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Windle N, Alam A, Patel H, Street JM, Lathwood M, Farrington T, Maruthappu M. A Retrospective Cohort Study Evaluating the Association Between Implementation of a Digital Care Plan and Hospitalization Rates for Home Care Residents in the United Kingdom. Home Health Care Management & Practice 2022. [DOI: 10.1177/10848223221135560] [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: 12/12/2022]
Abstract
Cera, a homecare provider, uses digital care plans (DCP), to streamline the provision of home care. DCP rollout is part of a larger digitization initiative, including carer visit reports collected through a mobile app and branch actions recorded in a web application supported by a secure central database. This retrospective cohort study aimed to assess the association of a DCP rollout with service user hospitalization rates. his study utilized retrospective data from 2 groups of service users, those for whom their first 30 days of Cera membership occurred prior to DCP rollout (pre-DCP group) versus those whose first 30 days of Cera membership occurred after DCP rollout (post-DCP group). The 30-day hospitalization rate was the primary outcome measure and was determined through a combination of carer reports, reporting from service users or their families, and branch staff follow-up. There were 55 hospitalizations among 392 users in the pre-DCP group in the 30 days after joining Cera (14.0% hospitalization rate), compared to 23 hospitalizations among 297 users in the post-DCP group (7.7% hospitalization rate). This represented a significant reduction in hospitalizations in the post-DCP group (6.3% absolute difference in hospitalization rate; 45% relative reduction; P < .001). This result was robust to multiple sensitivity analyses. The implementation of a DCP was associated with a 45% relative reduction in the 30-day hospitalization rate for new service users when compared to pre-DCP enrollment. These benefits could be further amplified by combining the DCP with additional initiatives aimed at the prediction and prevention of avoidable hospitalizations.
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Manimaran M, Arora A, Lovejoy CA, Gao W, Maruthappu M. Role of artificial intelligence and machine learning in haematology. J Clin Pathol 2022; 75:585-587. [PMID: 35470252 DOI: 10.1136/jclinpath-2021-208127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/14/2022] [Indexed: 11/03/2022]
Affiliation(s)
| | | | - Christopher A Lovejoy
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
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Cecula P, Behan SD, Maruthappu M. COVID-19: Challenges and opportunities in the care sector. EClinicalMedicine 2020; 23:100390. [PMID: 32395708 PMCID: PMC7211576 DOI: 10.1016/j.eclinm.2020.100390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Paulina Cecula
- Imperial College London Medicine, United Kingdom
- Corresponding author.
| | - Sir David Behan
- Cera Care Advisory Board, Former CEO, Care Quality Commission (CQC),United Kingdom
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Watkins J, Maruthappu M. Public health and economic responses to COVID-19: finding the tipping point. Public Health 2020; 191:21-22. [PMID: 33476938 PMCID: PMC7245272 DOI: 10.1016/j.puhe.2020.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- J Watkins
- PILAR Research and Education, London, UK.
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Nagendran M, Chen Y, Lovejoy CA, Gordon AC, Komorowski M, Harvey H, Topol EJ, Ioannidis JPA, Collins GS, Maruthappu M. Artificial intelligence versus clinicians: systematic review of design, reporting standards, and claims of deep learning studies. BMJ 2020; 368:m689. [PMID: 32213531 PMCID: PMC7190037 DOI: 10.1136/bmj.m689] [Citation(s) in RCA: 395] [Impact Index Per Article: 98.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To systematically examine the design, reporting standards, risk of bias, and claims of studies comparing the performance of diagnostic deep learning algorithms for medical imaging with that of expert clinicians. DESIGN Systematic review. DATA SOURCES Medline, Embase, Cochrane Central Register of Controlled Trials, and the World Health Organization trial registry from 2010 to June 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised trial registrations and non-randomised studies comparing the performance of a deep learning algorithm in medical imaging with a contemporary group of one or more expert clinicians. Medical imaging has seen a growing interest in deep learning research. The main distinguishing feature of convolutional neural networks (CNNs) in deep learning is that when CNNs are fed with raw data, they develop their own representations needed for pattern recognition. The algorithm learns for itself the features of an image that are important for classification rather than being told by humans which features to use. The selected studies aimed to use medical imaging for predicting absolute risk of existing disease or classification into diagnostic groups (eg, disease or non-disease). For example, raw chest radiographs tagged with a label such as pneumothorax or no pneumothorax and the CNN learning which pixel patterns suggest pneumothorax. REVIEW METHODS Adherence to reporting standards was assessed by using CONSORT (consolidated standards of reporting trials) for randomised studies and TRIPOD (transparent reporting of a multivariable prediction model for individual prognosis or diagnosis) for non-randomised studies. Risk of bias was assessed by using the Cochrane risk of bias tool for randomised studies and PROBAST (prediction model risk of bias assessment tool) for non-randomised studies. RESULTS Only 10 records were found for deep learning randomised clinical trials, two of which have been published (with low risk of bias, except for lack of blinding, and high adherence to reporting standards) and eight are ongoing. Of 81 non-randomised clinical trials identified, only nine were prospective and just six were tested in a real world clinical setting. The median number of experts in the comparator group was only four (interquartile range 2-9). Full access to all datasets and code was severely limited (unavailable in 95% and 93% of studies, respectively). The overall risk of bias was high in 58 of 81 studies and adherence to reporting standards was suboptimal (<50% adherence for 12 of 29 TRIPOD items). 61 of 81 studies stated in their abstract that performance of artificial intelligence was at least comparable to (or better than) that of clinicians. Only 31 of 81 studies (38%) stated that further prospective studies or trials were required. CONCLUSIONS Few prospective deep learning studies and randomised trials exist in medical imaging. Most non-randomised trials are not prospective, are at high risk of bias, and deviate from existing reporting standards. Data and code availability are lacking in most studies, and human comparator groups are often small. Future studies should diminish risk of bias, enhance real world clinical relevance, improve reporting and transparency, and appropriately temper conclusions. STUDY REGISTRATION PROSPERO CRD42019123605.
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Affiliation(s)
- Myura Nagendran
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, UK
| | - Yang Chen
- Institute of Cardiovascular Science, University College London, UK
| | | | - Anthony C Gordon
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, UK
- Centre for Perioperative and Critical Care Research, Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Eric J Topol
- Scripps Research Translational Institute, La Jolla, California, USA
| | - John P A Ioannidis
- Departments of Medicine, of Health Research and Policy, of Biomedical Data Sciences, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Gary S Collins
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, UK
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Affiliation(s)
- Dina Radenkovic
- Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Sir Bruce Keogh
- Birmingham Women's and Children's NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2TG, UK
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Lovejoy CA, Keogh B, Maruthappu M. How will artificial intelligence affect diagnosis and treatment of liver disease? Dig Liver Dis 2019; 51:1350-1352. [PMID: 31315815 DOI: 10.1016/j.dld.2019.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 06/25/2019] [Indexed: 12/11/2022]
Affiliation(s)
| | - Bruce Keogh
- Birmingham Women's and Children's Hospital NHS Foundation Trust, United Kingdom
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Lovejoy CA, Phillips E, Maruthappu M. Application of artificial intelligence in respiratory medicine: Has the time arrived? Respirology 2019; 24:1136-1137. [DOI: 10.1111/resp.13676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 07/29/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Christopher A. Lovejoy
- Emergency Department, St George's Hospital, St George's University Hospitals NHS Foundation Trust London UK
- Cera Care London UK
| | - Edward Phillips
- Department of Medicine, Northwick Park Hospital, London Northwest University Healthcare NHS Trust London UK
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Abstract
OBJECTIVES To examine the association between financial performance as measured by operating margin (surplus/deficit as a proportion of turnover) and clinical outcomes in English National Health Service (NHS) trusts. SETTING Longitudinal, observational study in 149 acute NHS trusts in England between the financial years 2011 and 2016. PARTICIPANTS Our analysis focused on outcomes at individual NHS Trust-level (composed of one or more acute hospitals). PRIMARY AND SECONDARY OUTCOMES Outcome measures included readmissions, inpatient satisfaction score and the following process measures: emergency department (Accident and Emergency (A&E)) waiting time targets, cancer referral and treatment targets and delayed transfers of care (DTOCs). RESULTS There was a progressive increase in the proportion of trusts in financial deficit: 22% in 2011, 27% in 2012, 28% in 2013, 51% in 2014, 68% in 2015 and 91% in 2016. In linear regression analyses, there was no significant association between operating margin and clinical outcomes (readmission rate or inpatient satisfaction score). There was, however, a significant association between operating margin and process measures (DTOCs, A&E breaches and cancer waiting time targets). Between the best and worst financially performing Trusts, there was an approximately 2-fold increase in A&E breaches and DTOCs overall although this variation decreased over the 6 years. Between the best and worst performing trusts on cancer targets, the magnitude of difference was smaller (1.16 and 1.15-fold), although the variation slowly rose during the 6 years. CONCLUSIONS Operating margins in English NHS trusts progressively worsened during 2011-2016, and this change was associated with poorer performance on several process measures but not with hospital readmissions or inpatient satisfaction. Significant variation exists between the best and worst financially performing Trusts. Further research is needed to examine the causal nature of relationships between financial performance, process measures and outcomes.
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Affiliation(s)
- Myura Nagendran
- NIHR Academic Clinical Fellow, Section of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
| | - Grace Kiew
- Foundation Doctor, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Rosalind Raine
- Professor, Department of Applied Health Care, University College London, London, UK
| | - Rifat Atun
- Professor, Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
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Affiliation(s)
- Christopher A Lovejoy
- Cera Care, London, UK. .,St George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
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Salciccioli JD, Marshall DC, Shalhoub J, Maruthappu M, De Carlo G, Chung KF. Respiratory disease mortality in the United Kingdom compared with EU15+ countries in 1985-2015: observational study. BMJ 2018; 363:k4680. [PMID: 30487157 PMCID: PMC6259045 DOI: 10.1136/bmj.k4680] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare age standardised death rates for respiratory disease mortality between the United Kingdom and other countries with similar health system performance. DESIGN Observational study. SETTING World Health Organization Mortality Database, 1985-2015. PARTICIPANTS Residents of the UK, Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden, Australia, Canada, the United States, and Norway (also known as EU15+ countries). MAIN OUTCOME MEASURES Mortality from all respiratory disease and infectious, neoplastic, interstitial, obstructive, and other respiratory disease. Differences between countries were tested over time by mixed effect regression models, and trends in subcategories of respiratory related diseases assessed by a locally weighted scatter plot smoother. RESULTS Between 1985 and 2015, overall mortality from respiratory disease in the UK and EU15+ countries decreased for men and remained static for women. In the UK, the age standardised death rate (deaths per 100 000 people) for respiratory disease mortality in the UK fell from 151 to 89 for men and changed from 67 to 68 for women. In EU15+ countries, the corresponding changes were from 108 to 69 for men and from 35 to 37 in women. The UK had higher mortality than most EU15+ countries for obstructive, interstitial, and infectious subcategories of respiratory disease in both men and women. CONCLUSION Mortality from overall respiratory disease was higher in the UK than in EU15+ countries between 1985 and 2015. Mortality was reduced in men, but remained the same in women. Mortality from obstructive, interstitial, and infectious respiratory disease was higher in the UK than in EU15+ countries.
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Affiliation(s)
- Justin D Salciccioli
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA 02138, USA
| | - Dominic C Marshall
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
| | - Joseph Shalhoub
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Giuseppe De Carlo
- European Federation of Allergy and Airways Diseases Patients Associations, Brussels, Belgium
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Foundation NHS Trust, London, UK
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Affiliation(s)
- Christopher A Lovejoy
- Cera Care, London, United Kingdom; Department of Psychiatry, Springfield University Hospital, South West London and St George's Mental Health NHS Trust, United Kingdom.
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Affiliation(s)
- Mahiben Maruthappu
- Cera Care, Office 4, 219 Kensington High Street, Kensington, London W8 6BD, UK
| | - Dominic C Marshall
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Marshall DC, Goodson RJ, Xu Y, Komorowski M, Shalhoub J, Maruthappu M, Salciccioli JD. Trends in mortality from pneumonia in the Europe union: a temporal analysis of the European detailed mortality database between 2001 and 2014. Respir Res 2018; 19:81. [PMID: 29728122 PMCID: PMC5935998 DOI: 10.1186/s12931-018-0781-4] [Citation(s) in RCA: 28] [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: 09/12/2017] [Accepted: 04/17/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Pneumonia is responsible for approximately 230,000 deaths in Europe, annually. Comprehensive and comparable reports on pneumonia mortality trends across the European Union (EU) are lacking. METHODS A temporal analysis of national mortality statistics to compare trends in pneumonia age-standardised death rates (ASDR) of EU countries between 2001 and 2014 was performed. International Classification of Diseases version 10 (ICD-10) codes were used to extract data from the World Health Organisation European Detailed Mortality Database and trends were analysed using Joinpoint regression. RESULTS Median pneumonia mortality across the EU for the last recorded observation was 19.8 / 100,000 and 6.9 / 100,000 for males and females, respectively. Mortality was higher in males across all EU countries, most notably in Estonia and Lithuania where the ratio of male to female ASDR was 4.0 and 3.7, respectively. Gender mortality differences were lowest in the UK and Demark with ASDR ratios of 1.1 and 1.5, respectively. Pneumonia mortality across all countries decreased by a median of 31.0% over the observation period. Countries that demonstrated an increase in pneumonia mortality were Poland (males + 33.1%, females + 10.2%), and Lithuania (males + 6.0%). CONCLUSIONS Mortality from pneumonia is improving in most EU countries, however substantial variation in trends remains between countries and between genders.
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Affiliation(s)
- Dominic C Marshall
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
| | - Ross J Goodson
- Department of Medicine, Imperial College London, London, UK
| | - Yiwang Xu
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Matthieu Komorowski
- Department of Medicine, Imperial College London, London, UK. .,Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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Zhou CD, Head MG, Marshall DC, Gilbert BJ, El-Harasis MA, Raine R, O'Connor H, Atun R, Maruthappu M. A systematic analysis of UK cancer research funding by gender of primary investigator. BMJ Open 2018; 8:e018625. [PMID: 29712689 PMCID: PMC5931297 DOI: 10.1136/bmjopen-2017-018625] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To categorically describe cancer research funding in the UK by gender of primary investigator (PIs). DESIGN Systematic analysis of all open-access data. METHODS Data about public and philanthropic cancer research funding awarded to UK institutions between 2000 and 2013 were obtained from several sources. Fold differences were used to compare total investment, award number, mean and median award value between male and female PIs. Mann-Whitney U tests were performed to determine statistically significant associations between PI gender and median grant value. RESULTS Of the studies included in our analysis, 2890 (69%) grants with a total value of £1.82 billion (78%) were awarded to male PIs compared with 1296 (31%) grants with a total value of £512 million (22%) awarded to female PIs. Male PIs received 1.3 times the median award value of their female counterparts (P<0.001). These apparent absolute and relative differences largely persisted regardless of subanalyses. CONCLUSIONS We demonstrate substantial differences in cancer research investment awarded by gender. Female PIs clearly and consistently receive less funding than their male counterparts in terms of total investment, the number of funded awards, mean funding awarded and median funding awarded.
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Affiliation(s)
- Charlie D Zhou
- Department of Nuclear Medicine, Royal Free NHS Foundation Trust, London, UK
| | - Michael G Head
- Faculty of Medicine, Institute for Life Sciences, Global Health Research Institute, University of Southampton, Southampton, UK
| | - Dominic C Marshall
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
| | | | | | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Henrietta O'Connor
- School of Media, Communication and Sociology, University of Leicester, Leicester, UK
| | - Rifat Atun
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Mahiben Maruthappu
- Department of Epidemiology and Public Health, University College London, London, UK
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Affiliation(s)
| | - G Varughese
- University Hospitals of North Midlands, Stoke-On-Trent, UK
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Li N, Marshall D, Sykes M, McCulloch P, Shalhoub J, Maruthappu M. Systematic review of methods for quantifying teamwork in the operating theatre. BJS Open 2018; 2:42-51. [PMID: 29951628 PMCID: PMC5952378 DOI: 10.1002/bjs5.40] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/28/2017] [Indexed: 12/22/2022] Open
Abstract
Background Teamwork in the operating theatre is becoming increasingly recognized as a major factor in clinical outcomes. Many tools have been developed to measure teamwork. Most fall into two categories: self‐assessment by theatre staff and assessment by observers. A critical and comparative analysis of the validity and reliability of these tools is lacking. Methods MEDLINE and Embase databases were searched following PRISMA guidelines. Content validity was assessed using measurements of inter‐rater agreement, predictive validity and multisite reliability, and interobserver reliability using statistical measures of inter‐rater agreement and reliability. Quantitative meta‐analysis was deemed unsuitable. Results Forty‐eight articles were selected for final inclusion; self‐assessment tools were used in 18 and observational tools in 28, and there were two qualitative studies. Self‐assessment of teamwork by profession varied with the profession of the assessor. The most robust self‐assessment tool was the Safety Attitudes Questionnaire (SAQ), although this failed to demonstrate multisite reliability. The most robust observational tool was the Non‐Technical Skills (NOTECHS) system, which demonstrated both test–retest reliability (P > 0·09) and interobserver reliability (Rwg = 0·96). Conclusion Self‐assessment of teamwork by the theatre team was influenced by professional differences. Observational tools, when used by trained observers, circumvented this.
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Affiliation(s)
- N Li
- Department of General Surgery Wexham Park Hospital Slough UK
| | - D Marshall
- Department of Medicine Imperial College London London UK
| | - M Sykes
- Department of Medicine Imperial College London London UK
| | - P McCulloch
- Nuffield Department of Surgery University of Oxford Oxford UK
| | - J Shalhoub
- Department of Surgery and Cancer Imperial College London London UK
| | - M Maruthappu
- Department of Medicine Imperial College London London UK
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Gray M, Sood H, Maruthappu M, Moss F. Training for population and personalised healthcare. J R Soc Med 2017; 110:476-482. [PMID: 29171781 DOI: 10.1177/0141076817741245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Muir Gray
- 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Harpreet Sood
- 2 Associate Chief Clinical Information Officer, NHS England, London SE1 6LH, UK
| | | | - Fiona Moss
- 4 Royal Society of Medicine, London W1G 0AE, UK
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Watkins J, Wulaningsih W, Da Zhou C, Marshall DC, Sylianteng GDC, Dela Rosa PG, Miguel VA, Raine R, King LP, Maruthappu M. Effects of health and social care spending constraints on mortality in England: a time trend analysis. BMJ Open 2017; 7:e017722. [PMID: 29141897 PMCID: PMC5719267 DOI: 10.1136/bmjopen-2017-017722] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/10/2017] [Accepted: 08/24/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Since 2010, England has experienced relative constraints in public expenditure on healthcare (PEH) and social care (PES). We sought to determine whether these constraints have affected mortality rates. METHODS We collected data on health and social care resources and finances for England from 2001 to 2014. Time trend analyses were conducted to compare the actual mortality rates in 2011-2014 with the counterfactual rates expected based on trends before spending constraints. Fixed-effects regression analyses were conducted using annual data on PES and PEH with mortality as the outcome, with further adjustments for macroeconomic factors and resources. Analyses were stratified by age group, place of death and lower-tier local authority (n=325). Mortality rates to 2020 were projected based on recent trends. RESULTS Spending constraints between 2010 and 2014 were associated with an estimated 45 368 (95% CI 34 530 to 56 206) higher than expected number of deaths compared with pre-2010 trends. Deaths in those aged ≥60 and in care homes accounted for the majority. PES was more strongly linked with care home and home mortality than PEH, with each £10 per capita decline in real PES associated with an increase of 5.10 (3.65-6.54) (p<0.001) care home deaths per 100 000. These associations persisted in lag analyses and after adjustment for macroeconomic factors. Furthermore, we found that changes in real PES per capita may be linked to mortality mostly via changes in nurse numbers. Projections to 2020 based on 2009-2014 trend was cumulatively linked to an estimated 152 141 (95% CI 134 597 and 169 685) additional deaths. CONCLUSIONS Spending constraints, especially PES, are associated with a substantial mortality gap. We suggest that spending should be targeted on improving care delivered in care homes and at home; and maintaining or increasing nurse numbers.
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Affiliation(s)
- Johnathan Watkins
- Institute for Mathematical and Molecular Biomedicine, King’s College London, London, UK
- PILAR Research and Education, Cambridge, UK
| | - Wahyu Wulaningsih
- PILAR Research and Education, Cambridge, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | | | - Dominic C Marshall
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
| | - Guia D C Sylianteng
- PILAR Research and Education, Cambridge, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Phyllis G Dela Rosa
- PILAR Research and Education, Cambridge, UK
- University of the Philippines Manila, Manila, Philippines
| | - Viveka A Miguel
- PILAR Research and Education, Cambridge, UK
- University of the Philippines Diliman, Quezon City, Philippines
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Lawrence P King
- Department of Sociology, University of Cambridge, Cambridge, UK
| | - Mahiben Maruthappu
- Department of Applied Health Research, University College London, London, UK
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Affiliation(s)
| | - David Nunan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | | | - Muir Gray
- Oxford University Hospitals NHS Trust, Oxford, UK
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Maruthappu M, Zhou C, Williams C, Zeltner T, Atun R. Unemployment and HIV mortality in the countries of the Organisation for Economic Co-operation and Development: 1981-2009. JRSM Open 2017; 8:2054270416685206. [PMID: 28748096 PMCID: PMC5507389 DOI: 10.1177/2054270416685206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES To determine an association between unemployment rates and human immunodeficiency virus (HIV) mortality in the Organisation for Economic Co-operation and Development (OECD). DESIGN Multivariate regression analysis. PARTICIPANTS OECD member states. SETTING OECD. MAIN OUTCOME MEASURES World Health Organization HIV mortality. RESULTS Between 1981 and 2009, a 1% increase in unemployment was associated with an increase in HIV mortality in the OECD (coefficient for men 0.711, 0.334-1.089, p = 0.0003; coefficient for women 0.166, 0.071-0.260, p = 0.0007). Time lag analysis showed a significant increase in HIV mortality for up to two years after rises in unemployment: p = 0.0008 for men and p = 0.0030 for women in year 1, p = 0.0067 for men and p = 0.0403 for women in year 2. CONCLUSIONS Rises in unemployment are associated with increased HIV mortality. Economic fiscal policy may impact upon population health. Policy discussions should take into consideration potential health outcomes.
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Affiliation(s)
- Mahiben Maruthappu
- Imperial College London SW7 2AZ, UK.,Faculty of Arts and Sciences, Harvard University, MA 02138 USA
| | - Charlie Zhou
- Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK
| | - Callum Williams
- The Economist, London SW1A 1HG,UK.,Faculty of History, University of Oxford, Oxford OX1 2RL, UK
| | - Thomas Zeltner
- World Health Organization, 1211 Geneva 27, Switzerland.,University of Bern, Bern CH 3011, Switzerland
| | - Rifat Atun
- Harvard T.H. Chan School of Public Health, Harvard University, MA 02115, USA
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Maruthappu M, Head MG, Zhou CD, Gilbert BJ, El-Harasis MA, Raine R, Fitchett JR, Atun R. Investments in cancer research awarded to UK institutions and the global burden of cancer 2000-2013: a systematic analysis. BMJ Open 2017; 7:e013936. [PMID: 28428185 PMCID: PMC5775472 DOI: 10.1136/bmjopen-2016-013936] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 01/30/2023] Open
Abstract
OBJECTIVES To systematically categorise cancer research investment awarded to United Kingdom (UK) institutions in the period 2000-2013 and to estimate research investment relative to disease burden as measured by mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs). DESIGN Systematic analysis of all open-access data. SETTING AND PARTICIPANTS Public and philanthropic funding to all UK cancer research institutions, 2000-2013. MAIN OUTCOME MEASURES Number and financial value of cancer research investments reported in 2013 UK pounds (UK£). Mortality, DALYs and YLDs data were acquired from the Global Burden of Disease Study. A compound metric was adapted to estimate research investment relative to disease burden as measured by mortality, DALYs and YLDs. RESULTS We identified 4299 funded studies with a total research investment of £2.4 billion. The highest fundings by anatomical sites were haematological, breast, prostate, colorectal and ovarian cancers. Relative to disease burden as determined by a compound metric combining mortality, DALYs and YLDs, gender-specific cancers were found to be highest funded-the five sites that received the most funding were prostate, ovarian, breast, mesothelioma and testicular cancer; the least well-funded sites were liver, thyroid, lung, upper gastrointestinal (GI) and bladder. Preclinical science accounted for 66.2% of award numbers and 62.2% of all funding. The top five areas of primary research focus by funding were pathogenesis, drug therapy, diagnostic, screening and monitoring, women's health and immunology. The largest individual funder was the Medical Research Council. In combination, the five lowest funded site-specific cancers relative to disease burden account for 47.9%, 44.3% and 20.4% of worldwide cancer mortality, DALYs and YLDs. CONCLUSIONS Research funding for cancer is not allocated according to relative disease burden. These findings are in line with earlier published studies. Funding agencies and industry should openly document their research investments to improve better targeting of research investment.
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Affiliation(s)
| | - Michael G Head
- Faculty of Medicine, Global Health Research Institute, Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Charlie D Zhou
- Medical Sciences Division, University of Oxford, Oxford, UK
| | | | | | | | - Joseph R Fitchett
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Rifat Atun
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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23
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Maruthappu M, Watson RA, Watkins J, Zeltner T, Raine R, Atun R. Effects of economic downturns on child mortality: a global economic analysis, 1981-2010. BMJ Glob Health 2017; 2:e000157. [PMID: 28589010 PMCID: PMC5435251 DOI: 10.1136/bmjgh-2016-000157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 08/13/2016] [Revised: 12/28/2016] [Accepted: 12/31/2016] [Indexed: 11/05/2022] Open
Abstract
Objectives To analyse how economic downturns affect child mortality both globally and among subgroups of countries of variable income levels. Design Retrospective observational study using economic data from the World Bank's Development Indicators and Global Development Finance (2013 edition). Child mortality data were sourced from the Institute for Health Metrics and Evaluation. Setting Global. Participants 204 countries between 1981 and 2010. Main outcome measures Child mortality, controlling for country-specific differences in political, healthcare, cultural, structural, educational and economic factors. Results 197 countries experienced at least 1 economic downturn between 1981 and 2010, with a mean of 7.97 downturns per country (range 0–21; SD 0.45). At the global level, downturns were associated with significant (p<0.0001) deteriorations in each child mortality measure, in comparison with non-downturn years: neonatal (coefficient: 1.11, 95% CI 0.855 to 1.37), postneonatal (2.00, 95% CI 1.61 to 2.38), child (2.93, 95% CI 2.26 to 3.60) and under 5 years of age (5.44, 95% CI 4.31 to 6.58) mortality rates. Stronger (larger falls in the growth rate of gross domestic product/capita) and longer (lasting 2 years rather than 1) downturns were associated with larger significant deteriorations (p<0.001). During economic downturns, countries in the poorest quartile experienced ∼1½ times greater deterioration in neonatal mortality, compared with their own baseline; a 3-fold deterioration in postneonatal mortality; a 9-fold deterioration in child mortality and a 3-fold deterioration in under-5 mortality, than countries in the wealthiest quartile (p<0.0005). For 1–5 years after downturns ended, each mortality measure continued to display significant deteriorations (p<0.0001). Conclusions Economic downturns occur frequently and are associated with significant deteriorations in child mortality, with worse declines in lower income countries.
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Affiliation(s)
- Mahiben Maruthappu
- Academic Clinical Fellow & Public Health Registrar, University College London, London, UK
| | - Robert A Watson
- Department of Primary Healthcare and Public Health, Imperial College London, London, UK
| | | | - Thomas Zeltner
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Rosalind Raine
- Head of Department of Applied Health Research, University College London, London, UK
| | - Rifat Atun
- Harvard School of Public Health, Harvard University, Cambridge, Massachusetts, USA
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Chapman SJ, Shelton B, Maruthappu M, Singh P, McCulloch P, Bhangu A. Cross-sectional observational study of the availability of evidence supporting novel implantable devices used in gastrointestinal surgery. Br J Surg 2017; 104:734-741. [PMID: 28218394 DOI: 10.1002/bjs.10485] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/25/2016] [Accepted: 12/08/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Evidence supporting the implementation of novel surgical devices is unstandardized, despite recommendations for assessing novel innovations. This study aimed to determine the proportion of novel implantable devices used in gastrointestinal surgery that are supported by evidence from RCTs. METHODS A list of novel implantable devices placed intra-abdominally during gastrointestinal surgery was produced. Systematic searches were performed for all devices via PubMed and clinical trial registries. The primary outcome measure was the availability of at least one published RCT for each device. Published RCTs were appraised using the Cochrane tool for assessing risk of bias. RESULTS A total of 116 eligible devices were identified (implantable mesh 42, topical haemostatics 22, antiadhesion barriers 10, gastric bands 8, suture and staple-line reinforcement 7, artificial sphincters 5, other 22). One hundred and twenty-eight published RCTs were found for 33 of 116 devices (28·4 per cent). Most were assessed as having a high risk of bias, with only 12 of 116 devices (10·3 per cent) supported by a published RCT considered to be low risk. A further 95 ongoing and 23 unpublished RCTs were identified for 42 of 116 devices (36·2 per cent), but many (64 of 116, 55·2 per cent) had no evidence from published, ongoing or unpublished RCTs. The highest stage of innovation according to the IDEAL Framework was stage 1 for 11 devices, stage 2a for 23 devices, stage 2b for one device and stage 3 for 33 devices. The remaining 48 devices had no relevant clinical evidence. CONCLUSION Only one in ten novel implantable devices available for use in gastrointestinal surgical practice is supported by high-quality RCT evidence.
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Affiliation(s)
- S J Chapman
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - B Shelton
- North West Thames Deanery, Imperial College London, London, UK
| | - M Maruthappu
- Department of Applied Health Research, Imperial College London, London, UK
| | - P Singh
- Department of Surgery and Cancer, Imperial College London, London, UK.,West Midlands Deanery, University of Birmingham, Birmingham, UK
| | - P McCulloch
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - A Bhangu
- Department of Colorectal Surgery, University of Birmingham, Birmingham, UK
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Chapman S, Shelton B, Maruthappu M, Singh P, Bhangu A. Availability of evidence supporting novel implantable devices used in gastrointestinal surgery: Cross-sectional, observational study. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Sun R, Sykes M, Marshall D, Shalhoub J, Maruthappu M. The impact of improving teamwork on patient outcomes in surgery: A systematic review. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Nagendran M, Pereira TV, Kiew G, Altman DG, Maruthappu M, Ioannidis JPA, McCulloch P. Very large treatment effects in randomised trials as an empirical marker to indicate whether subsequent trials are necessary: meta-epidemiological assessment. BMJ 2016; 355:i5432. [PMID: 27789483 PMCID: PMC5081692 DOI: 10.1136/bmj.i5432] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To examine whether a very large effect (VLE; defined as a relative risk of ≤0.2 or ≥5) in a randomised trial could be an empirical marker that subsequent trials are unnecessary. DESIGN Meta-epidemiological assessment of existing published data on randomised trials. DATA SOURCES Cochrane Database of Systematic Reviews (2010, issue 7) with data on subsequent large trials updated to 2015, issue 12. ELIGIBILITY CRITERIA All binary outcome forest plots were selected, which contained an index randomised trial with a VLE that was nominally statistically significant (P<0.05), included a subsequent large randomised trial (≥200 events and ≥200 non-events) for validation of the effect, assessed a primary outcome of the review, and was not a subgroup or sensitivity analysis. RESULTS Of 3082 reviews yielding 85 002 forest plots, only 44 (0.05%) satisfied the inclusion criteria. Index trials were generally small, with a median sample of 99 (median 14 events). Few index trials were rated at low risk of bias (9 of 44; 20%). The relative risk was closer to the null in the subsequent large trials in 43 of 44 cases. Subsequent large trial data failed to find a statistically significant (P<0.05) effect in the same direction in 19 cases (43%, 95% confidence interval 29% to 58%). Even when the subsequent large trials did find a significant effect in the same direction, the additional primary outcomes in most of these trials would have to be considered before deciding in favour of using the intervention. Subsequent large trial data found a statistically significant effect in the same direction in 19 of 21 cases when the index trial also had a value of P<0.001. CONCLUSIONS The frequency of VLEs followed by a large trial is vanishingly small, and where they occur they do not appear to be a reliable marker for a benefit that is reproducible and directly actionable. An empirical rule using a VLE in a randomised controlled trial as a marker that further trials are unnecessary would be neither practical nor useful. Caution should be taken when interpreting small studies with very large treatment effects.
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Affiliation(s)
- Myura Nagendran
- Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, UK
| | - Tiago V Pereira
- Health Technology Assessment Unit, Institute of Education and Sciences, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | - Grace Kiew
- Gonville and Caius College, University of Cambridge, UK
| | | | - Mahiben Maruthappu
- Department of Epidemiology and Public Health, University College London, UK
| | - John P A Ioannidis
- Departments of Medicine, of Health Research and Policy, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, USA
| | - Peter McCulloch
- Nuffield Department of Surgical Science, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
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28
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Maruthappu M, Watkins J, Noor AM, Williams C, Ali R, Sullivan R, Zeltner T, Atun R. Economic downturns, universal health coverage, and cancer mortality in high-income and middle-income countries, 1990-2010: a longitudinal analysis. Lancet 2016; 388:684-95. [PMID: 27236345 DOI: 10.1016/s0140-6736(16)00577-8] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The global economic crisis has been associated with increased unemployment and reduced public-sector expenditure on health care (PEH). We estimated the effects of changes in unemployment and PEH on cancer mortality, and identified how universal health coverage (UHC) affected these relationships. METHODS For this longitudinal analysis, we obtained data from the World Bank and WHO (1990-2010). We aggregated mortality data for breast cancer in women, prostate cancer in men, and colorectal cancers in men and women, which are associated with survival rates that exceed 50%, into a treatable cancer class. We likewise aggregated data for lung and pancreatic cancers, which have 5 year survival rates of less than 10%, into an untreatable cancer class. We used multivariable regression analysis, controlling for country-specific demographics and infrastructure, with time-lag analyses and robustness checks to investigate the relationship between unemployment, PEH, and cancer mortality, with and without UHC. We used trend analysis to project mortality rates, on the basis of trends before the sharp unemployment rise that occurred in many countries from 2008 to 2010, and compared them with observed rates. RESULTS Data were available for 75 countries, representing 2.106 billion people, for the unemployment analysis and for 79 countries, representing 2.156 billion people, for the PEH analysis. Unemployment rises were significantly associated with an increase in all-cancer mortality and all specific cancers except lung cancer in women. By contrast, untreatable cancer mortality was not significantly linked with changes in unemployment. Lag analyses showed significant associations remained 5 years after unemployment increases for the treatable cancer class. Rerunning analyses, while accounting for UHC status, removed the significant associations. All-cancer, treatable cancer, and specific cancer mortalities significantly decreased as PEH increased. Time-series analysis provided an estimate of more than 40,000 excess deaths due to a subset of treatable cancers from 2008 to 2010, on the basis of 2000-07 trends. Most of these deaths were in non-UHC countries. INTERPRETATION Unemployment increases are associated with rises in cancer mortality; UHC seems to protect against this effect. PEH increases are associated with reduced cancer mortality. Access to health care could underlie these associations. We estimate that the 2008-10 economic crisis was associated with about 260,000 excess cancer-related deaths in the Organisation for Economic Co-operation and Development alone. FUNDING None.
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Affiliation(s)
| | - Johnathan Watkins
- Institute for Mathematical & Molecular Biomedicine, King's College London, London, UK; Department of Research Oncology, King's College London, London, UK; PILAR Research and Education, Cambridge, UK
| | - Aisyah Mohd Noor
- Department of Research Oncology, King's College London, London, UK
| | | | - Raghib Ali
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK; Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Richard Sullivan
- Kings Health Partners, Integrated Cancer Centre, Guy's Hospital Campus, King's College London, London, UK
| | - Thomas Zeltner
- World Health Organization, Geneva, Switzerland; University of Bern, Bern, Switzerland
| | - Rifat Atun
- Harvard School of Public Health, Harvard University, Boston, MA, USA
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29
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Li MM, Shalhoub J, Davies AH, Maruthappu M. Guidance on feedback of outcome data to improve performance in vascular surgery. Br J Hosp Med (Lond) 2016; 77:476-80. [PMID: 27487059 DOI: 10.12968/hmed.2016.77.8.476] [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: 11/11/2022]
Abstract
Feedback of performance data is a well-established method of performance improvement in the health-care setting, although guidance has been limited in the context of surgical performance. This article outlines how optimal feedback can be achieved using surgeon outcome data.
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Affiliation(s)
- Mimi M Li
- Medical Student in the Section of Vascular Surgery, Imperial College London, Charing Cross Hospital, London W6 8RF
| | - Joseph Shalhoub
- Specialty Registrar in Vascular Surgery in the Section of Vascular Surgery, Imperial College Healthcare NHS Trust, London and Honorary Clinical Lecturer, Imperial College London, London
| | - Alun H Davies
- Professor of Vascular Surgery in the Section of Vascular Surgery, Imperial College London, London and Honorary Consultant Surgeon, Imperial College Healthcare NHS Trust, London
| | - Mahiben Maruthappu
- Academic Foundation Doctor in the Section of Vascular Surgery, Imperial College London, London
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30
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Maruthappu M, Sykes M, Green BL, Watson R, Gollop ND, Shalhoub J, Ng KYB. Implementation of a teaching programme to improve doctors' awareness of DVLA guidelines: a multicentre study. Postgrad Med J 2016; 93:71-75. [PMID: 27330117 DOI: 10.1136/postgradmedj-2015-133744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 05/19/2016] [Accepted: 05/24/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Over half of the UK population holds a driver's licence. Driver and Vehicle Licensing Authority (DVLA) guidelines are available for conditions from most specialties. Despite this, no focused training occurs in the undergraduate or postgraduate setting. We evaluate the impact of a teaching programme to improve guideline awareness. METHODS A 25-point questionnaire was designed using the current DVLA guidelines. Five questions were included for the following fields: neurology, cardiology, drug and alcohol abuse, visual disorders and respiratory. This was distributed to doctors in training at five hospitals. Four weeks later, a single-session teaching programme was implemented. The questionnaire was redistributed. Preintervention and postintervention scores were compared using the Wilcoxon rank sum test. RESULTS 139 preteaching and 144 post-teaching questionnaires were completed. Implementation of a single-session teaching programme significantly improved the knowledge of DVLA guidelines in all five areas explored. Median scores: neurology, preteaching 40%, post-teaching 100%, p<0.001; cardiology, 0%, 100%, p<0.001; drug and alcohol misuse, 0%, 100%, p<0.001; visual disorders, 40%, 100%, p<0.001; respiratory disorders, 20%, 100%, p<0.001; and overall, 28%, 92%, p<0.001. CONCLUSIONS Knowledge of DVLA guidelines among our cohort was poor. Implementation of a single-session teaching programme can significantly improve guideline knowledge and awareness, serving as a cost-effective intervention.
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Affiliation(s)
| | | | | | | | | | | | - Ka Ying Bonnie Ng
- Imperial College London, London, UK.,Princess Anne Hospital, Southampton, UK
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Hartley A, Marshall DC, Salciccioli JD, Sikkel MB, Maruthappu M, Shalhoub J. Trends in Mortality From Ischemic Heart Disease and Cerebrovascular Disease in Europe. Circulation 2016; 133:1916-26. [DOI: 10.1161/circulationaha.115.018931] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 03/18/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Adam Hartley
- From Imperial College London, United Kingdom (A.H., D.C.M., J.D.S., M.B.S., J.S.); and Foundation School, Imperial College London, United Kingdom (M.M.)
| | - Dominic C. Marshall
- From Imperial College London, United Kingdom (A.H., D.C.M., J.D.S., M.B.S., J.S.); and Foundation School, Imperial College London, United Kingdom (M.M.)
| | - Justin D. Salciccioli
- From Imperial College London, United Kingdom (A.H., D.C.M., J.D.S., M.B.S., J.S.); and Foundation School, Imperial College London, United Kingdom (M.M.)
| | - Markus B. Sikkel
- From Imperial College London, United Kingdom (A.H., D.C.M., J.D.S., M.B.S., J.S.); and Foundation School, Imperial College London, United Kingdom (M.M.)
| | - Mahiben Maruthappu
- From Imperial College London, United Kingdom (A.H., D.C.M., J.D.S., M.B.S., J.S.); and Foundation School, Imperial College London, United Kingdom (M.M.)
| | - Joseph Shalhoub
- From Imperial College London, United Kingdom (A.H., D.C.M., J.D.S., M.B.S., J.S.); and Foundation School, Imperial College London, United Kingdom (M.M.)
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Nagendran M, Maruthappu M, Gordon AC, Gurusamy KS. Comparative safety and efficacy of vasopressors for mortality in septic shock: A network meta-analysis. J Intensive Care Soc 2016; 17:136-145. [PMID: 28979478 PMCID: PMC5606402 DOI: 10.1177/1751143715620203] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Septic shock is a life-threatening condition requiring vasopressor agents to support the circulatory system. Several agents exist with choice typically guided by the specific clinical scenario. We used a network meta-analysis approach to rate the comparative efficacy and safety of vasopressors for mortality and arrhythmia incidence in septic shock patients. METHODS We performed a comprehensive electronic database search including Medline, Embase, Science Citation Index Expanded and the Cochrane database. Randomised trials investigating vasopressor agents in septic shock patients and specifically assessing 28-day mortality or arrhythmia incidence were included. A Bayesian network meta-analysis was performed using Markov chain Monte Carlo methods. RESULTS Thirteen trials of low to moderate risk of bias in which 3146 patients were randomised were included. There was no pairwise evidence to suggest one agent was superior over another for mortality. In the network meta-analysis, vasopressin was significantly superior to dopamine (OR 0.68 (95% CI 0.5 to 0.94)) for mortality. For arrhythmia incidence, standard pairwise meta-analyses confirmed that dopamine led to a higher incidence of arrhythmias than norepinephrine (OR 2.69 (95% CI 2.08 to 3.47)). In the network meta-analysis, there was no evidence of superiority of one agent over another. CONCLUSIONS In this network meta-analysis, vasopressin was superior to dopamine for 28-day mortality in septic shock. Existing pairwise information supports the use of norepinephrine over dopamine. Our findings suggest that dopamine should be avoided in patients with septic shock and that other vasopressor agents should continue to be based on existing guidelines and clinical judgement of the specific presentation of the patient.
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Affiliation(s)
- Myura Nagendran
- Section of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
| | - Mahiben Maruthappu
- North West Thames Foundation School, Imperial College London, London, UK
| | - Anthony C Gordon
- Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, UK
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Maruthappu M, Duclos A, Zhou CD, Lipsitz SR, Wright J, Orgill D, Carty MJ. The impact of team familiarity and surgical experience on operative efficiency: a retrospective analysis. J R Soc Med 2016; 109:147-53. [PMID: 27053357 DOI: 10.1177/0141076816634317] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The independent impact of individual surgical experience and team familiarity on surgical performance has been widely studied; however, the interplay of these factors and their relative, quantified, contributions to performance is poorly understood. We determined the impact of team familiarity and surgeon, and cumulative team experience on operative efficiency in total knee replacement. DESIGN Retrospective analysis of all total knee replacements conducted at the host institution in 1996-2009. Multivariate generalised-estimating-equation regression models were used to adjust for patient risk and clustering. SETTING Tertiary care academic hospital. PARTICIPANTS All patients undergoing TKR at the host institution in 1996-2009. MAIN OUTCOME MEASURE Operative efficiency. RESULTS A total of 4276 total knee replacements were completed by 1163 different surgical teams. The median experience level was 17.6 years for consultant surgeons and 3.7 years for trainee surgeons. After patient-risk adjustment, consultant surgical experience (p < 0.0001), trainee surgical experience (p < 0.05), cumulative team operative experience (p < 0.0001) and team familiarity (p < 0.0001) were associated with significant reductions in operative time. Surgical experience and team familiarity demonstrated concave and linear relationships with operative time, respectively. For a consultant surgeon, the expected reduction in operative time after 25 years in practice was 51 min, compared to a 21-min reduction over the span of 40 collaborations with the same team members. CONCLUSIONS Surgical experience and team familiarity display important and distinct relationships with operative time in total knee replacement. Appreciation of this interplay may serve to guide implementation and allocation of procedure-specific quality improvement strategies in surgery.
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Marshall DC, Webb TE, Hall RA, Salciccioli JD, Ali R, Maruthappu M. Trends in UK regional cancer mortality 1991-2007. Br J Cancer 2016; 114:340-7. [PMID: 26766741 PMCID: PMC4742578 DOI: 10.1038/bjc.2015.428] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 08/02/2015] [Revised: 10/28/2015] [Accepted: 11/07/2015] [Indexed: 11/18/2022] Open
Abstract
Background: Until 1990, there was an upward trend in mortality from breast, lung, prostate, and colon cancers in the United Kingdom. With improvements in cancer treatment there has, in general, been a fall in mortality over the last 20 years. We evaluate regional cancer mortality trends in the United Kingdom between 1991 and 2007. Methods: We analysed mortality trends for breast, lung, prostate, and colon cancers using data obtained from the EUREG cancer database. We have described changes in age-standardised rates (using European standard population) per 100 000 for cancer mortality and generated trends in mortality for the 11 regions using Joinpoint regression. Results: Across all regions in the United Kingdom there was a downward trend in mortality for the four most common cancers in males and females. Overall, deaths from colon cancer decreased most rapidly and deaths from prostate cancer decreased at the slowest rate. Similar downward trends in mortality were observed across all regions of the United Kingdom with the data for lung cancer exhibiting the greatest variation. Conclusions: Mortality from the four most common cancers decreased across all regions of the United Kingdom; however, the rate of decline varied between cancer type and in some instances by region.
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Affiliation(s)
| | - Thomas E Webb
- Department of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Richard A Hall
- Department of Medicine, Imperial College London, London SW7 2AZ, UK
| | | | - Raghib Ali
- Cancer Epidemiology Unit, University of Oxford, Oxford OX3 7LF, UK
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Abstract
OBJECTIVES The relative health effects of changes in unemployment, inflation and gross domestic product (GDP) per capita on population health have not been assessed. We aimed to determine the effect of changes in these economic measures on mortality metrics across Latin America. DESIGN Ecological study. SETTING Latin America (21 countries), 1981-2010. OUTCOME MEASURES Uses multivariate regression analysis to assess the effects of changes in unemployment, inflation and GDP per capita on 5 mortality indicators across 21 countries in Latin America, 1981-2010. Country-specific differences in healthcare infrastructure, population structure and population size were controlled for. RESULTS Between 1981 and 2010, a 1% rise in unemployment was associated with statistically significant deteriorations (p<0.05) in 5 population health outcomes, with largest deteriorations in 1-5 years of age and male adult mortality rates (1.14 and 0.53 rises per 1000 deaths respectively). A 1% rise in inflation rate was associated with significant deteriorations (p<0.05) in 4 population health outcomes, with the largest deterioration in male adult mortality rate (0.0033 rise per 1000 deaths). Lag analysis showed that 5 years after rises in unemployment and inflation, significant deteriorations (p<0.05) occurred in 3 and 5 mortality metrics, respectively. A 1% rise in GDP per capita was associated with no significant deteriorations in population health outcomes either in the short or long term. β coefficient comparisons indicated that the effect of unemployment increases was substantially greater than that of changes in GDP per capita or inflation. CONCLUSIONS Rises in unemployment and inflation are associated with long-lasting deteriorations in several population health outcomes. Unemployment exerted much larger effects on health than inflation. In contrast, changes in GDP per capita had almost no association with the explored health outcomes. Contrary to neoclassical development economics, policymakers should prioritise amelioration of unemployment if population health outcomes are to be optimised.
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Affiliation(s)
- Callum Williams
- Department of History, University of Oxford, Oxford, Oxfordshire, UK
| | - Barnabas James Gilbert
- Medical Sciences Division, University of Oxford, Green Templeton College, Oxford, Oxfordshire, UK
| | - Thomas Zeltner
- Department of Public Health, University of Bern, Bern, UK
| | - Johnathan Watkins
- Institute for Mathematical & Molecular Biomedicine, King's College London, London, UK
| | - Rifat Atun
- Department of Global Health Systems, Harvard University, Cambridge, Massachusetts, USA
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Ng KYB, Garnham J, Syed UM, Green BL, Watson R, Gollop ND, Shalhoub J, Maruthappu M. Knowledge of Driving Vehicle Licensing Agency guidelines among NHS doctors: a multicentre observational study. JRSM Open 2015; 6:2054270415601586. [PMID: 26688742 PMCID: PMC4601126 DOI: 10.1177/2054270415601586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Indexed: 11/29/2022] Open
Abstract
Objectives Over half of the UK population holds a driver's licence. The DVLA have produced guidelines to ensure drivers with medical conditions drive safely. Doctors should ensure that patients are given appropriate information and advice if they have a medical condition affecting their driving. We sought to evaluate doctors' knowledge of DVLA guidelines. Design A 25-point questionnaire was designed from DVLA guidelines (‘The DVLA Questionnaire’). Five questions were included for each of neurology, cardiology, drug and alcohol abuse, visual, and respiratory disorders. Setting Ealing Hospital, Northwick Park Hospital, Watford General Hospital, Norfolk and Norwich University Hospital and Leeds Teaching Hospitals Trust. Participants 140 UK doctors. Main outcome measures Questionnaire scores assessing knowledge of DVLA guidelines in five specialty areas. Results The median overall questionnaire score was 28%, interquartile range 20–36% and range 0–100% [Watford 28%, Leeds 30%, Norfolk and Norwich 36%, Ealing 30%, Northwick Park 28%]. There were no significant differences between the scores for each centre (p = 0.1332), Mean scores for specialty areas were: neurology 33.1%, standard deviation 22.1; cardiology 35.6%, standard deviation 26.9; drug and alcohol abuse 30.6%, standard deviation 23.8; visual disorders 33.9%, standard deviation 23.5 and respiratory disorders 20.3%, standard deviation 24.8; overall score 30.7%. There was no significant difference between the scores of the specialty areas (p = 0.4060). Conclusions Knowledge of DVLA guidelines in our cohort was low. There is a need for increased awareness among hospital doctors through focused education on driving restrictions for common medical conditions. Improving physician knowledge in this area may help optimise patient safety.
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Affiliation(s)
- Ka Y Bonnie Ng
- Department of Medicine, Chelsea and Westminster Hospital, London SW10 9NH, UK
| | - Jack Garnham
- Faculty of Medicine, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Usama M Syed
- Faculty of Medicine, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Ben L Green
- Department of Medicine, St James University Hospital, Leeds LS9 7TF, UK
| | - Robert Watson
- North West Thames Academic Foundation School, Imperial College London, London SW7 2AZ, UK
| | | | - Joseph Shalhoub
- Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, UK
| | - Mahiben Maruthappu
- North West Thames Academic Foundation School, Imperial College London, London SW7 2AZ, UK
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Maruthappu M. Rethink the Staff-system Relationship. Health Serv J 2015:18. [PMID: 26898008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Budhdeo S, Watkins J, Atun R, Williams C, Zeltner T, Maruthappu M. Changes in government spending on healthcare and population mortality in the European union, 1995-2010: a cross-sectional ecological study. J R Soc Med 2015; 108:490-8. [PMID: 26510733 DOI: 10.1177/0141076815600907] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Economic measures such as unemployment and gross domestic product are correlated with changes in health outcomes. We aimed to examine the effects of changes in government healthcare spending, an increasingly important measure given constrained government budgets in several European Union countries. DESIGN Multivariate regression analysis was used to assess the effect of changes in healthcare spending as a proportion of total government expenditure, government healthcare spending as a proportion of gross domestic product and government healthcare spending measured in purchasing power parity per capita, on five mortality indicators. Additional variables were controlled for to ensure robustness of data. One to five year lag analyses were conducted. SETTING AND PARTICIPANTS European Union countries 1995-2010. MAIN OUTCOME MEASURES Neonatal mortality, postneonatal mortality, one to five years of age mortality, under five years of age mortality, adult male mortality, adult female mortality. RESULTS A 1% decrease in government healthcare spending was associated with significant increase in all mortality metrics: neonatal mortality (coefficient -0.1217, p = 0.0001), postneonatal mortality (coefficient -0.0499, p = 0.0018), one to five years of age mortality (coefficient -0.0185, p = 0.0002), under five years of age mortality (coefficient -0.1897, p = 0.0003), adult male mortality (coefficient -2.5398, p = 0.0000) and adult female mortality (coefficient -1.4492, p = 0.0000). One per cent decrease in healthcare spending, measured as a proportion of gross domestic product and in purchasing power parity, was both associated with significant increases (p < 0.05) in all metrics. Five years after the 1% decrease in healthcare spending, significant increases (p < 0.05) continued to be observed in all mortality metrics. CONCLUSIONS Decreased government healthcare spending is associated with increased population mortality in the short and long term. Policy interventions implemented in response to the financial crisis may be associated with worsening population health.
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Affiliation(s)
- Sanjay Budhdeo
- Homerton College, Cambridge University, Cambridge CB2 8PH, UK MRC Unit for Longitudinal Health and Ageing, University College London, London WC1B 5JU, UK
| | - Johnathan Watkins
- Institute for Mathematical & Molecular Biomedicine, King's College London, London SE1 1UL, UK
| | - Rifat Atun
- Harvard School of Public Health, Harvard University, MA 02115, USA
| | - Callum Williams
- The Economist, London SW1A 1HG, UK Faculty of History, University of Oxford, Oxford, OX1 2RL, UK
| | - Thomas Zeltner
- Special Envoy for Financing to the Director General of the World Health Organization (WHO), Geneva 27, Switzerland Department of Public Health, University of Bern, Bern, CH 3011, Switzerland
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Maruthappu M, Barnes I, Sayeed S, Ali R. Incidence of prostate and urological cancers in England by ethnic group, 2001-2007: a descriptive study. BMC Cancer 2015; 15:753. [PMID: 26486598 PMCID: PMC4618465 DOI: 10.1186/s12885-015-1771-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 02/17/2015] [Accepted: 10/10/2015] [Indexed: 01/08/2023] Open
Abstract
Background The aetiology of urological cancers is poorly understood and variations in incidence by ethnic group may provide insights into the relative importance of genetic and environmental risk factors. Our objective was to compare the incidence of four urological cancers (kidney, bladder, prostate and testicular) among six ‘non-White’ ethnic groups in England (Indian, Pakistani, Bangladeshi, Black African, Black Caribbean and Chinese) to each other and to Whites. Methods We obtained Information on ethnicity for all urological cancer registrations from 2001 to 2007 (n = 329,524) by linkage to the Hospital Episodes Statistics database. We calculated incidence rate ratios adjusted for age, sex and income, comparing the six ethnic groups (and combined ‘South Asian’ and ‘Black’ groups) to Whites and to each other. Results There were significant differences in the incidence of all four cancers between the ethnic groups (all p < 0.001). In general, ‘non-White’ groups had a lower incidence of urological cancers compared to Whites, except prostate cancer, which displayed a higher incidence in Blacks. (IRR 2.55) There was strong evidence of differences in risk between Indians, Pakistanis and Bangladeshis for kidney, bladder and prostate cancer (p < 0.001), and between Black Africans and Black Caribbeans for all four cancers (p < 0.001). Conclusions The risk of urological cancers in England varies greatly by ethnicity, including within groups that have traditionally been analysed together (South Asians and Blacks). In general, these differences are not readily explained by known risk factors, although the very high incidence of prostate cancer in both black Africans and Caribbeans suggests increased genetic susceptibility. g. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1771-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Isobel Barnes
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK.
| | - Shameq Sayeed
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK.
| | - Raghib Ali
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK. .,New York University Abu Dhabi, Abu Dhabi, PO Box 129188, United Arab Emirates.
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Affiliation(s)
| | - Harpreet Sood
- Chair and Chief Executive's Office, NHS England, London SE1 6LH, UK
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Abstract
Abstract-The integration of medical and social care aims to address the fragmentation in patient services observed in many health care systems. Increasing rates of chronic disease and multimorbidity have drawn attention to the often significant reforms necessary to address these problems. In this article we discuss how integration may be achieved. To date there is no single best practice model or well-defined guidelines for integration. We suggest that three groups of patients with complex health needs would experience the greatest benefit: multimorbid patients with two or more chronic diseases, patients with moderate or severe mental health conditions, and the elderly. Integration has been demonstrated to achieve improvements in the coordination, quality, efficiency, and cost control of health care. Considering these benefits, a broad effort should be made to implement integrated care.
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Affiliation(s)
| | | | - Thomas Zeltner
- Department of Public Health; University of Bern ; Bern , Switzerland
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Maruthappu M, Watson RA, Watkins J, Williams C, Zeltner T, Faiz O, Ali R, Atun R. Unemployment, public-sector healthcare expenditure and colorectal cancer mortality in the European Union: 1990–2009. Int J Public Health 2015; 61:119-130. [DOI: 10.1007/s00038-015-0727-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 08/08/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022] Open
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Maruthappu M, Sood H, Obrien J, Keogh B. Diabetes prevention in England - Authors' reply. Lancet Diabetes Endocrinol 2015; 3:503. [PMID: 26138169 DOI: 10.1016/s2213-8587(15)00226-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 06/09/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Mahiben Maruthappu
- Chair and Chief Executive's Office, NHS England, Skipton House, London SE1 6LH, UK.
| | - Harpreet Sood
- Chair and Chief Executive's Office, NHS England, Skipton House, London SE1 6LH, UK
| | | | - Bruce Keogh
- National Medical Director, NHS England, Skipton House, London SE1 6LH, UK
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Abstract
OBJECTIVES Increasing patient demands, costs and emphasis on safety, coupled with reductions in the length of time surgical trainees spend in the operating theatre, necessitate means to improve the efficiency of surgical training. In this respect, feedback based on intraoperative surgical performance may be beneficial. Our aim was to systematically review the impact of intraoperative feedback based on surgical performance. SETTING MEDLINE, Embase, PsycINFO, AMED and the Cochrane Database of Systematic Reviews were searched. Two reviewers independently reviewed citations using predetermined inclusion and exclusion criteria. 32 data-points per study were extracted. PARTICIPANTS The search strategy yielded 1531 citations. Three studies were eligible, which comprised a total of 280 procedures by 62 surgeons. RESULTS Overall, feedback based on intraoperative surgical performance was found to be a powerful method for improving performance. In cholecystectomy, feedback led to a reduction in procedure time (p=0.022) and an improvement in economy of movement (p<0.001). In simulated laparoscopic colectomy, feedback led to improvements in instrument path length (p=0.001) and instrument smoothness (p=0.045). Feedback also reduced error scores in cholecystectomy (p=0.003), simulated laparoscopic colectomy (p<0.001) and simulated renal artery angioplasty (p=0.004). In addition, feedback improved balloon placement accuracy (p=0.041), and resulted in a smoother learning curve and earlier plateau in performance in simulated renal artery angioplasty. CONCLUSIONS Intraoperative feedback appears to be associated with an improvement in performance, however, there is a paucity of research in this area. Further work is needed in order to establish the long-term benefits of feedback and the optimum means and circumstances of feedback delivery.
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Affiliation(s)
| | | | | | - Peter McCulloch
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Affiliation(s)
| | - Bruce Keogh
- Chair and Chief Executive's Office, NHS England, London SE1 6LH, UK
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Maruthappu M, Watkins J, Taylor A, Williams C, Ali R, Zeltner T, Atun R. Unemployment and prostate cancer mortality in the OECD, 1990-2009. Ecancermedicalscience 2015; 9:538. [PMID: 26045715 PMCID: PMC4448991 DOI: 10.3332/ecancer.2015.538] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Indexed: 02/01/2023] Open
Abstract
The global economic downturn has been associated with increased unemployment in many countries. Insights into the impact of unemployment on specific health conditions remain limited. We determined the association between unemployment and prostate cancer mortality in members of the Organisation for Economic Co-operation and Development (OECD). We used multivariate regression analysis to assess the association between changes in unemployment and prostate cancer mortality in OECD member states between 1990 and 2009. Country-specific differences in healthcare infrastructure, population structure, and population size were controlled for and lag analyses conducted. Several robustness checks were also performed. Time trend analyses were used to predict the number of excess deaths from prostate cancer following the 2008 global recession. Between 1990 and 2009, a 1% rise in unemployment was associated with an increase in prostate cancer mortality. Lag analysis showed a continued increase in mortality years after unemployment rises. The association between unemployment and prostate cancer mortality remained significant in robustness checks with 46 controls. Eight of the 21 OECD countries for which a time trend analysis was conducted, exhibited an estimated excess of prostate cancer deaths in at least one of 2008, 2009, or 2010, based on 2000-2007 trends. Rises in unemployment are associated with significant increases in prostate cancer mortality. Initiatives that bolster employment may help to minimise prostate cancer mortality during times of economic hardship.
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Affiliation(s)
| | - Johnathan Watkins
- Institute for Mathematical and Molecular Biomedicine, King's College London, London SE1 1UL, UK
| | - Abigail Taylor
- Medical Sciences Division, University of Oxford, OX1 2JD, UK
| | | | - Raghib Ali
- Cancer Epidemiology Unit, University of Oxford, Oxford OX3 7LF, UK ; Faculty of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, United Arab Emirates
| | - Thomas Zeltner
- Special Envoy for Financing to the Director General of the World Health Organization (WHO), 1211 Geneva 27, Switzerland ; University of Bern, Bern CH 3011, Switzerland
| | - Rifat Atun
- Faculty of Medicine, Imperial College London, London SW7 2AZ, UK ; Harvard School of Public Health, Harvard University, MA 02115, USA
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Ng KYB, Maruthappu M, Farrukh J, Williams C, Atun R, Zeltner T. The effect of economic downturns on maternal mortality among pregnancies with abortive outcomes in 81 countries, 1981-2010. Int J Gynaecol Obstet 2015; 130:169-73. [PMID: 25980366 DOI: 10.1016/j.ijgo.2015.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 02/25/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the association between economic downturns and abortion-related maternal mortality in multiple countries over 30 years. METHODS In a retrospective study, WHO data were obtained for maternal deaths among pregnancies with abortive outcomes between January 1, 1981, and December 31, 2010. Economic data for the same period were obtained from The World Bank. An economic downturn was defined as an annual decline in gross domestic product per head. Multivariate regression-controlling for country-specific differences in infrastructure, population size, and demographic structure-and 5-year lag analyses were performed. RESULTS Data were available for 81 countries. Abortion-related maternal mortality was significantly increased in years of economic downturns (R=0.0708; 95% confidence interval [CI] 0.0264-0.1151; P=0.0018). The association was sustained for 4 years after an economic downturn (year 1: R=0.0709 [95% CI 0.0231-0.1187], P=0.0037; year 2: R=0.0634 [0.0178-0.1089], P=0.0065; year 3: R=0.0554 [0.0105-0.1004], P=0.0157; year 4: R=0.0593 [0.0148-0.1037], P=0.009). There was an annual 36% increase in deaths associated with unsafe abortion during economic downturn years. CONCLUSION Economic downturns were associated with increased abortion-related maternal mortality, possibly due to changes in government healthcare spending and service provision. A global economic downturn could impede a reduction in maternal mortality.
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Affiliation(s)
- Ka Ying Bonnie Ng
- Imperial College London, London, UK; Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK.
| | | | - Jawaad Farrukh
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Callum Williams
- The Economist, London, UK; Faculty of History, University of Oxford, Oxford, UK
| | - Rifat Atun
- Imperial College London, London, UK; Harvard School of Public Health, Harvard University, Cambridge, MA, USA
| | - Thomas Zeltner
- Special Envoy for Financing, World Health Organization, Geneva, Switzerland; University of Bern, Bern, Switzerland
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Halim MU, Maruthappu M, Christian A, Giles MF, Manuel A, Rahman NM. The Pulmonary Embolism Severity Index: Underused Despite Its Clinical Merits. J Emerg Med 2015; 48:609. [DOI: 10.1016/j.jemermed.2014.07.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 07/25/2014] [Indexed: 10/24/2022]
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