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Tajuria G, Dobel-Ober D, Bradley E, Charnley C, Lambley-Burke R, Mallen C, Honeyford K, Kingstone T. Evaluating the impact of the supporting the advancement of research skills (STARS) programme on research knowledge, engagement and capacity-building in a health and social care organisation in England. BMC Med Educ 2024; 24:126. [PMID: 38331811 PMCID: PMC10854097 DOI: 10.1186/s12909-024-05059-0] [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] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES To evaluate the impact a novel education programme - to improve research engagement, awareness, understanding and confidence - had on a diverse health and social care workforce. Barriers and facilitators to engagement were explored together with research capacity-building opportunities and ways to embed a research culture. The programme is entitled 'Supporting The Advancement of Research Skills' (STARS programme); the paper reports findings from a health and social care setting in England, UK. METHODS A four-level outcome framework guided the approach to evaluation and was further informed by key principles of research capacity development and relevant theory. Quantitative data were collected from learners before and after engagement; these were analysed descriptively. Semi-structured online interviews were conducted with learners and analysed thematically. A purposive sample was achieved to include a diversity in age, gender, health and social care profession, and level of attendance (regular attendees, moderate attendees and non-attenders). RESULTS The evaluation spanned 18 half-day workshops and 11 seminars delivered by expert educators. 165 (2% of total staff at Midlands Partnership University NHS Foundation Trust (MPFT)) staffs booked one or more education sessions; 128 (77%) including Allied Health Professionals (AHPs), psychologists, nursing and midwifery, and social workers attended one or more session. Key themes of engagement with teaching sessions, relevance and impact of training and promoting a research active environment were identified with relevant sub-themes. Positive impacts of training were described in terms of research confidence, intentions, career planning and application of research skills as a direct result of training. Lack of dedicated time for research engagement, work pressures and time commitments required for the programme were key barriers. Facilitators that facilitated engagement are also described. CONCLUSIONS Findings demonstrate the impact that a free, virtual and high-quality research education programme had at individual and organisational levels. The programme is the product of a successful collaboration between health and social care and academic organisations; this provides a useful framework for others to adapt and adopt. Key barriers to attendance and engagement spoke to system-wide challenges that an education programme could not address in the short-term. Potential solutions are discussed in relation to protecting staff time, achieving management buy-in, recognising research champions, and having a clear communication strategy.
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Affiliation(s)
- Gulshan Tajuria
- Research and Innovation Department, Midlands Partnership University NHS Foundation Trust, St George's Hospital, Block 7, Corporation Street, Stafford, ST16 3AG, UK.
- School of Medicine, Keele University, David Weatherall Building, Newcastle, ST5 5BG, UK.
| | - David Dobel-Ober
- Research and Innovation Department, Midlands Partnership University NHS Foundation Trust, St George's Hospital, Block 7, Corporation Street, Stafford, ST16 3AG, UK
| | - Eleanor Bradley
- College of Health and Science, University of Worcester, Henwick Road, Worcester, Worcestershire, WR2 6AJ, UK
| | - Claire Charnley
- Research and Innovation Department, Midlands Partnership University NHS Foundation Trust, St George's Hospital, Block 7, Corporation Street, Stafford, ST16 3AG, UK
| | - Ruth Lambley-Burke
- Research and Innovation Department, Midlands Partnership University NHS Foundation Trust, St George's Hospital, Block 7, Corporation Street, Stafford, ST16 3AG, UK
| | - Christian Mallen
- Research and Innovation Department, Midlands Partnership University NHS Foundation Trust, St George's Hospital, Block 7, Corporation Street, Stafford, ST16 3AG, UK
- School of Medicine, Keele University, David Weatherall Building, Newcastle, ST5 5BG, UK
| | - Kate Honeyford
- Research and Innovation Department, Midlands Partnership University NHS Foundation Trust, St George's Hospital, Block 7, Corporation Street, Stafford, ST16 3AG, UK
| | - Tom Kingstone
- Research and Innovation Department, Midlands Partnership University NHS Foundation Trust, St George's Hospital, Block 7, Corporation Street, Stafford, ST16 3AG, UK
- School of Medicine, Keele University, David Weatherall Building, Newcastle, ST5 5BG, UK
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Mendelsohn E, Honeyford K, Brittin A, Mercuri L, Klaber RE, Expert P, Costelloe C. The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study. Sci Rep 2023; 13:15417. [PMID: 37723183 PMCID: PMC10507077 DOI: 10.1038/s41598-023-41966-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023] Open
Abstract
The architectural design of hospitals worldwide is centred around individual departments, which require the movement of patients between wards. However, patients do not always take the simplest route from admission to discharge, but can experience convoluted movement patterns, particularly when bed availability is low. Few studies have explored the impact of these rarer, atypical trajectories. Using a mixed-method explanatory sequential study design, we firstly used three continuous years of electronic health record data prior to the Covid-19 pandemic, from 55,152 patients admitted to a London hospital network to define the ward specialities by patient type using the Herfindahl-Hirschman index. We explored the impact of 'regular transfers' between pairs of wards with shared specialities, 'atypical transfers' between pairs of wards with no shared specialities and 'site transfers' between pairs of wards in different hospital site locations, on length of stay, 30-day readmission and mortality. Secondly, to understand the possible reasons behind atypical transfers we conducted three focus groups and three in-depth interviews with site nurse practitioners and bed managers within the same hospital network. We found that at least one atypical transfer was experienced by 12.9% of patients. Each atypical transfer is associated with a larger increase in length of stay, 2.84 days (95% CI 2.56-3.12), compared to regular transfers, 1.92 days (95% CI 1.82-2.03). No association was found between odds of mortality, or 30-day readmission and atypical transfers after adjusting for confounders. Atypical transfers appear to be driven by complex patient conditions, a lack of hospital capacity, the need to reach specific services and facilities, and more exceptionally, rare events such as major incidents. Our work provides an important first step in identifying unusual patient movement and its impacts on key patient outcomes using a system-wide, data-driven approach. The broader impact of moving patients between hospital wards, and possible downstream effects should be considered in hospital policy and service planning.
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Affiliation(s)
| | | | | | - Luca Mercuri
- Information Communications and Technology Department, Imperial College Healthcare NHS Trust, London, UK
| | - Robert Edward Klaber
- Department of Paediatrics, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Academic Centre for Paediatrics and Child Health, Imperial College London, London, UK
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Honeyford K, Nwosu AP, Lazzarino R, Kinderlerer A, Welch J, Brent AJ, Cooke G, Ghazal P, Patil S, Costelloe CE. Prevalence of electronic screening for sepsis in National Health Service acute hospitals in England. BMJ Health Care Inform 2023; 30:e100743. [PMID: 37169397 PMCID: PMC10186434 DOI: 10.1136/bmjhci-2023-100743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023] Open
Abstract
Sepsis is a worldwide public health problem. Rapid identification is associated with improved patient outcomes-if followed by timely appropriate treatment. OBJECTIVES Describe digital sepsis alerts (DSAs) in use in English National Health Service (NHS) acute hospitals. METHODS A Freedom of Information request surveyed acute NHS Trusts on their adoption of electronic patient records (EPRs) and DSAs. RESULTS Of the 99 Trusts that responded, 84 had an EPR. Over 20 different EPR system providers were identified as operational in England. The most common providers were Cerner (21%). System C, Dedalus and Allscripts Sunrise were also relatively common (13%, 10% and 7%, respectively). 70% of NHS Trusts with an EPR responded that they had a DSA; most of these use the National Early Warning Score (NEWS2). There was evidence that the EPR provider was related to the DSA algorithm. We found no evidence that Trusts were using EPRs to introduce data driven algorithms or DSAs able to include, for example, pre-existing conditions that may be known to increase risk.Not all Trusts were willing or able to provide details of their EPR or the underlying algorithm. DISCUSSION The majority of NHS Trusts use an EPR of some kind; many use a NEWS2-based DSA in keeping with national guidelines. CONCLUSION Many English NHS Trusts use DSAs; even those using similar triggers vary and many recreate paper systems. Despite the proliferation of machine learning algorithms being developed to support early detection of sepsis, there is little evidence that these are being used to improve personalised sepsis detection.
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Affiliation(s)
- Kate Honeyford
- Team Health Informatics, Institute of Cancer Research, London, UK
| | - Amen-Patrick Nwosu
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Runa Lazzarino
- Nuffield Department of Primary Care and Health Sciences, University of Oxford, Oxford, UK
| | | | - John Welch
- Critical Care Department, University College Hospital, London, UK
| | - Andrew J Brent
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Graham Cooke
- Imperial College Healthcare NHS Trust, London, UK
- Department of Infectious Disease, Imperial College, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
| | - Peter Ghazal
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - Shashank Patil
- Emergency Department, Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Ceire E Costelloe
- Team Health Informatics, Institute of Cancer Research, London, UK
- Health Informatics Team, Royal Marsden NHS Foundation Trust, London, UK
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Roland D, Gardiner A, Razzaq D, Rose K, Bressan S, Honeyford K, Buonsenso D, Da Dalt L, De T, Farrugia R, Parri N, Oostenbrink R, Maconochie IK, Bognar Z, Moll HA, Titomanlio L, Nijman RGG. Influence of epidemics and pandemics on paediatric ED use: a systematic review. Arch Dis Child 2023; 108:115-122. [PMID: 36162959 DOI: 10.1136/archdischild-2022-324108] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/05/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the impact of epidemics and pandemics on the utilisation of paediatric emergency care services to provide health policy advice. SETTING Systematic review. DESIGN Searches were conducted of Medline, EMBASE, CINAHL, Scopus, Web of Science and the Cochrane Library for studies that reported on changes in paediatric emergency care utilisation during epidemics (as defined by the WHO). PATIENTS Children under 18 years. INTERVENTIONS National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies was used. MAIN OUTCOME MEASURES Changes in paediatric emergency care utilisation. RESULTS 131 articles were included within this review, 80% of which assessed the impact of COVID-19. Studies analysing COVID-19, SARS, Middle East respiratory syndrome (MERS) and Ebola found a reduction in paediatric emergency department (PED) visits, whereas studies reporting on H1N1, chikungunya virus and Escherichia coli outbreaks found an increase in PED visits. For COVID-19, there was a reduction of 63.86% (95% CI 60.40% to 67.31%) with a range of -16.5% to -89.4%. Synthesis of results suggests that the fear of the epidemic disease, from either contracting it or its potential adverse clinical outcomes, resulted in reductions and increases in PED utilisation, respectively. CONCLUSIONS The scale and direction of effect of PED use depend on both the epidemic disease, the public health measures enforced and how these influence decision-making. Policy makers must be aware how fear of virus among the general public may influence their response to public health advice. There is large inequity in reporting of epidemic impact on PED use which needs to be addressed. TRIAL REGISTRATION NUMBER CRD42021242808.
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Affiliation(s)
- Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Adam Gardiner
- School of Medicine, University of Leicester, Leicester, UK
| | - Darakhshan Razzaq
- Northampton General Hospital NHS Trust, Northampton, Northamptonshire, UK
| | - Katy Rose
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
- Division of Emergency Medicine, University College London NHS Foundation Trust, London, UK
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, Università degli Studi di Padova, Padova, Italy
| | - Kate Honeyford
- Health Informatics Team, Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - Danilo Buonsenso
- Department of Women, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
- Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, Università degli Studi di Padova, Padova, Italy
| | - Tisham De
- Imperial College Medical School, Imperial College London, London, UK
| | - Ruth Farrugia
- Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
| | - Niccolo Parri
- Emergency Department & Trauma Center, Ospedale Paediatrico Meyer Firenze, Florence, Italy
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Ian K Maconochie
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
| | - Zsolt Bognar
- Department of Paediatric Emergency Medicine, Heim Pal National Paediatric Institute, Budapest, Hungary
| | - Henriette A Moll
- Department of General Paediatrics, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Luigi Titomanlio
- Pediatric Emergency Department, Hopital Universitaire Robert-Debre, Paris, France
| | - Ruud Gerard Gerard Nijman
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
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Lenglart L, Ouldali N, Honeyford K, Bognar Z, Bressan S, Buonsenso D, Da Dalt L, De T, Farrugia R, Maconochie IK, Moll HA, Oostenbrink R, Parri N, Roland D, Rose K, Akyüz Özkan E, Angoulvant F, Aupiais C, Barber C, Barrett M, Basmaci R, Castanhinha S, Chiaretti A, Durnin S, Fitzpatrick P, Fodor L, Gomez B, Greber-Platzer S, Guedj R, Hey F, Jankauskaite L, Kohlfuerst D, Mascarenhas I, Musolino AM, Pučuka Z, Reis S, Rybak A, Salamon P, Schaffert M, Shahar-Nissan K, Supino MC, Teksam O, Turan C, Velasco R, Nijman RG, Titomanlio L. Respective roles of non-pharmaceutical interventions in bronchiolitis outbreaks: an interrupted time-series analysis based on a multinational surveillance system. Eur Respir J 2023; 61:13993003.01172-2022. [PMID: 36356971 DOI: 10.1183/13993003.01172-2022] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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] [Received: 06/08/2022] [Accepted: 09/23/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Bronchiolitis is a major source of morbimortality among young children worldwide. Non-pharmaceutical interventions (NPIs) implemented to reduce the spread of severe acute respiratory syndrome coronavirus 2 may have had an important impact on bronchiolitis outbreaks, as well as major societal consequences. Discriminating between their respective impacts would help define optimal public health strategies against bronchiolitis. We aimed to assess the respective impact of each NPI on bronchiolitis outbreaks in 14 European countries. METHODS We conducted a quasi-experimental interrupted time-series analysis based on a multicentre international study. All children diagnosed with bronchiolitis presenting to the paediatric emergency department of one of 27 centres from January 2018 to March 2021 were included. We assessed the association between each NPI and change in the bronchiolitis trend over time by seasonally adjusted multivariable quasi-Poisson regression modelling. RESULTS In total, 42 916 children were included. We observed an overall cumulative 78% (95% CI -100- -54%; p<0.0001) reduction in bronchiolitis cases following NPI implementation. The decrease varied between countries from -97% (95% CI -100- -47%; p=0.0005) to -36% (95% CI -79-7%; p=0.105). Full lockdown (incidence rate ratio (IRR) 0.21 (95% CI 0.14-0.30); p<0.001), secondary school closure (IRR 0.33 (95% CI 0.20-0.52); p<0.0001), wearing a mask indoors (IRR 0.49 (95% CI 0.25-0.94); p=0.034) and teleworking (IRR 0.55 (95% CI 0.31-0.97); p=0.038) were independently associated with reducing bronchiolitis. CONCLUSIONS Several NPIs were associated with a reduction of bronchiolitis outbreaks, including full lockdown, school closure, teleworking and facial masking. Some of these public health interventions may be considered to further reduce the global burden of bronchiolitis.
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Affiliation(s)
- Lea Lenglart
- Paediatric Emergency Department, Robert Debré University Hospital, AP-HP, Université de Paris, Paris, France
- L. Lenglart and N. Ouldali contributed equally to this work
| | - Naim Ouldali
- Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, AP-HP, Université de Paris, Paris, France
- Infectious Diseases Division, CHU Sainte Justine, Montreal University, Montreal, QC, Canada
- Paris University, INSERM UMR 1123, ECEVE, Paris, France
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, St Maur-des-Fossés, France
- L. Lenglart and N. Ouldali contributed equally to this work
| | - Kate Honeyford
- Health Informatics Team, Division of Clinical studies, Institute of Cancer Research, London, UK
| | - Zsolt Bognar
- Paediatric Emergency Department, Heim Pal National Paediatric Institute, Budapest, Hungary
| | - Silvia Bressan
- Division of Paediatric Emergency Medicine, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Liviana Da Dalt
- Division of Paediatric Emergency Medicine, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Tisham De
- Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Ruth Farrugia
- Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
| | - Ian K Maconochie
- Department of Paediatric Emergency Medicine, Division of Medicine, St Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
| | - Henriette A Moll
- Department of General Paediatrics, ErasmusMC - Sophia, Rotterdam, The Netherlands
| | - Rianne Oostenbrink
- Department of General Paediatrics, ErasmusMC - Sophia, Rotterdam, The Netherlands
| | - Niccolo Parri
- Emergency Department and Trauma Center, Ospedale Paediatrico Meyer Firenze, Florence, Italy
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, Leicester University, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Hospitals, Leicester, UK
| | - Katy Rose
- Department of Paediatric Emergency Medicine, Division of Medicine, St Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK
| | - Esra Akyüz Özkan
- Paediatric Emergency Department, Ondokuz Mayıs University, Samsun, Turkey
| | - François Angoulvant
- Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, AP-HP, Université de Paris, Paris, France
| | - Camille Aupiais
- Paris University, INSERM UMR 1123, ECEVE, Paris, France
- Paediatric Emergency Department, Jean Verdier Hospital, AP-HP, Sorbonne Paris Cité, Bondy, France
| | - Clarissa Barber
- Paediatric Emergency Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Michael Barrett
- Paediatric Emergency Department, Children's Health Ireland at Crumlin, Dublin, Ireland
- Women's and Children's Health, School of Medicine, University College Dublin, Dublin, Ireland
| | - Romain Basmaci
- Paediatric Emergency Department, Louis Mourier Hospital, AP-HP, Université de Paris, Colombes, France
| | - Susana Castanhinha
- Hospital Dona Estefania, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Antonio Chiaretti
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sheena Durnin
- Department of Paediatric Emergency Medicine, Children's Health Ireland at Tallaght, Dublin, Ireland
| | - Patrick Fitzpatrick
- Paediatric Emergency Department, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Laszlo Fodor
- Paediatric Emergency Department, Szent Gyorgy University Teaching Hospital of Fejer County, Szekesfehervar, Hungary
| | - Borja Gomez
- Paediatric Emergency Department, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Susanne Greber-Platzer
- Clinical Division of Paediatric Pulmonology, Allergology and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre for Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Romain Guedj
- Paediatric Emergency Department, Armand Trousseau Hospital, AP-HP, Sorbonne Université, CRESS Inserm U-1153 Paris, Epopé Team, Paris, France
| | - Florian Hey
- Pediatric Intensive Care Unit and Emergency Department, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lina Jankauskaite
- Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania
| | - Daniela Kohlfuerst
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Ines Mascarenhas
- Departamento da Criança e do Jovem, Urgencia Pediatrica, Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal
| | | | - Zanda Pučuka
- Paediatric Emergency Department, Children's Clinical University Hospital, Riga Stradins University, Riga, Latvia
| | - Sofia Reis
- Paediatric Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Alexis Rybak
- Paediatric Emergency Department, Robert Debré University Hospital, AP-HP, Université de Paris, Paris, France
- Paris University, INSERM UMR 1123, ECEVE, Paris, France
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, St Maur-des-Fossés, France
| | - Petra Salamon
- Paediatric Emergency Department, Heim Pal National Paediatric Institute, Budapest, Hungary
| | - Matthias Schaffert
- Department of Pediatrics and Department of Paediatric and Adolescent Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Keren Shahar-Nissan
- Paediatric Emergency Department, Schneider Children's Medical Center of Israel and Sackler Faculty of Medicine, Petach Tikva, Israel
| | | | - Ozlem Teksam
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Caner Turan
- Department of Paediatrics, Division of Emergency Medicine, Mersin City Training and Research Hospital, Toroslar, Turkey
| | - Roberto Velasco
- Paediatric Emergency Unit, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Ruud G Nijman
- Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatric Emergency Medicine, Division of Medicine, St Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- R.G. Nijman and L. Titomanlio contributed equally to this work
| | - Luigi Titomanlio
- Paediatric Emergency Department, Robert Debré University Hospital, AP-HP, Université de Paris, Paris, France
- Paris University, INSERM U1141, DHU Protect, Paris, France
- R.G. Nijman and L. Titomanlio contributed equally to this work
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Venkatraman T, Honeyford K, Ram B, M F van Sluijs E, Costelloe CE, Saxena S. Identifying local authority need for, and uptake of, school-based physical activity promotion in England-a cluster analysis. J Public Health (Oxf) 2022; 44:694-703. [PMID: 33942861 PMCID: PMC9424056 DOI: 10.1093/pubmed/fdab138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND School-based physical activity interventions such as The Daily Mile (TDM) are widely promoted in children's physical activity guidance. However, targeting such interventions to areas of greatest need is challenging since determinants vary across geographical areas. Our study aimed to identify local authorities in England with the greatest need to increase children's physical activity and assess whether TDM reaches school populations in areas with the highest need. METHODS This was a cross-sectional study using routinely collected data from Public Health England. Datasets on health, census and the built environment were linked. We conducted a hierarchical cluster analysis to group local authorities by 'need' and estimated the association between 'need' and registration to TDM. RESULTS We identified three clusters of high, medium and low need for physical activity interventions in 123 local authorities. Schools in high-need areas were more likely to be registered with TDM (incidence rate ratio 1.25, 95% confidence interval: 1.12-1.39) compared with low-need areas. CONCLUSIONS Determinants of children's physical activity cluster geographically across local authorities in England. TDM appears to be an equitable intervention reaching schools in local authorities with the highest needs. Health policy should account for clustering of health determinants to match interventions with populations most in need.
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Affiliation(s)
- Tishya Venkatraman
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
| | - Kate Honeyford
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
| | - Bina Ram
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
| | - Esther M F van Sluijs
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Céire E Costelloe
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
| | - Sonia Saxena
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
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Honeyford K, Expert P, Mendelsohn E, Post B, Faisal A, Glampson B, Mayer E, Costelloe C. Challenges and recommendations for high quality research using electronic health records. Front Digit Health 2022; 4:940330. [PMID: 36060540 PMCID: PMC9437583 DOI: 10.3389/fdgth.2022.940330] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/28/2022] [Indexed: 12/02/2022] Open
Abstract
Harnessing Real World Data is vital to improve health care in the 21st Century. Data from Electronic Health Records (EHRs) are a rich source of patient centred data, including information on the patient's clinical condition, laboratory results, diagnoses and treatments. They thus reflect the true state of health systems. However, access and utilisation of EHR data for research presents specific challenges. We assert that using data from EHRs effectively is dependent on synergy between researchers, clinicians and health informaticians, and only this will allow state of the art methods to be used to answer urgent and vital questions for patient care. We propose that there needs to be a paradigm shift in the way this research is conducted - appreciating that the research process is iterative rather than linear. We also make specific recommendations for organisations, based on our experience of developing and using EHR data in trusted research environments.
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Affiliation(s)
- K Honeyford
- Global Digital Health Unit, School of Public Health, Imperial College London, London, United Kingdom
- Health Informatics Team, Division of Clinical studies, Institute of Cancer Research, London, United Kingdom
| | - P Expert
- Global Digital Health Unit, School of Public Health, Imperial College London, London, United Kingdom
- Global Business School for Health, University College London, London, United Kingdom
| | - E.E Mendelsohn
- Global Digital Health Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - B Post
- Department of Computing, Imperial College London, London, United Kingdom
- UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, United Kingdom
| | - A.A Faisal
- Department of Computing, Imperial College London, London, United Kingdom
- UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, United Kingdom
- Chair in Digital Health, Faculty of Life Sciences, University of Bayreuth, Bayreuth, Germany
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - B Glampson
- Translational Data Analytics and Informatics in Healthcare, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Imperial Clinical Analytics, Informatics and Evaluation (iCARE), NIHR Imperial BRC, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - E.K Mayer
- UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, United Kingdom
- Translational Data Analytics and Informatics in Healthcare, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Imperial Clinical Analytics, Informatics and Evaluation (iCARE), NIHR Imperial BRC, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - C.E Costelloe
- Global Digital Health Unit, School of Public Health, Imperial College London, London, United Kingdom
- Health Informatics Team, Division of Clinical studies, Institute of Cancer Research, London, United Kingdom
- Health Informatics Team, Royal Marsden Hospital, London, United Kingdom
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8
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Jauneikaite E, Honeyford K, Blandy O, Mosavie M, Pearson M, Ramzan FA, Ellington MJ, Parkhill J, Costelloe CE, Woodford N, Sriskandan S. Bacterial genotypic and patient risk factors for adverse outcomes in Escherichia coli bloodstream infections: a prospective molecular epidemiological study. J Antimicrob Chemother 2022; 77:1753-1761. [PMID: 35265995 PMCID: PMC9155631 DOI: 10.1093/jac/dkac071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/07/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Escherichia coli bloodstream infections have shown a sustained increase in England, for reasons that are unknown. Furthermore, the contribution of MDR lineages such as ST131 to overall E. coli disease burden and outcome is undetermined. METHODS We genome-sequenced E. coli blood isolates from all patients with E. coli bacteraemia in north-west London from July 2015 to August 2016 and assigned MLST genotypes, virulence factors and AMR genes to all isolates. Isolate STs were then linked to phenotypic antimicrobial susceptibility, patient demographics and clinical outcome data to explore relationships between the E. coli STs, patient factors and outcomes. RESULTS A total of 551 E. coli genomes were analysed. Four STs (ST131, 21.2%; ST73, 14.5%; ST69, 9.3%; and ST95, 8.2%) accounted for over half of cases. E. coli genotype ST131-C2 was associated with phenotypic non-susceptibility to quinolones, third-generation cephalosporins, amoxicillin, amoxicillin/clavulanic acid, gentamicin and trimethoprim. Among 300 patients from whom outcome was known, an association between the ST131-C2 lineage and longer length of stay was detected, although multivariable regression modelling did not demonstrate an association between E. coli ST and mortality. Several unexpected associations were identified between gentamicin non-susceptibility, ethnicity, sex and adverse outcomes, requiring further research. CONCLUSIONS Although E. coli ST was associated with defined antimicrobial non-susceptibility patterns and prolonged length of stay, E. coli ST was not associated with increased mortality. ST131 has outcompeted other lineages in north-west London. Where ST131 is prevalent, caution is required when devising empiric regimens for suspected Gram-negative sepsis, in particular the pairing of β-lactam agents with gentamicin.
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Affiliation(s)
- Elita Jauneikaite
- NIHR Health Protection Research Unit for Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK,Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Kate Honeyford
- NIHR Health Protection Research Unit for Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK,Global Digital Health Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Oliver Blandy
- NIHR Health Protection Research Unit for Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - Mia Mosavie
- NIHR Health Protection Research Unit for Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - Max Pearson
- NIHR Health Protection Research Unit for Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - Farzan A. Ramzan
- NIHR Health Protection Research Unit for Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - Matthew J. Ellington
- NIHR Health Protection Research Unit for Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK,National Infection Service Laboratories, National Infection Service, UK Health Security Agency (formerly Public Health England), UK
| | - Julian Parkhill
- Wellcome Sanger Institute, Hinxton, Cambridge, UK,Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Céire E. Costelloe
- Global Digital Health Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Neil Woodford
- NIHR Health Protection Research Unit for Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK,National Infection Service Laboratories, National Infection Service, UK Health Security Agency (formerly Public Health England), UK
| | - Shiranee Sriskandan
- NIHR Health Protection Research Unit for Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK,Medical Research Council Centre for Molecular Bacteriology & Infection, Imperial College London, London, UK,Corresponding author. E-mail:
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9
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Rose K, Bressan S, Honeyford K, Bognar Z, Buonsenso D, Da Dalt L, De T, Farrugia R, Parri N, Oostenbrink R, Maconochie I, Moll HA, Roland D, Titomanlio L, Nijman R. Responses of paediatric emergency departments to the first wave of the COVID-19 pandemic in Europe: a cross-sectional survey study. BMJ Paediatr Open 2021; 5:10.1136/bmjpo-2021-001269. [PMID: 35413003 PMCID: PMC8688729 DOI: 10.1136/bmjpo-2021-001269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/14/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Understanding how paediatric emergency departments (PEDs) across Europe adapted their healthcare pathways in response to COVID-19 will help guide responses to ongoing waves of COVID-19 and potential future pandemics. This study aimed to evaluate service reconfiguration across European PEDs during the initial COVID-19 wave. DESIGN This cross-sectional survey included 39 PEDs in 17 countries. The online questionnaire captured (1) study site characteristics, (2) departmental changes and (3) pathways for children with acute illness pre and during the first wave of COVID-19 pandemic (January-May 2020). Number of changes to health services, as a percentage of total possible changes encompassed by the survey, was compared with peak national SARS-CoV-2 incidence rates, and for both mixed and standalone paediatric centres. RESULTS Overall, 97% (n=38) of centres remained open as usual during the pandemic. The capacity of 18 out of 28 (68%) short-stay units decreased; in contrast, 2 units (7%) increased their capacity. In 12 (31%) PEDs, they reported acting as receiving centres for diverted children during the pandemic.There was minimal change to the availability of paediatric consultant telephone advice services, consultant supervision of juniors or presence of responsible specialists within the PEDs.There was no relationship between percentage of possible change at each site and the peak national SARS-CoV-2 incidence rate. Mixed paediatric and adult hospitals made 8% of possible changes and standalone paediatric centres made 6% of possible changes (p=0.086). CONCLUSION Overall, there was limited change to the organisation or delivery of services across surveyed PEDs during the first wave of the COVID-19 pandemic.
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Affiliation(s)
- Katy Rose
- Department of Paediatric Emergency Medicine, Division of Medicine, Imperial College Healthcare NHS Trust, London, UK .,Division of Emergency Medicine - Paediatrics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Silvia Bressan
- Division of Paediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Kate Honeyford
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Zsolt Bognar
- Department of Paediatric Emergency Medicine, Heim Pal National Paediatric Institute, Budapest, Hungary
| | - Danilo Buonsenso
- Department of Pediatrics, Catholic University of Rome, Rome, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Liviana Da Dalt
- Division of Paediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Tisham De
- Imperial College Medical School, Imperial College London, London, UK
| | - Ruth Farrugia
- Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
| | - Niccolo Parri
- Emergency Department & Trauma Center, Ospedale Pediatrico Meyer Firenze, Florence, Italy
| | - Rianne Oostenbrink
- Department of Pediatrics, Erasmus MC-Sophia Childrens Hospital, Rotterdam, The Netherlands
| | - Ian Maconochie
- Department of Paediatric Emergency Medicine, Division of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Henriette A Moll
- Department of Pediatrics, Erasmus MC-Sophia Childrens Hospital, Rotterdam, The Netherlands
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK.,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Luigi Titomanlio
- Department of Pediatric Emergency Care, Hopital Universitaire Robert-Debre Pole de biologie recherche et produits de sante, Paris, Île-de-France, France.,FHU I2-D2 - INSERM U1141, University of Paris, Paris, France
| | - Ruud Nijman
- Department of Paediatric Emergency Medicine, Division of Medicine, Imperial College Healthcare NHS Trust, London, UK.,Faculty of Medicine, Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, UK
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10
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Venkatraman T, Honeyford K, van Sluijs EMF, Costelloe C, Saxena S. Are children at schools registered to The Daily Mile™ more physically active? Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Daily Mile (TDM) is among the most popular school-based running programmes recommended globally by governments and the WHO to meet the shortfalls in children's physical activity. In England, it has been adopted by 1 in 5 primary schools. However, its impact on children's physical activity has not been assessed at scale. We aimed to compare a)minutes (mins) of moderate to vigorous physical activity (MVPA) in and outside school hours and b)meeting physical activity guidelines in primary school children in England, comparing those in schools registered with TDM with those that were not.
Methods
This was a cross-sectional study. We used self-reported data of 49,561 English primary school children(5-11 years) from the Active Lives Children and Young People Survey and TDM registration data of their school. We compared mins of MVPA in and outside school hours between children in TDM-registered and non-registered schools using a multilevel zero-inflated negative binomial model; and the differences in the likelihood of meeting physical activity guidelines based on TDM registration with a multilevel logistic regression model. All models included a random effect for school and adjusted for potential confounders.
Results
Children attending TDM-registered schools reported an extra 36 mins of MVPA a week overall, including 10 additional mins (95%CI:3,16) MVPA/week during school hours and 26 additional (95%CI:4,44) mins MVPA/week outside school hours. Children in TDM-registered schools were 6% more likely to meet physical activity guidelines compared to those who were not(RR:1.06 (95%CI:1.02,1.11)).
Conclusions
Children in primary schools registered to TDM report more physical activity that is not compensated for outside school hours. However, the absolute differences fall considerably short of international guidelines across the whole child population. Therefore, a whole school and systems-based approach is required, embedding school-based running programmes.
Key messages
Children in schools registered to TDM report more MVPA overall, inside, and outside school hours; suggesting no compensation of activity in those who are registered. TDM is a potential solution to increase children’s physical activity during the school day.
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Affiliation(s)
- T Venkatraman
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - K Honeyford
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - EMF van Sluijs
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - C Costelloe
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - S Saxena
- Department of Primary Care and Public Health, Imperial College London, London, UK
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11
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Vollmer MAC, Radhakrishnan S, Kont MD, Flaxman S, Bhatt S, Costelloe C, Honeyford K, Aylin P, Cooke G, Redhead J, Sanders A, Mangan H, White PJ, Ferguson N, Hauck K, Nayagam S, Perez-Guzman PN. The impact of the COVID-19 pandemic on patterns of attendance at emergency departments in two large London hospitals: an observational study. BMC Health Serv Res 2021; 21:1008. [PMID: 34556119 PMCID: PMC8460185 DOI: 10.1186/s12913-021-07008-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 07/20/2020] [Accepted: 09/09/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hospitals in England have undergone considerable change to address the surge in demand imposed by the COVID-19 pandemic. The impact of this on emergency department (ED) attendances is unknown, especially for non-COVID-19 related emergencies. METHODS This analysis is an observational study of ED attendances at the Imperial College Healthcare NHS Trust (ICHNT). We calibrated auto-regressive integrated moving average time-series models of ED attendances using historic (2015-2019) data. Forecasted trends were compared to present year ICHNT data for the period between March 12, 2020 (when England implemented the first COVID-19 public health measure) and May 31, 2020. We compared ICHTN trends with publicly available regional and national data. Lastly, we compared hospital admissions made via the ED and in-hospital mortality at ICHNT during the present year to the historic 5-year average. RESULTS ED attendances at ICHNT decreased by 35% during the period after the first lockdown was imposed on March 12, 2020 and before May 31, 2020, reflecting broader trends seen for ED attendances across all England regions, which fell by approximately 50% for the same time frame. For ICHNT, the decrease in attendances was mainly amongst those aged < 65 years and those arriving by their own means (e.g. personal or public transport) and not correlated with any of the spatial dependencies analysed such as increasing distance from postcode of residence to the hospital. Emergency admissions of patients without COVID-19 after March 12, 2020 fell by 48%; we did not observe a significant change to the crude mortality risk in patients without COVID-19 (RR 1.13, 95%CI 0.94-1.37, p = 0.19). CONCLUSIONS Our study findings reflect broader trends seen across England and give an indication how emergency healthcare seeking has drastically changed. At ICHNT, we find that a larger proportion arrived by ambulance and that hospitalisation outcomes of patients without COVID-19 did not differ from previous years. The extent to which these findings relate to ED avoidance behaviours compared to having sought alternative emergency health services outside of hospital remains unknown. National analyses and strategies to streamline emergency services in England going forward are urgently needed.
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Affiliation(s)
- Michaela A C Vollmer
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Modelling and Economics Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
- NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Sreejith Radhakrishnan
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Mara D Kont
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Seth Flaxman
- Department of Mathematics, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Samir Bhatt
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ceire Costelloe
- Imperial College London Department of Primary Care and Public Health, Global Digital Health Unit, St Dunstan's Rd, Hammersmith, London, W6 8RP, UK
| | - Kate Honeyford
- Imperial College London Department of Primary Care and Public Health, Global Digital Health Unit, St Dunstan's Rd, Hammersmith, London, W6 8RP, UK
| | - Paul Aylin
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Graham Cooke
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, London, W2 1NY, UK
| | - Julian Redhead
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, London, W2 1NY, UK
| | - Alison Sanders
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, London, W2 1NY, UK
| | - Helen Mangan
- West London Mental Health NHS Trust, 1 Armstrong Way, Southall, London, UB2 4SD, UK
| | - Peter J White
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Modelling and Economics Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
- NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Neil Ferguson
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Katharina Hauck
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Shevanthi Nayagam
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, London, W2 1NY, UK
| | - Pablo N Perez-Guzman
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.
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12
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Sangkaew S, Ming D, Boonyasiri A, Honeyford K, Kalayanarooj S, Yacoub S, Dorigatti I, Holmes A. Risk predictors of progression to severe disease during the febrile phase of dengue: a systematic review and meta-analysis. Lancet Infect Dis 2021; 21:1014-1026. [PMID: 33640077 PMCID: PMC8240557 DOI: 10.1016/s1473-3099(20)30601-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 05/01/2020] [Accepted: 06/30/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND The ability to accurately predict early progression of dengue to severe disease is crucial for patient triage and clinical management. Previous systematic reviews and meta-analyses have found significant heterogeneity in predictors of severe disease due to large variation in these factors during the time course of the illness. We aimed to identify factors associated with progression to severe dengue disease that are detectable specifically in the febrile phase. METHODS We did a systematic review and meta-analysis to identify predictors identifiable during the febrile phase associated with progression to severe disease defined according to WHO criteria. Eight medical databases were searched for studies published from Jan 1, 1997, to Jan 31, 2020. Original clinical studies in English assessing the association of factors detected during the febrile phase with progression to severe dengue were selected and assessed by three reviewers, with discrepancies resolved by consensus. Meta-analyses were done using random-effects models to estimate pooled effect sizes. Only predictors reported in at least four studies were included in the meta-analyses. Heterogeneity was assessed using the Cochrane Q and I2 statistics, and publication bias was assessed by Egger's test. We did subgroup analyses of studies with children and adults. The study is registered with PROSPERO, CRD42018093363. FINDINGS Of 6643 studies identified, 150 articles were included in the systematic review, and 122 articles comprising 25 potential predictors were included in the meta-analyses. Female patients had a higher risk of severe dengue than male patients in the main analysis (2674 [16·2%] of 16 481 vs 3052 [10·5%] of 29 142; odds ratio [OR] 1·13 [95% CI 1·01-1·26) but not in the subgroup analysis of studies with children. Pre-existing comorbidities associated with severe disease were diabetes (135 [31·3%] of 431 with vs 868 [16·0%] of 5421 without; crude OR 4·38 [2·58-7·43]), hypertension (240 [35·0%] of 685 vs 763 [20·6%] of 3695; 2·19 [1·36-3·53]), renal disease (44 [45·8%] of 96 vs 271 [16·0%] of 1690; 4·67 [2·21-9·88]), and cardiovascular disease (nine [23·1%] of 39 vs 155 [8·6%] of 1793; 2·79 [1·04-7·50]). Clinical features during the febrile phase associated with progression to severe disease were vomiting (329 [13·5%] of 2432 with vs 258 [6·8%] of 3797 without; 2·25 [1·87-2·71]), abdominal pain and tenderness (321 [17·7%] of 1814 vs 435 [8·1%] of 5357; 1·92 [1·35-2·74]), spontaneous or mucosal bleeding (147 [17·9%] of 822 vs 676 [10·8%] of 6235; 1·57 [1·13-2·19]), and the presence of clinical fluid accumulation (40 [42·1%] of 95 vs 212 [14·9%] of 1425; 4·61 [2·29-9·26]). During the first 4 days of illness, platelet count was lower (standardised mean difference -0·34 [95% CI -0·54 to -0·15]), serum albumin was lower (-0·5 [-0·86 to -0·15]), and aminotransferase concentrations were higher (aspartate aminotransferase [AST] 1·06 [0·54 to 1·57] and alanine aminotransferase [ALT] 0·73 [0·36 to 1·09]) among individuals who progressed to severe disease. Dengue virus serotype 2 was associated with severe disease in children. Secondary infections (vs primary infections) were also associated with severe disease (1682 [11·8%] of 14 252 with vs 507 [5·2%] of 9660 without; OR 2·26 [95% CI 1·65-3·09]). Although the included studies had a moderate to high risk of bias in terms of study confounding, the risk of bias was low to moderate in other domains. Heterogeneity of the pooled results varied from low to high on different factors. INTERPRETATION This analysis supports monitoring of the warning signs described in the 2009 WHO guidelines on dengue. In addition, testing for infecting serotype and monitoring platelet count and serum albumin, AST, and ALT concentrations during the febrile phase of illness could improve the early prediction of severe dengue. FUNDING Wellcome Trust, National Institute for Health Research, Collaborative Project to Increase Production of Rural Doctors, and Royal Thai Government.
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Affiliation(s)
- Sorawat Sangkaew
- Section of Adult Infectious Disease, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK; Department of Social Medicine, Hatyai Hospital, Songkhla, Thailand.
| | - Damien Ming
- Section of Adult Infectious Disease, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Adhiratha Boonyasiri
- Section of Adult Infectious Disease, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Kate Honeyford
- Global Digital Health Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Siripen Kalayanarooj
- Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Sophie Yacoub
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Ilaria Dorigatti
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Alison Holmes
- Section of Adult Infectious Disease, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK; Antimicrobial Resistance Collaborative, Imperial College London, London, UK
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13
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Coughlan C, Rahman S, Honeyford K, Costelloe CE. Developing useful early warning and prognostic scores for COVID-19. Postgrad Med J 2021; 97:477-480. [PMID: 37066681 DOI: 10.1136/postgradmedj-2021-140086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 12/23/2022]
Affiliation(s)
- Charles Coughlan
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK .,Department of Tropical and Infectious Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shati Rahman
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Kate Honeyford
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Céire E Costelloe
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
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14
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Honeyford K, Coughlan C, Nijman RG, Expert P, Burcea G, Maconochie I, Kinderlerer A, Cooke GS, Costelloe CE. Changes in Emergency Department Activity and the First COVID-19 Lockdown: A Cross-sectional Study. West J Emerg Med 2021; 22:603-607. [PMID: 34125034 PMCID: PMC8203011 DOI: 10.5811/westjem.2021.2.49614] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Received: 08/25/2020] [Accepted: 02/13/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction Emergency department (ED) attendances fell across the UK after the ‘lockdown’ introduced on 23rd March 2020 to limit the spread of coronavirus disease 2019 (COVID-19). We hypothesised that reductions would vary by patient age and disease type. We examined pre- and in-lockdown ED attendances for two COVID-19 unrelated diagnoses: one likely to be affected by lockdown measures (gastroenteritis), and one likely to be unaffected (appendicitis). Methods We conducted a retrospective cross-sectional study across two EDs in one London hospital Trust. We compared all adult and paediatric ED attendances, before (January 2020) and during lockdown (March/April 2020). Key patient demographics, method of arrival, and discharge location were compared. We used Systemised Nomenclature of Medicine codes to define attendances for gastroenteritis and appendicitis. Results ED attendances fell from 1129 per day before lockdown to 584 in lockdown, 51.7% of pre-lockdown rates. In-lockdown attendances were lowest for under-18s (16.0% of pre-lockdown). The proportion of patients admitted to hospital increased from 17.3% to 24.0%, and the proportion admitted to intensive care increased fourfold. Attendances for gastroenteritis fell from 511 to 103, 20.2% of pre-lockdown rates. Attendances for appendicitis also decreased, from 144 to 41, 28.5% of pre-lockdown rates. Conclusion ED attendances fell substantially following lockdown implementation. The biggest reduction was for under-18s. We observed reductions in attendances for gastroenteritis and appendicitis. This may reflect lower rates of infectious disease transmission, although the fall in appendicitis-related attendances suggests that behavioural factors were also important. Larger studies are urgently needed to understand changing patterns of ED use and access to emergency care during the coronavirus 2019 pandemic.
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Affiliation(s)
- Kate Honeyford
- Imperial College London, Department of Primary Care and Public Health, Global Digital Health Unit, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
| | - Charles Coughlan
- Imperial College London, Department of Primary Care and Public Health, Global Digital Health Unit, London, United Kingdom.,Imperial College Healthcare NHS Trust, Department of Paediatrics, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
| | - Ruud G Nijman
- St. Mary's Hospital, Imperial College Healthcare NHS Trust, Department of Paediatric Emergency Medicine, London, United Kingdom.,Imperial College London, Section of Paediatric Infectious Diseases, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
| | - Paul Expert
- Imperial College London, Department of Primary Care and Public Health, Global Digital Health Unit, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
| | - Gabriel Burcea
- Imperial College London, Department of Primary Care and Public Health, Global Digital Health Unit, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
| | - Ian Maconochie
- St. Mary's Hospital, Imperial College Healthcare NHS Trust, Department of Paediatric Emergency Medicine, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
| | - Anne Kinderlerer
- St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
| | - Graham S Cooke
- Imperial College London, Department of Infectious Disease, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
| | - Ceire E Costelloe
- Imperial College London, Department of Primary Care and Public Health, Global Digital Health Unit, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
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15
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Honeyford K, Cooke GS, Kinderlerer A, Williamson E, Gilchrist M, Holmes A, Glampson B, Mulla A, Costelloe C. Evaluating a digital sepsis alert in a London multisite hospital network: a natural experiment using electronic health record data. J Am Med Inform Assoc 2021; 27:274-283. [PMID: 31743934 PMCID: PMC7025344 DOI: 10.1093/jamia/ocz186] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/19/2019] [Accepted: 09/30/2019] [Indexed: 11/23/2022] Open
Abstract
Objective The study sought to determine the impact of a digital sepsis alert on patient outcomes in a UK multisite hospital network. Materials and Methods A natural experiment utilizing the phased introduction (without randomization) of a digital sepsis alert into a multisite hospital network. Sepsis alerts were either visible to clinicians (patients in the intervention group) or running silently and not visible (the control group). Inverse probability of treatment-weighted multivariable logistic regression was used to estimate the effect of the intervention on individual patient outcomes. Outcomes In-hospital 30-day mortality (all inpatients), prolonged hospital stay (≥7 days) and timely antibiotics (≤60 minutes of the alert) for patients who alerted in the emergency department. Results The introduction of the alert was associated with lower odds of death (odds ratio, 0.76; 95% confidence interval [CI], 0.70-0.84; n = 21 183), lower odds of prolonged hospital stay ≥7 days (OR, 0.93; 95% CI, 0.88-0.99; n = 9988), and in patients who required antibiotics, an increased odds of receiving timely antibiotics (OR, 1.71; 95% CI, 1.57-1.87; n = 4622). Discussion Current evidence that digital sepsis alerts are effective is mixed. In this large UK study, a digital sepsis alert has been shown to be associated with improved outcomes, including timely antibiotics. It is not known whether the presence of alerting is responsible for improved outcomes or whether the alert acted as a useful driver for quality improvement initiatives. Conclusions These findings strongly suggest that the introduction of a network-wide digital sepsis alert is associated with improvements in patient outcomes, demonstrating that digital based interventions can be successfully introduced and readily evaluated.
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Affiliation(s)
- Kate Honeyford
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Graham S Cooke
- Infectious Diseases Section, Imperial College London, London, United Kingdom
| | - Anne Kinderlerer
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Elizabeth Williamson
- Electronic Health Records Research Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Gilchrist
- Department of Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Alison Holmes
- Health Protection Research Unit, Imperial College London, London, United Kingdom
| | | | - Ben Glampson
- Department of Research Informatics, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Abdulrahim Mulla
- Department of Research Informatics, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ceire Costelloe
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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16
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Boncea EE, Expert P, Honeyford K, Kinderlerer A, Mitchell C, Cooke GS, Mercuri L, Costelloe CE. Association between intrahospital transfer and hospital-acquired infection in the elderly: a retrospective case-control study in a UK hospital network. BMJ Qual Saf 2021; 30:457-466. [PMID: 33495288 PMCID: PMC8142451 DOI: 10.1136/bmjqs-2020-012124] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/19/2020] [Accepted: 12/23/2020] [Indexed: 11/11/2022]
Abstract
Background Intrahospital transfers have become more common as hospital staff balance patient needs with bed availability. However, this may leave patients more vulnerable to potential pathogen transmission routes via increased exposure to contaminated surfaces and contacts with individuals. Objective This study aimed to quantify the association between the number of intrahospital transfers undergone during a hospital spell and the development of a hospital-acquired infection (HAI). Methods A retrospective case–control study was conducted using data extracted from electronic health records and microbiology cultures of non-elective, medical admissions to a large urban hospital network which consists of three hospital sites between 2015 and 2018 (n=24 240). As elderly patients comprise a large proportion of hospital users and are a high-risk population for HAIs, the analysis focused on those aged 65 years or over. Logistic regression was conducted to obtain the OR for developing an HAI as a function of intrahospital transfers until onset of HAI for cases, or hospital discharge for controls, while controlling for age, gender, time at risk, Elixhauser comorbidities, hospital site of admission, specialty of the dominant healthcare professional providing care, intensive care admission, total number of procedures and discharge destination. Results Of the 24 240 spells, 2877 cases were included in the analysis. 72.2% of spells contained at least one intrahospital transfer. On multivariable analysis, each additional intrahospital transfer increased the odds of acquiring an HAI by 9% (OR=1.09; 95% CI 1.05 to 1.13). Conclusion Intrahospital transfers are associated with increased odds of developing an HAI. Strategies for minimising intrahospital transfers should be considered, and further research is needed to identify unnecessary transfers. Their reduction may diminish spread of contagious pathogens in the hospital environment.
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Affiliation(s)
- Emanuela Estera Boncea
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Paul Expert
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK.,Department of Mathematics, Imperial College London, London, UK.,Tokyo Tech World Research Hub Initiative, Tokyo Institute of Technology, Tokyo, Japan
| | - Kate Honeyford
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Anne Kinderlerer
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Colin Mitchell
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Graham S Cooke
- Infectious Diseases Section, Imperial College London, London, UK
| | - Luca Mercuri
- Information Communications and Technology Department, Imperial College Healthcare NHS Trust, London, UK
| | - Céire E Costelloe
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
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17
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Sangkaew S, Ming D, Boonyasiri A, Honeyford K, Kalayanarooj S, Yacoub S, Dorigatti I, Holmes A. Enhancing risk prediction of progression to severe disease during the febrile phase of dengue: A systematic review and meta-analysis. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.11.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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18
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Venkatraman T, Honeyford K, Costelloe CE, Bina R, M F van Sluijs E, Viner RM, Saxena S. Sociodemographic profiles, educational attainment and physical activity associated with The Daily Mile™ registration in primary schools in England: a national cross-sectional linkage study. J Epidemiol Community Health 2020; 75:137-144. [PMID: 33004657 PMCID: PMC7815899 DOI: 10.1136/jech-2020-214203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/30/2020] [Accepted: 08/14/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine primary school and local authority characteristics associated with registration for The Daily Mile (TDM), an active mile initiative aimed at increasing physical activity in children. DESIGN A cross-sectional linkage study using routinely collected data. SETTING All state-funded primary schools in England from 2012 to 2018 (n=15,815). RESULTS 3,502 of all 15,815 (22.1%) state-funded primary schools in England were registered to do TDM, ranging from 16% in the East Midlands region to 31% in Inner London. Primary schools registered for TDM had larger mean pupil numbers compared with schools that had not registered (300 vs 269, respectively). There was a higher proportion of TDM-registered schools in urban areas compared with non-urban areas. There was local authority variation in the likelihood of school registration (intraclass correlation coefficient: 0.094). After adjusting for school and local authority characteristics, schools located in a major urban conurbation (OR 1.46 (95% CI 1.24 to 1.71) urban vs rural) and schools with a higher proportion of disadvantaged pupils had higher odds of being registered for TDM (OR 1.16 (95% CI 1.02 to 1.33)). Area-based physical activity and schools' educational attainment were not significantly associated with registration to TDM. CONCLUSION One in five primary schools in England has registered for TDM since 2012. TDM appears to be a wide-reaching school-based physical activity intervention that is reaching more disadvantaged primary school populations in urban areas where obesity prevalence is highest. TDM-registered schools include those with both high and low educational attainment and are in areas with high and low physical activity.
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Affiliation(s)
| | - Kate Honeyford
- Primary Care and Public Health, Imperial College London, London, UK
| | | | - Ram Bina
- Primary Care and Public Health, Imperial College London, London, UK
| | - Esther M F van Sluijs
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Institute of Child Health, London, UK
| | - Sonia Saxena
- Primary Care and Public Health, Imperial College London, London, UK
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19
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Ram B, Venkatraman T, Foley K, Honeyford K, Ells L, van Sluijs E, Hargreaves D, Greaves F, Viner R, Saxena S. Impact of school-based physical activity interventions in primary schools: measuring what matters. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
A growing number of small studies suggest that school-based physical activity initiatives can help children achieve the recommended 60 minutes of physical activity per day. However, the heterogeneity of outcomes and measures used in small studies prevents pooling of results to demonstrate whether short-term health benefits are sustained. Qualitative studies suggest many benefits that are not represented by outcomes in trials to date. The aim of this study was to generate a list of outcomes that have been studied to develop a core outcome set (COS) acceptable to key stakeholders for future studies evaluating school-based physical activity initiatives.
Methods
We searched six databases (MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL and Cochrane Database of Systematic Reviews) systematically for reviews of school-based physical activity interventions, and extracted relevant studies to identify the outcomes and measures used in each paper. A long list was generated from the literature and a previous workshop with stakeholders. This study is registered with COMET (#1322), and with PROSPERO (CRD42019146621).
Results
75/121 cited studies drawn from 53/2409 reviews met our inclusion criteria. We grouped 65 outcomes into 3 domains: (i) physical activity and health (ii) social and emotional health, and (iii) educational attainment. We will conduct two Delphi survey rounds with four stakeholder groups (health professionals, researchers, educators and parents) to rate the importance of each outcome. A core outcome set will be generated from a consensus process.
Conclusions
There is currently a large variation of outcomes and measures studied that precludes evidence synthesis of the impact of school-based physical activity interventions. Consensus methods are needed to focus research on the outcomes that matter the most to key stakeholders and to provide tools for future studies to assess long-term impact.
Key messages
Variations in outcomes studied precludes evidence synthesis of SBPA intervention impacts. A core outcome set is needed to ensure future SBPA interventions measure outcomes that matter the most.
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Affiliation(s)
- B Ram
- Primary Care and Public Health, Imperial College London, London, UK
| | - T Venkatraman
- Primary Care and Public Health, Imperial College London, London, UK
| | - K Foley
- Primary Care and Public Health, Imperial College London, London, UK
| | - K Honeyford
- Primary Care and Public Health, Imperial College London, London, UK
| | - L Ells
- Applied Obesity Research Centre, Leeds Beckett University, Leeds, UK
| | - E van Sluijs
- Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
| | - D Hargreaves
- Primary Care and Public Health, Imperial College London, London, UK
| | - F Greaves
- Primary Care and Public Health, Imperial College London, London, UK
- Science and Strategic Information, Public Health England, London, UK
| | - R Viner
- Institute of Child Health, University College London, London, UK
| | - S Saxena
- Primary Care and Public Health, Imperial College London, London, UK
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20
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Powell N, Honeyford K, Sandoe J. Impact of penicillin allergy records on antibiotic costs and length of hospital stay: a single-centre observational retrospective cohort. J Hosp Infect 2020; 106:35-42. [DOI: 10.1016/j.jhin.2020.05.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/27/2020] [Indexed: 12/01/2022]
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21
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Giuliani S, Honeyford K, Chang CY, Bottle A, Aylin P. Outcomes of Primary versus Multiple-Staged Repair in Hirschsprung's Disease in England. Eur J Pediatr Surg 2020; 30:104-110. [PMID: 31910450 DOI: 10.1055/s-0039-3402712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The study aimed to compare 1-year outcomes for primary versus multiple-staged (three operations with colostomy) repairs in Hirschsprung's disease (HD). MATERIALS AND METHODS Retrospective analysis of a large national administrative database (Hospital Episode Statistics) including all the neonates born with HD in England between 2003 and 2015. Main outcomes were: 1-year mortality, postoperative readmissions, and reoperations. SECONDARY OUTCOMES cumulative length of hospital stay (cLOS) and hospital volume-outcome relationship. RESULTS A total of 1,333 neonates with HD were treated in 21 specialist pediatric surgical centers; 874 (65.5%) patients had a primary repair for HD. One-year mortality was 2.8%. The overall readmission rate was 70.2%, with a significant difference between primary and multiple-staged repair (79.9 vs. 90.1%, p < 0.01). There was no difference in reoperation. Primary pull-through was associated with a significantly lower probability of postoperative readmission (odds ratio [OR] = 0.08, 95% confidence interval [CI] = 0.06-0.11, p < 0.001) and cLOS (OR = 0.38, 95% CI = 0.28-0.52, p < 0.001) compared with multiple-staged repair. There were no significant difference in outcomes between patients treated in low-volume (<37 cases/year) and high-volume (> 55 cases/year) specialist centers. CONCLUSION Whenever clinically indicated, primary repair should be used in HD as this is associated with fewer readmissions and shorter time spent in the hospital.
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Affiliation(s)
- Stefano Giuliani
- Division of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Kate Honeyford
- Dr Foster Unit, Imperial College London, London, United Kingdom
| | - Chieh-Yu Chang
- Dr Foster Unit, Imperial College London, London, United Kingdom
| | - Alex Bottle
- Dr Foster Unit, Imperial College London, London, United Kingdom
| | - Paul Aylin
- Dr Foster Unit, Imperial College London, London, United Kingdom
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22
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Honeyford K, Cooke GS, Kinderlerer A, Williamson E, Gilchrist M, Holmes A, Glampson B, Mulla A, Costelloe C. Evaluating a digital sepsis alert in a multi-site hospital: a natural experiment. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
This study investigated the impact of a digital sepsis alert on patient outcomes in a busy London multi-site hospital. Sepsis is a serious illness and common cause of death, but rapid diagnosis and treatment improve patient outcomes. Digital health records allow algorithms to be embedded which ‘alert’ clinicians to patients who are at risk of developing sepsis. Despite the current promotion of ‘digital health’, evidence of the impact of algorithm driven alerts on patient outcomes is limited.
Methods
A retrospective natural experiment utilising the phased introduction of a digital sepsis alert into a large, multi-site hospital in England. Silent alerts (not visible to clinicians) acted as controls. Outcome measures were in-hospital all-cause mortality within 30 days of the alert, extended hospital stay (≥7 days) and timely antibiotics (≤60 minutes of the alert). Inversely weighted multivariable logistic regression was used to determine associations between alert and patient outcomes.
Results
In a sample of 21,183 inpatients, the mortality rate was 5.9%. The active, visible alert was associated with lower odds of death (Odds Ratio (OR):0.76; 95%CI:(0.70, 0.84)). In 9988 emergency department attendances ending in admission, 40.6% had an extended hospital stay and 41.5% received timely antibiotics. The active alert was associated with lower odds of extended hospital stay (OR:0.93; 95%CI:(0.88, 0.99)) and increased odds of receiving timely antibiotics (OR:1.71; 95%CI:(1.57, 1.87)).
Conclusions
This study demonstrates that a move to digital health, through an automated sepsis alert, embedded in digital health records, was associated with improved health outcomes. Further work is needed to identify the causal pathway, which is likely to include more rapid treatment with antibiotics, and possible unintended consequences. These findings support the ongoing roll out of digital alerting and provide a model for robustly evaluating their impact.
Key messages
The introduction of an automated sepsis alert associated with the use of improvement methodology was associated with improved process measures and patient outcomes. Introduction of digital health interventions can, and should, be robustly evaluated with appropriate statistical approaches.
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Affiliation(s)
- K Honeyford
- Global Digital Health Unit, Imperial College, London, UK
| | - G S Cooke
- Infectious Disease Section, Imperial College, London, UK
| | - A Kinderlerer
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - E Williamson
- Electronic Health Records Research, LSHTM, London, UK
| | - M Gilchrist
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - A Holmes
- HPRU-AMR, Imperial College, London, UK
| | - B Glampson
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - A Mulla
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - C Costelloe
- Global Digital Health Unit, Imperial College, London, UK
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23
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Aliabadi S, Honeyford K, Jauneikaite E, Muller-Pebody B, Costelloe C. Risk factors for E. coli Susceptibility in Bloods Stream Infections in England Between 2013-2017. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Antimicrobial resistance (AMR) is a significant threat to global health. Escherichia coli is a frequent cause of Gram-Negative Bloodstream Infections (GNBSIs) and a key organism that contributes to the burden of AMR. This was a cross-sectional surveillance study that looked at 154,791 isolates between 1st January 2013 and 31st December 2017. Analysis was performed using routine surveillance data from Public Health England (PHE) containing data on the incidence and susceptibility results of E. coli bacteraemia. Exposure variables extracted were potential risk factors for AMR. The outcome variable was resistance to at least one antibiotic. Descriptive statistics and graphs were used to summarise the data. Associations between variables and the resistance to at least one antibiotic were assessed using univariate logistic regression. A multivariable logistic regression examined adjusted associations between the variables and resistance to at least one antibiotic. The final model included variables that showed strong evidence of association with resistance to at least one antibiotic. 43.2% of isolates were resistant to at least one antibiotic. Logistic regression showed an association between resistance of E. coli isolates to at least one antibiotic and children of school age (1.39 OR, 95% CI: 1.18-1.64; p ≤ 0.001), isolates taken from patients in Greater Manchester (1.50 OR, 95% CI: 1.41-1.60; p ≤ 0.001) and isolates taken from male patients (1.14 OR, 95% CI: 1.11-1.17; p ≤ 0.001), on adjustment. Visual assessment of trend graphs showed a decrease in resistance for common carbapenems and piperacillin/tazobactam. Prevalence of resistance has increased for common cephalosporins, gentamicin, and co-amoxiclav. Initial analyses suggest an increase in rates of E. coli resistance to at least one antibiotic in GNBSIs between 2013 and 2017 in England. Findings of this study have implications for appropriate antibiotic prescribing guidelines and for directing future AMR policies.
Key messages
Initial analysis of the dataset suggests that rates of AMR of E. coli in BSIs have increased between 2013 and 2017. There is evidence of an increase in E.coli infections that are resistant to cephalosporins over time and a decrease in E.coli infections that are resistant to carbapenems.
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Affiliation(s)
- S Aliabadi
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - K Honeyford
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - E Jauneikaite
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | - C Costelloe
- Department of Primary Care and Public Health, Imperial College London, London, UK
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24
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Honeyford K, Bell D, Chowdhury F, Quint J, Aylin P, Bottle A. Unscheduled hospital contacts after inpatient discharge: A national observational study of COPD and heart failure patients in England. PLoS One 2019; 14:e0218128. [PMID: 31194792 PMCID: PMC6563993 DOI: 10.1371/journal.pone.0218128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/26/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Readmissions are a recognised challenge for providers of healthcare and incur financial penalties in a growing number of countries. However, the scale of unscheduled hospital contacts including attendances at emergency departments that do not result in admission is not well known. In addition, little is known about the route to readmission for patients recently discharged from an emergency hospital stay. Methods This is an observational study of national hospital administration data for England. In this retrospective cohort study, we tracked patients for 30 days after discharge from an emergency admission for heart failure (HF) or chronic obstructive pulmonary disorder (COPD). Results The majority of patients (COPD:79%; HF:75%) had no unscheduled contact with secondary health care within 30 days of discharge. Of those who did have unscheduled contact, the most common first unscheduled contact was emergency department (ED) attendance (COPD:16%; HF:18%). A further 5% of COPD patients and 4% of HF patients were admitted for an emergency inpatient stay, but not through the ED. A small percentage of patients (COPD:<1%, HF:2%) died without any known contact with secondary care. ED conversion rates at first attendance for both COPD and HF were high: 75% and 79% respectively. A quarter of patients who were not admitted during this first ED attendance attended the ED again within the 30-day follow-up period, and around half (COPD:56%; HF:63%) of these were admitted at this point. Patients who live alone, had an index admission which included an overnight stay and were comorbid had higher odds of being admitted through the ED than via other routes. Conclusion While the majority of patients did not have unscheduled contact with secondary care in the 30 days after index discharge, many patients attended the ED, often multiple times, and many were admitted to hospital, not always via the ED. More frail patients were more likely to be admitted through the ED, suggesting a possible area of focus as discharge bundles are developed.
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Affiliation(s)
- Kate Honeyford
- Digital Health Unit, Department of Primary Care and Public Health, Imperial College, London, United Kingdom
- * E-mail:
| | - Derek Bell
- School of Public Health, Imperial College London, Chelsea and Westminster Campus, London, United Kingdom
| | - Faiza Chowdhury
- NIHR CLAHRC for North West London, Imperial College London, Chelsea & Westminster Campus, London, United Kingdom
| | - Jennifer Quint
- National Heart and Lung Institute, Imperial College London, Royal Brompton Campus, London, United Kingdom
| | - Paul Aylin
- Dr Foster Unit, Department of Primary care and Public Health, Imperial College, London, United Kingdom
| | - Alex Bottle
- Dr Foster Unit, Department of Primary care and Public Health, Imperial College, London, United Kingdom
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Blandy O, Honeyford K, Gharbi M, Thomas A, Ramzan F, Ellington M, Hope R, Holmes A, Johnson A, Aylin P, Woodford N, Sriskandan S. Factors that impact on the burden of Escherichia coli bacteraemia: multivariable regression analysis of 2011–2015 data from West London. J Hosp Infect 2019; 101:120-128. [DOI: 10.1016/j.jhin.2018.10.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/30/2018] [Indexed: 11/24/2022]
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Wang Y, Honeyford K, Aylin P, Bottle A, Giuliani S. One-year outcomes for congenital diaphragmatic hernia. BJS Open 2019; 3:305-313. [PMID: 31183446 PMCID: PMC6551417 DOI: 10.1002/bjs5.50135] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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] [Received: 10/03/2018] [Accepted: 11/27/2018] [Indexed: 11/20/2022] Open
Abstract
Background Congenital diaphragmatic hernia (CDH) is a congenital anomaly with high mortality and long‐term morbidity. The aim of this study was to benchmark trends in 1‐year and hospital volume outcomes for this condition. Methods This study included all infants born with CDH in England between 2003 and 2016. This was a retrospective analysis of the Hospital Episode Statistics database. The main outcomes were: 1‐year mortality, neonatal length of hospital stay (nLOS), total bed‐days at 1 year and readmission rate. The association between hospital volume and outcomes was assessed for specialist paediatric surgery centres. Results A total of 2336 infants were included (incidence 2·5 per 10 000 live births). No significant time trends were found in incidence and main outcomes. Some 1491 infants (63·8 per cent) underwent surgical repair. The 1‐year mortality rate was 31·2 per cent. Median nLOS and total bed‐days were 17 and 19 days respectively. The readmission rate in specialist paediatric centres was 6·3 per cent. Higher mortality was associated with birthweight lower than 1 kg (OR 5·90, 95 per cent c.i. 1·03 to 33·75), gestational age of 36 weeks or less (OR 1·75, 1·12 to 2·75) and black ethnicity (OR 2·13, 1·03 to 4·48). Only 4·0 per cent had extracorporeal membrane oxygenation, which was associated with higher mortality (OR 5·34, 3·01 to 9·46), longer nLOS (OR 3·70, 2·14 to 6·14) and longer total bed‐days (OR 3·87, 2·19 to 6·83). Specialist paediatric centres showed variation in 30‐day mortality (4·6 per cent with 84 per cent coefficient of variation), nLOS (median 25 (i.q.r. 15–42) days) and total bed‐days (median 28 (i.q.r. 16–51) days), but no significant volume–outcome relationship. Conclusion Key outcomes for CDH were similar to those of other developed countries. High variation among specialist paediatric centres was found and should be investigated further to explore the value of regionalization of care.
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Affiliation(s)
- Y Wang
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London London UK
| | - K Honeyford
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London London UK
| | - P Aylin
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London London UK
| | - A Bottle
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London London UK
| | - S Giuliani
- Department of Specialist Neonatal and Paediatric Surgery Great Ormond Street Hospital for Children NHS Foundation Trust London UK
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Honeyford K, Cecil E, Lo M, Bottle A, Aylin P. The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis. BMC Health Serv Res 2018; 18:870. [PMID: 30458758 PMCID: PMC6245775 DOI: 10.1186/s12913-018-3688-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/05/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The concept of a weekend effect, poorer outcomes for patients admitted to hospitals at the weekend is not new, but is the focus of debate in England. Many studies have been published which consider outcomes for patients on admitted at the weekend. This systematic review and meta-analysis aims to estimate the effect of weekend admission on mortality in UK hospitals. METHODS This is a systematic review and meta-analysis of published studies on the weekend effect in UK hospitals. We used EMBASE, MEDLINE, HMIC, Cochrane, Web of Science and Scopus to search for relevant papers. We included systematic reviews, randomised controlled trials and observational studies) on patients admitted to hospital in the UK and published after 2001. Our outcome was death; studies reporting mortality were included. Reviewers identified studies, extracted data and assessed the quality of the evidence, independently and in duplicate. Discrepancy in assessment was considered by a third reviewer. All meta-analyses were performed using a random-effects meta-regression to incorporate the heterogeneity into the weighting. RESULTS Forty five articles were included in the qualitative synthesis. 53% of the articles concluded that outcomes for patients either undergoing surgery or admitted at the weekend were worse. We included 39 in the meta-analysis which contributed 50 separate analyses. We found an overall effect of 1.07 [odds ratio (OR)] (95%CI:1.03-1.12), suggesting that patients admitted at the weekend had higher odds of mortality than those admitted during the week. Sub-group analyses suggest that the weekend effect remained when measures of case mix severity were included in the models (OR:1.06 95%CI:1.02-1.10), but that the weekend effect was not significant when clinical registry data was used (OR:1.03 95%CI: 0.98-1.09). Heterogeneity was high, which may affect generalisability. CONCLUSIONS Despite high levels of heterogeneity, we found evidence of a weekend effect in the UK, even after accounting for severity of disease. Further work is required to examine other potential explanations for the "weekend effect" such as staffing levels and other organisational factors. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews -registration number: CRD42016041225 .
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Affiliation(s)
- Kate Honeyford
- Department of Primary Care and Public Health, Dr Foster Unit at Imperial College, 3 Dorset Rise, London, EC4Y 8EN, UK.
| | - Elizabeth Cecil
- Department of Primary Care and Public Health, Dr Foster Unit at Imperial College, 3 Dorset Rise, London, EC4Y 8EN, UK
| | - Michelle Lo
- Department of Family Medicine and Primary Healthcare, Hospital Authority, Hong Kong, Hong Kong
| | - Alex Bottle
- Department of Primary Care and Public Health, Dr Foster Unit at Imperial College, 3 Dorset Rise, London, EC4Y 8EN, UK
| | - Paul Aylin
- Department of Primary Care and Public Health, Dr Foster Unit at Imperial College, 3 Dorset Rise, London, EC4Y 8EN, UK
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Bottle A, Honeyford K, Chowdhury F, Bell D, Aylin P. Factors associated with hospital emergency readmission and mortality rates in patients with heart failure or chronic obstructive pulmonary disease: a national observational study. Health Serv Deliv Res 2018. [PMID: 30044581 DOI: 10.3310/hsdr06260] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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
BackgroundHeart failure (HF) and chronic obstructive pulmonary disease (COPD) lead to unplanned hospital activity, but our understanding of what drives this is incomplete.ObjectivesTo model patient, primary care and hospital factors associated with readmission and mortality for patients with HF and COPD, to assess the statistical performance of post-discharge emergency department (ED) attendance compared with readmission metrics and to compare all the results for the two conditions.DesignObservational study.SettingEnglish NHS.ParticipantsAll patients admitted to acute non-specialist hospitals as an emergency for HF or COPD.InterventionsNone.Main outcome measuresOne-year mortality and 30-day emergency readmission following the patient’s first unplanned admission (‘index admission’) for HF or COPD.Data sourcesPatient-level data from Hospital Episodes Statistics were combined with publicly available practice- and hospital-level data on performance, patient and staff experience and rehabilitation programme website information.ResultsOne-year mortality rates were 39.6% for HF and 24.1% for COPD and 30-day readmission rates were 19.8% for HF and 16.5% for COPD. Most patients were elderly with multiple comorbidities. Patient factors predicting mortality included older age, male sex, white ethnicity, prior missed outpatient appointments, (long) index length of hospital stay (LOS) and several comorbidities. Older age, missed appointments, (short) LOS and comorbidities also predicted readmission. Of the practice and hospital factors we considered, only more doctors per 10 beds [odds ratio (OR) 0.95 per doctor;p < 0.001] was significant for both cohorts for mortality, with staff recommending to friends and family (OR 0.80 per unit increase;p < 0.001) and number of general practitioners (GPs) per 1000 patients (OR 0.89 per extra GP;p = 0.004) important for COPD. For readmission, only hospital size [OR per 100 beds = 2.16, 95% confidence interval (CI) 1.34 to 3.48 for HF, and 2.27, 95% CI 1.40 to 3.66 for COPD] and doctors per 10 beds (OR 0.98;p < 0.001) were significantly associated. Some factors, such as comorbidities, varied in importance depending on the readmission diagnosis. ED visits were common after the index discharge, with 75% resulting in admission. Many predictors of admission at this visit were as for readmission minus comorbidities and plus attendance outside the day shift and numbers of admissions that hour. Hospital-level rates for ED attendance varied much more than those for readmission, but the omega statistics favoured them as a performance indicator.LimitationsData lacked direct information on disease severity and ED attendance reasons; NHS surveys were not specific to HF or COPD patients; and some data sets were aggregated.ConclusionsFollowing an index admission for HF or COPD, older age, prior missed outpatient appointments, LOS and many comorbidities predict both mortality and readmission. Of the aggregated practice and hospital information, only doctors per bed and numbers of hospital beds were strongly associated with either outcome (both negatively). The 30-day ED visits and diagnosis-specific readmission rates seem to be useful performance indicators.Future workHospital variations in ED visits could be investigated using existing data despite coding limitations. Primary care management could be explored using individual-level linked databases.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Alex Bottle
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Kate Honeyford
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Faiza Chowdhury
- Department of Acute Medicine, Chelsea and Westminster Hospital, Imperial College London, London, UK
- National Institute for Health Research under the Collaborations for Leadership in Applied Health Research and Care Programme North West London, Imperial College London, London, UK
| | - Derek Bell
- Department of Acute Medicine, Chelsea and Westminster Hospital, Imperial College London, London, UK
- National Institute for Health Research under the Collaborations for Leadership in Applied Health Research and Care Programme North West London, Imperial College London, London, UK
- Royal College of Physicians, Edinburgh, UK
| | - Paul Aylin
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
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Bou-Antoun S, Costelloe C, Honeyford K, Mazidi M, Hayhoe BWJ, Holmes A, Johnson AP, Aylin P. Age-related decline in antibiotic prescribing for uncomplicated respiratory tract infections in primary care in England following the introduction of a national financial incentive (the Quality Premium) for health commissioners to reduce use of antibiotics in the community: an interrupted time series analysis. J Antimicrob Chemother 2018; 73:2883-2892. [DOI: 10.1093/jac/dky237] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/22/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sabine Bou-Antoun
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Ceire Costelloe
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Kate Honeyford
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Mahsa Mazidi
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Benedict W J Hayhoe
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Alison Holmes
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Alan P Johnson
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Department of Healthcare-Associated Infections and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - Paul Aylin
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Honeyford K, Greaves F, Aylin P, Bottle A. Secondary analysis of hospital patient experience scores across England's National Health Service - How much has improved since 2005? PLoS One 2017; 12:e0187012. [PMID: 29073218 PMCID: PMC5658118 DOI: 10.1371/journal.pone.0187012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/14/2016] [Accepted: 10/11/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine trends in patient experience and consistency between hospital trusts and settings. METHODS Observational study of publicly available patient experience surveys of three hospital settings (inpatients (IP), accident and emergency (A&E) and outpatients (OP)) of 130 acute NHS hospital trusts in England between 2004/05 and 2014/15. RESULTS Overall patient experience has been good, showing modest improvements over time across the three hospital settings. Individual questions with the biggest improvement across all three settings are cleanliness (IP: +7.1, A&E: +6.5, OP: +4.7) and information about danger signals (IP: +3.8, A&E: +3.9, OP: +4.0). Trust performance has been consistent over time: 71.5% of trusts ranked in the same cluster for more than five years. There is some consistency across settings, especially between outpatients and inpatients. The lowest-scoring questions, regarding information at discharge, are the same in all years and all settings. CONCLUSIONS The greatest improvement across all three settings has been for cleanliness, which has seen national policies and targets. Information about danger signals and medication side-effects showed least consistency across settings and scores have remained low over time, despite information about danger signals showing a big increase in score. Patient experience of aspects of access and waiting have declined, as has experience of discharge delay, likely reflecting known increases in pressure on England's NHS.
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Affiliation(s)
- Kate Honeyford
- Dr Foster Unit at Imperial College, London, England
- * E-mail:
| | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College, London, England
| | - Paul Aylin
- Dr Foster Unit at Imperial College, London, England
| | - Alex Bottle
- Dr Foster Unit at Imperial College, London, England
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Honeyford K, Bell D, Aylin P, Bottle A. 5 The relation between length of stay, a&e attendance and readmission for heart failure patients. Heart 2017. [DOI: 10.1136/heartjnl-2017-311726.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Baker R, Honeyford K, Levene LS, Mainous AG, Jones DR, Bankart MJ, Stokes T. Population characteristics, mechanisms of primary care and premature mortality in England: a cross-sectional study. BMJ Open 2016; 6:e009981. [PMID: 26868945 PMCID: PMC4762103 DOI: 10.1136/bmjopen-2015-009981] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Health systems with strong primary care tend to have better population outcomes, but in many countries demand for care is growing. We sought to identify mechanisms of primary care that influence premature mortality. DESIGN We developed a conceptual model of the mechanisms by which primary care influences premature mortality, and undertook a cross-sectional study in which population and primary care variables reflecting the model were used to explain variations in mortality of those aged under 75 years. The premature standardised mortality ratios (SMRs) for each practice, available from the Department of Health, had been calculated from numbers of deaths in the 5 years from 2006 to 2010. A regression model was undertaken with explanatory variables for the year 2009/2010, and repeated to check stability using data for 2008/2009 and 2010/2011. SETTING All general practices in England were eligible for inclusion and, of the total of 8290, complete data were available for 7858. RESULTS Population variables, particularly deprivation, were the most powerful predictors of premature mortality, but the mechanisms of primary care depicted in our model also affected mortality. The number of GPs/1000 population and detection of hypertension were negatively associated with mortality. In less deprived practices, continuity of care was also negatively associated with mortality. CONCLUSIONS Greater supply of primary care is associated with lower premature mortality even in a health system that has strong primary care (England). Health systems need to sustain the capacity of primary care to deliver effective care, and should assist primary care providers in identifying and meeting the needs of socioeconomically deprived groups.
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Affiliation(s)
- Richard Baker
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kate Honeyford
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Louis S Levene
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Arch G Mainous
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
| | - David R Jones
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - M John Bankart
- Department of Primary Care and Health Sciences, University of Keele, Keele, UK
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Abstract
OBJECTIVES To determine to what extent underlying data published as part of Quality and Outcomes Framework (QOF) can be used to estimate smoking prevalence within practice populations and local areas and to explore the usefulness of these estimates. DESIGN Cross-sectional, observational study of QOF smoking data. Smoking prevalence in general practice populations and among patients with chronic conditions was estimated by simple manipulation of QOF indicator data. Agreement between estimates from the integrated household survey (IHS) and aggregated QOF-based estimates was calculated. The impact of including smoking estimates in negative binomial regression models of counts of premature coronary heart disease (CHD) deaths was assessed. SETTING Primary care in the East Midlands. PARTICIPANTS All general practices in the area of study were eligible for inclusion (230). 14 practices were excluded due to incomplete QOF data for the period of study (2006/2007-2012/2013). One practice was excluded as it served a restricted practice list. MEASUREMENTS Estimates of smoking prevalence in general practice populations and among patients with chronic conditions. RESULTS Median smoking prevalence in the practice populations for 2012/2013 was 19.2% (range 5.8-43.0%). There was good agreement (mean difference: 0.39%; 95% limits of agreement (-3.77, 4.55)) between IHS estimates for local authority districts and aggregated QOF register estimates. Smoking prevalence estimates in those with chronic conditions were lower than for the general population (mean difference -3.05%), but strongly correlated (Rp=0.74, p<0.0001). An important positive association between premature CHD mortality and smoking prevalence was shown when smoking prevalence was added to other population and service characteristics. CONCLUSIONS Published QOF data allow useful estimation of smoking prevalence within practice populations and in those with chronic conditions; the latter estimates may sometimes be useful in place of the former. It may also provide useful estimates of smoking prevalence in local areas by aggregating practice based data.
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Affiliation(s)
- Kate Honeyford
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Richard Baker
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - M John G Bankart
- Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - David R Jones
- Department of Health Sciences, University of Leicester, Leicester, UK
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Abstract
OBJECTIVES To identify features of primary care quality improvement associated with improved health outcomes using premature coronary heart disease (CHD) mortality as an example, and to determine impacts of different modelling approaches. DESIGN Cross-sectional study of mortality rates in 229 general practices. SETTING General practices from three East Midlands primary care trusts. PARTICIPANTS Patients registered to the practices above between April 2006 and March 2009. MAIN OUTCOME MEASURES Numbers of CHD deaths in those aged under 75 (premature mortality) and at all ages in each practice. RESULTS Population characteristics and markers of quality of primary care were associated with variations in premature CHD mortality. Increasing levels of deprivation, percentages of practice populations on practice diabetes registers, white, over 65 and male were all associated with increasing levels of premature CHD mortality. Control of serum cholesterol levels in those with CHD and the percentage of patients recalling access to their preferred general practitioner were both associated with decreased levels of premature CHD mortality. Similar results were found for all-age mortality. A combined measure of quality of primary care for CHD comprising 12 quality outcomes framework indicators was associated with decreases in both all-age and premature CHD mortality. The selected models suggest that practices in less deprived areas may have up to 20% lower premature CHD mortality than those with median deprivation and that improvement in the CHD care quality from 83% (lower quartile) to 86% (median) could reduce premature CHD mortality by 3.6%. Different modelling approaches yielded qualitatively similar results. CONCLUSIONS High-quality primary care, including aspects of access to and continuity of care, detection and management, appears to be associated with reducing CHD mortality. The impact on premature CHD mortality is greater than on all-age CHD mortality. Determining the most useful measures of quality of primary care needs further consideration.
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Affiliation(s)
- Kate Honeyford
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Richard Baker
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - M John G Bankart
- Insitute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - David Jones
- Department of Health Sciences, University of Leicester, Leicester, UK
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