to 0.079 versus short stabilisation 0.044, 95% CI: 0.039 to 0.048). Critical incidents involving the child increased the adjusted odds of mortality within 30 days (odds ratio: 3.07). Conclusions Variations in team composition between PCCTs appear to have little effect on patient outcomes. We believe differences in stabilisation approaches are due to residual confounding. Our finding that critical incidents were associated with worse outcomes indicates that safety during critical care transport is an important area for future quality improvement work. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02689-x.
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Affiliation(s)
- Sarah E Seaton
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK.
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - Fatemah Rajah
- Yorkshire and Humber Infant and Children's Transport Service (Embrace), Barnsley, UK
| | - Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Padmanabhan Ramnarayan
- Children's Acute Transport Service (CATS), Great Ormond Street Hospital NHS Foundation Trust, London, UK.,Respiratory, Critical Care and Anaesthesia Section, Infection, Immunity and Inflammation Research & Teaching Department, UCL GOS Institute of Child Health, London, UK
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Affiliation(s)
- Christina Pagel
- Clinical Operational Research Unit, University College London, UK
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Kung E, Seaton SE, Ramnarayan P, Pagel C. Using a genetic algorithm to solve a non-linear location allocation problem for specialised children’s ambulances in England and Wales. Health Syst (Basingstoke) 2021; 11:161-171. [PMID: 36147554 PMCID: PMC9487932 DOI: 10.1080/20476965.2021.1908176] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Since 1997, special paediatric intensive care retrieval teams (PICRTs) based in 11 locations across England and Wales have been used to transport sick children from district general hospitals to one of 24 paediatric intensive care units. We develop a location allocation optimisation framework to help inform decisions on the optimal number of locations for each PICRT, where those locations should be, which local hospital each location serves and how many teams should station each location. Our framework allows for stochastic journey times, differential weights for each journey leg and incorporates queuing theory by considering the time spent waiting for a PICRT to become available. We examine the average waiting time and the average time to bedside under different number of operational PICRT stations, different number of teams per station and different levels of demand. We show that consolidating the teams into fewer stations for higher availability leads to better performance.
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Affiliation(s)
- Enoch Kung
- Department of Mathematics, UCL Clinical Operational Research Unit, University College London, London, UK
| | - Sarah E. Seaton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Christina Pagel
- Department of Mathematics, UCL Clinical Operational Research Unit, University College London, London, UK
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Affiliation(s)
| | - Christian Yates
- Department of Mathematical Sciences, University of Bath, Bath, UK
| | | | - Deepti Gurdasani
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, UK
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Affiliation(s)
- Christina Pagel
- Clinical Operational Research Unit, University College London, UK
| | - Edward Palmer
- London, UK
- Bloomsbury Institute of Intensive Care Medicine, University College London, UK
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Hoskote A, Ridout D, Banks V, Kakat S, Lakhanpaul M, Pagel C, Franklin RC, Witter T, Lakhani R, Tibby SM, Anderson D, Tsang V, Wray J, Brown K. Neurodevelopmental status and follow-up in preschool children with heart disease in London, UK. Arch Dis Child 2021; 106:263-271. [PMID: 32907808 DOI: 10.1136/archdischild-2019-317824] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 06/15/2020] [Accepted: 08/05/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe neurodevelopment and follow-up services in preschool children with heart disease (HD). DESIGN Secondary analysis of a prospectively collected multicentre dataset. SETTING Three London tertiary cardiac centres. PATIENTS Preschool children<5 years of age: both inpatients and outpatients. METHODS We analysed results of Mullen Scales of Early Learning (MSEL) and parental report of follow-up services in a representative convenience sample evaluated between January 2014 and July 2015 within a previous study. RESULTS Of 971 preschool children: 577 (59.4%) had ≥1 heart operation, 236 (24.3%) had a known diagnosis linked to developmental delay (DD) ('known group') and 130 (13.4%) had history of clinical event linked to DD. On MSEL assessment, 643 (66.2%) had normal development, 181 (18.6%) had borderline scores and 147 (15.1%) had scores indicative of DD. Of 971 children, 609 (62.7%) were not receiving follow-up linked to child development and were more likely to be under these services with a known group diagnosis, history of clinical event linked to DD and DD (defined by MSEL). Of 236 in known group, parents of 77 (32.6%) and of 48 children not in a known group but with DD 29 (60.4%), reported no child development related follow-up. DD defined by MSEL assessment was more likely with a known group and older age at assessment. CONCLUSIONS Our findings indicate that a 'structured neurodevelopmental follow-up pathway' in preschool children with HD should be considered for development and evaluation as children get older, with particular focus on those at higher risk.
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Affiliation(s)
- Aparna Hoskote
- Heart and Lung Directorate, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK .,NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Deborah Ridout
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,Population Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Victoria Banks
- Information Office, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Suzan Kakat
- Heart and Lung Directorate, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Monica Lakhanpaul
- Population Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK.,Whittington Health NHS Trust, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College of London, London, UK
| | - Rodney Cg Franklin
- Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
| | - Thomas Witter
- Paediatric Cardiology and Cardiac Surgery, Evelina London Children's Hospital, London, UK
| | - Rhian Lakhani
- Paediatric Cardiology and Cardiac Surgery, Evelina London Children's Hospital, London, UK
| | - Shane M Tibby
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - David Anderson
- Cardiothoracic Surgery, Evelina London Children's Hospital, London, UK
| | - Victor Tsang
- Heart and Lung Directorate, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Katherine Brown
- Heart and Lung Directorate, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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Gurdasani D, Bear L, Bogaert D, Burgess RA, Busse R, Cacciola R, Charpak Y, Colbourn T, Drury J, Friston K, Gallo V, Goldman LR, Greenhalgh T, Hyde Z, Kuppalli K, Majumder MS, Martin-Moreno JM, McKee M, Michie S, Mossialos E, Nouri A, Pagel C, Pimenta D, Popescu S, Priesemann V, Rasmussen AL, Reicher S, Ricciardi W, Rice K, Silver J, Smith TC, Wenham C, West R, Yamey G, Yates C, Ziauddeen H. The UK needs a sustainable strategy for COVID-19. Lancet 2020; 396:1800-1801. [PMID: 33181080 PMCID: PMC7834725 DOI: 10.1016/s0140-6736(20)32350-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Laura Bear
- London School of Economics and Political Science, London, UK
| | | | | | | | - Roberto Cacciola
- Department of Surgical Sciences, Università Di Tor Vergata, Rome, Italy
| | - Yves Charpak
- Fondation Charpak, L'esprit des Sciences, Paris, France
| | | | | | | | - Valentina Gallo
- University of Groningen, Campus Fryslân, Leeuwarden, Netherlands
| | - Lynn R Goldman
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | | | - Zoë Hyde
- University of Western Australia, Perth, WA, Australia
| | | | | | | | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Elias Mossialos
- London School of Economics and Political Science, London, UK
| | - Ali Nouri
- Federation of American Scientists, Washington, DC, USA
| | | | | | | | - Viola Priesemann
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
| | | | | | | | - Ken Rice
- University of Edinburgh, Edinburgh, UK
| | | | | | - Clare Wenham
- London School of Economics and Political Science, London, UK
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Dorobantu DM, Ridout D, Brown KL, Rodrigues W, Sharabiani MTA, Pagel C, Anderson D, Wellman P, McLean A, Cassidy J, Barron DJ, Tsang VT, Stoica SC. Factors associated with unplanned reinterventions and their relation to early mortality after pediatric cardiac surgery. J Thorac Cardiovasc Surg 2020; 161:1155-1166.e9. [PMID: 33419533 DOI: 10.1016/j.jtcvs.2020.10.145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/25/2020] [Accepted: 10/25/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Unplanned reintervention (uRE) is used as an indicator of patient morbidity and quality of care in pediatric cardiac surgery. We investigated associated factors and early mortality after uREs. METHODS Morbidity data were prospectively collected in 5 UK centers between 2015 and 2017; uRE included surgical cardiac, interventional transcatheter cardiac, permanent pacemaker, and diaphragm plication procedures. Mortality (30-day and 6-month) in uRE/no-uRE patients was reported before and after matching. Predicted 30-day mortality was calculated using the Partial Risk Adjustment in Surgery score. RESULTS A total of 3090 procedures (2861 patients) were included (median age, 228 days). There were 146 uREs, resulting in an uRE rate of 4.7%. Partial Risk Adjustment in Surgery score, 30-day mortality and 6-month mortality in uRE and no-uRE groups were 2.4% versus 1.3%, 8.9% versus 1%, and 17.1% versus 2.4%, respectively. After matching, mortality at 6 months remained higher in uRE compared with no-uRE (12.2% vs 1.4%; P = .02; 74 pairs). In the uRE group, 21 out of 25 deaths at 6 months occurred when at least 1 additional postoperative complication was present. In multivariable analysis, neonatal age (P = .002), low weight (P = .009), univentricular heart (P < .001), and arterial shunt (P < .001) were associated with increased risk of uRE, but Partial Risk Adjustment in Surgery score was not (only in univariable analysis). CONCLUSIONS uREs are a relatively frequent complication after pediatric cardiac surgery and are associated with some patient characteristics, but not the Partial Risk Adjustment in Surgery risk score. Early mortality was higher after uRE, independent of preoperative factors, but linked to other postoperative complications.
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Affiliation(s)
- Dan M Dorobantu
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom; Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom
| | - Deborah Ridout
- Population, Policy, and Practice Programme, University College London, Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Katherine L Brown
- Cardiac and Critical Care Division, Great Ormond Street Hospital, London, United Kingdom
| | - Warren Rodrigues
- Cardiac and Critical Care Division, Great Ormond Street Hospital, London, United Kingdom
| | - Mansour T A Sharabiani
- Department of Primary Care & Public Health, School of Public Health, Imperial College of London, London, United Kingdom
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, United Kingdom
| | - David Anderson
- Departments of Paediatric Cardiology, Intensive Care, and Cardiac Surgery, Evelina London Children's Hospital, London, United Kingdom
| | - Paul Wellman
- Departments of Paediatric Cardiology, Intensive Care, and Cardiac Surgery, Evelina London Children's Hospital, London, United Kingdom
| | - Andrew McLean
- Department of Paediatric Cardiac Surgery, Royal Hospital for Children Glasgow, Glasgow, United Kingdom
| | - Jane Cassidy
- Department of Intensive Care and Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - David J Barron
- Division of Cardiovascular Surgery, Toronto Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Victor T Tsang
- Cardiac and Critical Care Division, Great Ormond Street Hospital, London, United Kingdom
| | - Serban C Stoica
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom; Department of Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, United Kingdom.
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Hudson E, Brown K, Pagel C, Wray J, Barron D, Rodrigues W, Stoica S, Tibby SM, Tsang V, Ridout D, Morris S. Costs of postoperative morbidity following paediatric cardiac surgery: observational study. Arch Dis Child 2020; 105:1068-1074. [PMID: 32381518 PMCID: PMC7588404 DOI: 10.1136/archdischild-2019-318499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/27/2020] [Accepted: 04/11/2020] [Indexed: 12/04/2022]
Abstract
OBJECTIVE Early mortality rates for paediatric cardiac surgery have fallen due to advancements in care. Alternative indicators of care quality are needed. Postoperative morbidities are of particular interest. However, while health impacts have been reported, associated costs are unknown. Our objective was to calculate the costs of postoperative morbidities following paediatric cardiac surgery. DESIGN Two methods of data collection were integrated into the main study: (1) case-matched cohort study of children with and without predetermined morbidities; (2) incidence rates of morbidity, measured prospectively. SETTING Five specialist paediatric cardiac surgery centres, accounting for half of UK patients. PATIENTS Cohort study included 666 children (340 with morbidities). Incidence rates were measured in 3090 consecutive procedures. METHODS Risk-adjusted regression modelling to determine marginal effects of morbidities on per-patient costs. Calculation of costs for hospital providers according to incidence rates. Extrapolation using mandatory audit data to report annual financial burden for the health service. OUTCOME MEASURES Impact of postoperative morbidities on per-patient costs, hospital costs and UK health service costs. RESULTS Seven of the 10 morbidity categories resulted in significant costs, with mean (95% CI) additional costs ranging from £7483 (£3-£17 289) to £66 784 (£40 609-£103 539) per patient. On average all morbidities combined increased hospital costs by 22.3%. Total burden to the UK health service exceeded £21 million each year. CONCLUSION Postoperative morbidities are associated with a significant financial burden. Our findings could aid clinical teams and hospital providers to account for costs and contextualise quality improvement initiatives.
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Affiliation(s)
- Emma Hudson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Katherine Brown
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College of London, London, UK,Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Jo Wray
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - David Barron
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Warren Rodrigues
- Paediatric Intensive care Unit, NHS Greater Glasgow and Clyde Inverclyde Royal Hospital, Glasgow, UK
| | - Serban Stoica
- Department of Cardiac Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Shane M Tibby
- Department of Paediatric Intensive Care, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Victor Tsang
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Deborah Ridout
- Paediatric Epidemiology Biostatistics, Institute of Child Health, London, UK
| | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Brown KL, Pagel C, Ridout D, Wray J, Tsang VT, Anderson D, Banks V, Barron DJ, Cassidy J, Chigaru L, Davis P, Franklin R, Grieco L, Hoskote A, Hudson E, Jones A, Kakat S, Lakhani R, Lakhanpaul M, McLean A, Morris S, Rajagopal V, Rodrigues W, Sheehan K, Stoica S, Tibby S, Utley M, Witter T. Early morbidities following paediatric cardiac surgery: a mixed-methods study. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08300] [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: 01/18/2023] Open
Abstract
Background
Over 5000 paediatric cardiac surgeries are performed in the UK each year and early survival has improved to > 98%.
Objectives
We aimed to identify the surgical morbidities that present the greatest burden for patients and health services and to develop and pilot routine monitoring and feedback.
Design and setting
Our multidisciplinary mixed-methods study took place over 52 months across five UK paediatric cardiac surgery centres.
Participants
The participants were children aged < 17 years.
Methods
We reviewed existing literature, ran three focus groups and undertook a family online discussion forum moderated by the Children’s Heart Federation. A multidisciplinary group, with patient and carer involvement, then ranked and selected nine key morbidities informed by clinical views on definitions and feasibility of routine monitoring. We validated a new, nurse-administered early warning tool for assessing preoperative and postoperative child development, called the brief developmental assessment, by testing this among 1200 children. We measured morbidity incidence in 3090 consecutive surgical admissions over 21 months and explored risk factors for morbidity. We measured the impact of morbidities on quality of life, clinical burden and costs to the NHS and families over 6 months in 666 children, 340 (51%) of whom had at least one morbidity. We developed and piloted methods suitable for routine monitoring of morbidity by centres and co-developed new patient information about morbidities with parents and user groups.
Results
Families and clinicians prioritised overlapping but also different morbidities, leading to a final list of acute neurological event, unplanned reoperation, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, surgical infection and prolonged pleural effusion. The brief developmental assessment was valid in children aged between 4 months and 5 years, but not in the youngest babies or 5- to 17-year-olds. A total of 2415 (78.2%) procedures had no measured morbidity. There was a higher risk of morbidity in neonates, complex congenital heart disease, increased preoperative severity of illness and with prolonged bypass. Patients with any morbidity had a 6-month survival of 81.5% compared with 99.1% with no morbidity. Patients with any morbidity scored 5.2 points lower on their total quality of life score at 6 weeks, but this difference had narrowed by 6 months. Morbidity led to fewer days at home by 6 months and higher costs. Extracorporeal life support patients had the lowest days at home (median: 43 days out of 183 days) and highest costs (£71,051 higher than no morbidity).
Limitations
Monitoring of morbidity is more complex than mortality, and hence this requires resources and clinician buy-in.
Conclusions
Evaluation of postoperative morbidity provides important information over and above 30-day survival and should become the focus of audit and quality improvement.
Future work
National audit of morbidities has been initiated. Further research is needed to understand the implications of feeding problems and renal failure and to evaluate the brief developmental assessment.
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. 30. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Katherine L Brown
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - Deborah Ridout
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jo Wray
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Victor T Tsang
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - David Anderson
- Departments of Paediatric Intensive Care, Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, UK
| | - Victoria Banks
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - David J Barron
- Departments of Intensive Care and Paediatric Cardiac Surgery, Birmingham Children’s Hospital, Birmingham, UK
| | - Jane Cassidy
- Departments of Intensive Care and Paediatric Cardiac Surgery, Birmingham Children’s Hospital, Birmingham, UK
| | - Linda Chigaru
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Peter Davis
- Departments of Intensive Care and Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Rodney Franklin
- Paediatric Cardiology Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Luca Grieco
- Clinical Operational Research Unit, University College London, London, UK
| | - Aparna Hoskote
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Emma Hudson
- Department of Applied Health Research, University College London, London, UK
| | - Alison Jones
- Departments of Intensive Care and Paediatric Cardiac Surgery, Birmingham Children’s Hospital, Birmingham, UK
| | - Suzan Kakat
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Rhian Lakhani
- Departments of Paediatric Intensive Care, Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, UK
| | - Monica Lakhanpaul
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Community Child Health, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Andrew McLean
- Department of Intensive care, Royal Hospital for Children, Glasgow, UK
| | - Steve Morris
- Department of Applied Health Research, University College London, London, UK
| | - Veena Rajagopal
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Warren Rodrigues
- Department of Intensive care, Royal Hospital for Children, Glasgow, UK
| | - Karen Sheehan
- Departments of Intensive Care and Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Serban Stoica
- Departments of Intensive Care and Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Shane Tibby
- Departments of Paediatric Intensive Care, Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, UK
| | - Martin Utley
- Clinical Operational Research Unit, University College London, London, UK
| | - Thomas Witter
- Departments of Paediatric Intensive Care, Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, UK
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Abstract
INTRODUCTION Medication errors (MEs), which occur commonly in the perioperative period, have the potential to cause patient harm or death. Many published recommendations exist for preventing perioperative MEs; however, many of these recommendations conflict and are often not applicable to middle-income and low-income countries. The goal of this study is to develop and disseminate consensus-based recommendations for perioperative medication safety that are tailored to country income level. METHODS AND ANALYSIS The primary site of this mixed-methods study is Massachusetts General Hospital/Harvard Medical School. Participants include a minimum of 108 international medication safety experts, 27 from each of the World Bank's four country income groups (high, upper-middle, lower-middle and low-income). Using the Delphi method, participants will rate the appropriateness of candidate medication safety recommendations by completing online surveys using RedCAP. We will use Condorcet ranking methods to prioritise the final recommendations for each country income group. We will execute a comprehensive dissemination strategy for the recommendations across each country income group. Finally, we will conduct semistructured interviews with our participants to evaluate the initial adoption and implementation of the recommendations in each country income group. ETHICS AND DISSEMINATION This study was approved by the Human Research Committee/Institutional Review Board at Partners Healthcare (2019P003567). Findings will be published in peer-reviewed journals and presented at local and international conferences. TRIAL REGISTRATION NUMBER NCT04240301.
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Affiliation(s)
- Karen C Nanji
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Anaestheisa, Harvard Medical School, Boston, Massachusetts, USA
| | - Alan Forbes Merry
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Sofia D Shaikh
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - Hao Deng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joyce A Wahr
- Anesthesiology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Adrian W Gelb
- Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
| | - Beverley A Orser
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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46
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Seaton SE, Ramnarayan P, Pagel C, Davies P, Draper ES. Impact on 30-day survival of time taken by a critical care transport team to reach the bedside of critically ill children. Intensive Care Med 2020; 46:1953-1955. [PMID: 32572530 DOI: 10.1007/s00134-020-06149-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah E Seaton
- Department of Health Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Padmanabhan Ramnarayan
- Children's Acute Transport Service (CATS), Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - Patrick Davies
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Elizabeth S Draper
- Department of Health Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK.
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47
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Seaton SE, Ramnarayan P, Davies P, Hudson E, Morris S, Pagel C, Rajah F, Wray J, Draper ES. Does time taken by paediatric critical care transport teams to reach the bedside of critically ill children affect survival? A retrospective cohort study from England and Wales. BMC Pediatr 2020; 20:301. [PMID: 32560633 PMCID: PMC7304220 DOI: 10.1186/s12887-020-02195-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/05/2020] [Indexed: 11/19/2022] Open
Abstract
Background Reaching the bedside of a critically ill child within three hours of agreeing the child requires intensive care is a key target for Paediatric Critical Care Transport teams (PCCTs) to achieve in the United Kingdom. Whilst timely access to specialist care is necessary for these children, it is unknown to what extent time taken for the PCCT to arrive at the bedside affects clinical outcome. Methods Data from transports of critically ill children who were admitted to Paediatric Intensive Care Units (PICUs) in England and Wales from 1 January 2014 to 31 December 2016 were extracted from the Paediatric Intensive Care Audit Network (PICANet) and linked with adult critical care data and Office for National Statistics mortality data. Logistic regression models, adjusted for pre-specified confounders, were fitted to investigate the impact of time-to-bedside on mortality within 30 days of admission and other key time points. Negative binomial models were used to investigate the impact of time-to-bedside on PICU length of stay and duration of invasive ventilation. Results There were 9116 children transported during the study period, and 645 (7.1%) died within 30 days of PICU admission. There was no evidence that 30-day mortality changed as time-to-bedside increased. A similar relationship was seen for mortality at other pre-selected time points. In children who waited longer for a team to arrive, there was limited evidence of a small increase in PICU length of stay (expected number of days increased from: 7.17 to 7.58). Conclusion There is no evidence that reducing the time-to-bedside target for PCCTs will improve the survival of critically ill children. A shorter time to bedside may be associated with a small reduction in PICU length of stay.
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Affiliation(s)
- Sarah E Seaton
- Department of Health Sciences, University of Leicester, University Road, Leicester, UK
| | - Padmanabhan Ramnarayan
- Children's Acute Transport Service (CATS), Great Ormond Street Hospital NHS Foundation Trust, London, UK.,Respiratory, Critical Care and Anaesthesia Section, Infection, Immunity and Inflammation Research & Teaching Department, UCL GOS Institute of Child Health, London, UK
| | - Patrick Davies
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Emma Hudson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - Fatemah Rajah
- Yorkshire and Humber Infant and Children's Transport Service (Embrace), Barnsley, UK
| | - Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, University Road, Leicester, UK.
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48
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Banerjee A, Pasea L, Harris S, Gonzalez-Izquierdo A, Torralbo A, Shallcross L, Noursadeghi M, Pillay D, Sebire N, Holmes C, Pagel C, Wong WK, Langenberg C, Williams B, Denaxas S, Hemingway H. Estimating excess 1-year mortality associated with the COVID-19 pandemic according to underlying conditions and age: a population-based cohort study. Lancet 2020; 395:1715-1725. [PMID: 32405103 PMCID: PMC7217641 DOI: 10.1016/s0140-6736(20)30854-0] [Citation(s) in RCA: 306] [Impact Index Per Article: 76.5] [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: 03/23/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The medical, societal, and economic impact of the coronavirus disease 2019 (COVID-19) pandemic has unknown effects on overall population mortality. Previous models of population mortality are based on death over days among infected people, nearly all of whom thus far have underlying conditions. Models have not incorporated information on high-risk conditions or their longer-term baseline (pre-COVID-19) mortality. We estimated the excess number of deaths over 1 year under different COVID-19 incidence scenarios based on varying levels of transmission suppression and differing mortality impacts based on different relative risks for the disease. METHODS In this population-based cohort study, we used linked primary and secondary care electronic health records from England (Health Data Research UK-CALIBER). We report prevalence of underlying conditions defined by Public Health England guidelines (from March 16, 2020) in individuals aged 30 years or older registered with a practice between 1997 and 2017, using validated, openly available phenotypes for each condition. We estimated 1-year mortality in each condition, developing simple models (and a tool for calculation) of excess COVID-19-related deaths, assuming relative impact (as relative risks [RRs]) of the COVID-19 pandemic (compared with background mortality) of 1·5, 2·0, and 3·0 at differing infection rate scenarios, including full suppression (0·001%), partial suppression (1%), mitigation (10%), and do nothing (80%). We also developed an online, public, prototype risk calculator for excess death estimation. FINDINGS We included 3 862 012 individuals (1 957 935 [50·7%] women and 1 904 077 [49·3%] men). We estimated that more than 20% of the study population are in the high-risk category, of whom 13·7% were older than 70 years and 6·3% were aged 70 years or younger with at least one underlying condition. 1-year mortality in the high-risk population was estimated to be 4·46% (95% CI 4·41-4·51). Age and underlying conditions combined to influence background risk, varying markedly across conditions. In a full suppression scenario in the UK population, we estimated that there would be two excess deaths (vs baseline deaths) with an RR of 1·5, four with an RR of 2·0, and seven with an RR of 3·0. In a mitigation scenario, we estimated 18 374 excess deaths with an RR of 1·5, 36 749 with an RR of 2·0, and 73 498 with an RR of 3·0. In a do nothing scenario, we estimated 146 996 excess deaths with an RR of 1·5, 293 991 with an RR of 2·0, and 587 982 with an RR of 3·0. INTERPRETATION We provide policy makers, researchers, and the public a simple model and an online tool for understanding excess mortality over 1 year from the COVID-19 pandemic, based on age, sex, and underlying condition-specific estimates. These results signal the need for sustained stringent suppression measures as well as sustained efforts to target those at highest risk because of underlying conditions with a range of preventive interventions. Countries should assess the overall (direct and indirect) effects of the pandemic on excess mortality. FUNDING National Institute for Health Research University College London Hospitals Biomedical Research Centre, Health Data Research UK.
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Affiliation(s)
- Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK; University College London Hospitals NHS Trust, London, UK; Barts Health NHS Trust, The Royal London Hospital, London, UK.
| | - Laura Pasea
- Institute of Health Informatics, University College London, London, UK
| | - Steve Harris
- University College London Hospitals NHS Trust, London, UK
| | | | - Ana Torralbo
- Institute of Health Informatics, University College London, London, UK
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Deenan Pillay
- Division of Infection and Immunity, University College London, London, UK
| | | | - Chris Holmes
- University of Oxford, Oxford, UK; Alan Turing Institute, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - Wai Keong Wong
- University College London Hospitals NHS Trust, London, UK
| | | | - Bryan Williams
- Institute of Cardiovascular Science, University College London, London, UK; University College London Hospitals NHS Trust, London, UK; University College London Hospitals National Institute for Health Research Biomedical Research Centre, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK; Alan Turing Institute, London, UK; Health Data Research UK, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, London, UK
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49
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Rajagopal V, Brown K, Pagel C, Wray J. Parental understanding of our communication of morbidity associated with paediatric cardiac surgery: a qualitative study. BMJ Paediatr Open 2020; 4:e000578. [PMID: 32154385 PMCID: PMC7047488 DOI: 10.1136/bmjpo-2019-000578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/11/2020] [Accepted: 01/22/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Following paediatric cardiac surgery, quality of life may be significantly impacted by morbidities associated with cardiac surgery. Parental understanding of the potential for postoperative morbidity is important for informed decision making. As part of a broader research study, we aimed to elicit parental understanding and experience of the communication of morbidities following their child's cardiac surgery, using traditional focus groups together with an online forum. METHODS The Children's Heart Federation set up and moderated a closed, anonymous online discussion group via their Facebook page, focusing on complications, information needs and methods of providing families with information. Additionally, we ran three focus groups with parents/carers, moderated by an experienced independent professional. Focus groups were recorded and transcribed and a single transcript was generated from the online forum. All transcripts were thematically analysed. RESULTS All data were collected in 2014. The forum ran over 3 months in 2014 and involved 72 participants. Focus groups involved 13 participants. Three broad themes were identified: (1) clinicians' use of language, (2) feeling unprepared for complications and (3) information needs of families. CONCLUSIONS Clinicians' language is often misunderstood, with wide variability in the way morbidities are described, and between differing teams looking after the same child. Information may not be easily absorbed or retained by families, who often felt unprepared for morbidities that arose after their child's heart surgery. Here, we propose key principles of good communication tailored to the individual receiving it.
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Affiliation(s)
- Veena Rajagopal
- Heart and Lung, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Katherine Brown
- Heart and Lung, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Christina Pagel
- Heart and Lung, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,Clinical Operational Research Unit, University College London, London, UK
| | - Jo Wray
- Heart and Lung, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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50
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King M, Ramnarayan P, Seaton SE, Pagel C. Modelling the allocation of paediatric intensive care retrieval teams in England and Wales. Arch Dis Child 2019; 104:962-966. [PMID: 31540943 DOI: 10.1136/archdischild-2018-316056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/30/2018] [Accepted: 01/18/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Following centralisation of UK paediatric intensive care units in 1997, specialist paediatric intensive care retrieval teams (PICRTs) were established to transport critically ill children from district general hospitals (DGHs). The current location and catchment area of PICRTs covering England and Wales are based on historical referral patterns. National quality standards specify that PICRTs should reach the patient bedside within 3 hours of accepting a referral. OBJECTIVE To determine what proportion of demand for PICRT services in England and Wales can be reached within 3 hours and to explore the potential coverage impact of more stringent 'time to bedside' standards. METHODS We used mathematical location-allocation methods to: (1) determine the optimal allocation of DGHs to current PICRT locations to minimise road journey time and calculated the proportion of demand reachable within 3 hours, 2 hours, 90 min, 75 min and 1 hour and (2) explore the impact of changing the number and location of PICRTs on demand coverage for the different time thresholds. RESULTS For current (and optimal) location of 11 PICRTs, 98% (98%) of demand is reachable within 3 hours; 86% (91%) within 2 hours; 59% (69%) within 90 min; 33% (39%) within 75 min; and 20% (20%) within 1 hour. Five hospitals were not reachable within 3 hours. For the 3-hour standard, eight optimally located PICRT locations had similar coverage as the current 11 locations. CONCLUSIONS If new evidence supports reduction in the time to bedside standard, many more hospitals will not be adequately covered. Location-allocation optimisation is a powerful technique for supporting evidence-based service configuration.
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Affiliation(s)
- Madeline King
- Washington University, St Louis, Missouri, USA.,Clinical Operational Research Unit, University College of London, London, UK
| | | | | | - Christina Pagel
- Clinical Operational Research Unit, University College of London, London, UK
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