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Selinger C, Bottle A, Lamb CA, Ainley R, Wakeman R, Hawthorne B. Evaluation of emergency hospital admissions for inflammatory bowel disease as a possible marker of quality of care of British IBD inflammatory bowel disease units. Frontline Gastroenterol 2024; 15:228-232. [PMID: 38665788 PMCID: PMC11042453 DOI: 10.1136/flgastro-2023-102577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/21/2023] [Indexed: 04/28/2024] Open
Abstract
Background Key performance indicators (KPIs) are required to facilitate quality improvement for inflammatory bowel disease (IBD). Emergency admissions for IBD may represent a possible KPI. Methods IBD emergency admissions for 2018-2019 from Hospital Episodes Statistics for England were compared per population and per IBD cases with patient-reported quality of care from the IBD Patient Survey 2019. Patient-reported accident and emergency (A&E) attendances and hospital admissions for IBD were also compared with patient-reported quality of care. Results For 124 IBD services within England we found only a weak and not statistically significant correlation between IBD admissions per 100 000 population and patient-rated quality of care (Spearman's rho=0.171; p=0.057). Similarly, there was no significant correlation between IBD admissions per case and patient-rated quality of care (Spearman's rho=0.164; p=0.113). Patients with ≥2 A&E attendances (OR: 0.72, 95% CI: 0.57 to 0.91; p<0.001) were less likely to report quality of IBD care as good or very good compared with those without A&E attendances. Patients with ≥2 admissions were less likely to rate their care as good or very good (OR: 0.75, 95% CI: 0.65 to 0.88; p<0.0001) compared with those without hospital admissions. Conclusions There is a clear association for individual patients with ≥2 admissions or A&E attendances with a lower perceived quality of care. In contrast we found no correlation on a per-unit basis for IBD admissions derived from Hospital Episode Statistics with patient-assessed quality of care. Further work is required to determine whether hospital admissions could be a useful KPI for IBD.
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Affiliation(s)
| | - Alex Bottle
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Christopher A Lamb
- Newcastle University, Newcastle Upon Tyne, Tyne and Wear, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Northumberland, UK
| | | | | | - Barney Hawthorne
- Department of Gastroenterology, Cardiff and Vale UHB, Cardiff, UK
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Narula P, Gasparetto M, Wong C, Branchflower J, Sebastian S, McLaughlin J, Rao A, Wakeman R, Ainley R, Smith PJ, Kammermeier J, Younge L, Randall S, Bukhari S, Manson J, Ellis P, Arebi N. Top 10 research priorities for digital technology for adolescents and young persons with inflammatory bowel disease: Results of a James Lind Alliance Priority Setting Partnership. J Pediatr Gastroenterol Nutr 2024; 78:670-676. [PMID: 38504402 DOI: 10.1002/jpn3.12105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/06/2023] [Accepted: 12/10/2023] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Priority Setting Partnerships (PSP's) using the James Lind Alliance (JLA) methodology, bring together health professionals, patients and parents/carers to identify and prioritise unanswered questions that can be addressed by future research projects. To identify and prioritise the top 10 unanswered research priorities in digital technology for adolescents and young people (AYP) with inflammatory bowel disease (IBD). METHODS A steering group (SG) consisting of AYP with IBD, their parents/carers, representatives from two charities (Crohn's & Colitis UK, Crohn's in Childhood Research Association), patient information forum and paediatric and adult and primary care healthcare professionals was established in 2021. The SG agreed the protocol, and scope of the PSP and oversaw all aspects. SG meetings were chaired by a JLA advisor and followed the established JLA methodology. RESULTS The initial survey generated 414 in-scope questions from 156 respondents, thematically categorised into 10 themes and consolidated into 92 summary questions by the SG. A comprehensive literature review followed by SG deliberation narrowed the unanswered summary questions to 45, for the interim prioritising survey. One hundred and two respondents ranked their top 10 research questions. Outputs generated top 18 research priorities presented at a final virtual prioritisation workshop, facilitated by JLA advisors and attended by key stakeholders, ranked into top 10 research priorities. DISCUSSION The top 10 research priorities will encourage researchers to undertake research that addresses these areas of unmet need for AYP living with IBD, their parents/carers and their healthcare professionals, thereby facilitating improved patient care.
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Affiliation(s)
- Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS FT, Sheffield, UK
| | - Marco Gasparetto
- Paediatric Gastroenterology Unit, Jenny Lind Children's Hospital, University of East Anglia (UEA), Norwich, UK
| | - Charlotte Wong
- Department of IBD, St Mark's National Bowel Hospital, London, UK
- Department of Metabolism, Digestion & Reproduction Imperial College, London, UK
| | - Jacob Branchflower
- Sheffield CRF, NIHR MedTech & In Vitro diagnostics Co-operatives (MICs), Sheffield
| | | | - John McLaughlin
- Division of Diabetes, Endocrinology & Gastroenterology, Manchester and Salford Royal Hospital, University of Manchester, London, UK
| | - Arati Rao
- Department of Paediatrics, Royal Free Hospital, London, UK
| | | | | | - Philip J Smith
- Department of Gastroenterology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jochen Kammermeier
- Paediatric Gastroenterology Department, Evelina London Children's Hospital, London, UK
| | - Lisa Younge
- Department of IBD, St Mark's National Bowel Hospital, London, UK
| | - Sophie Randall
- Crohn's & Colitis UK Representative Patient Information Forum, Hatfield, UK
| | | | | | | | - Naila Arebi
- Department of IBD, St Mark's National Bowel Hospital, London, UK
- Department of Metabolism, Digestion & Reproduction Imperial College, London, UK
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Quraishi MN, Dobson E, Ainley R, Din S, Wakeman R, Cummings F, Sebastian S, Bloom S, Limdi JK, Dhar A, Speight RA, Bodger K, Kennedy NA, Lamb CA, Arnott ID, Selinger CP. Establishing key performance indicators for inflammatory bowel disease in the UK. Frontline Gastroenterol 2023; 14:407-414. [PMID: 37581184 PMCID: PMC10423598 DOI: 10.1136/flgastro-2023-102409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/02/2023] [Indexed: 08/16/2023] Open
Abstract
Background and aims Healthcare quality improvement (QI) is the systematic process to continuously improve the quality of care and outcomes for patients. The landmark Inflammatory Bowel Disease (IBD) UK National Audits provided a means to measure the variation in care, highlighting the need to define the standards of excellence in IBD care. Through a consensus approach, we aimed to establish key performance indicators (KPIs), providing reliable benchmarks for IBD care delivery in UK. Methods KPIs that measure critical aspects of a patient journey within an IBD service were identified though stakeholder meetings. A two-stage Delphi consensus was then conducted. The first involved a multidisciplinary team of IBD clinicians and patients to refine definitions and methodology. The second stage assessed feasibility and utility of the proposed QI process by surveying gastroenterology services across UK. Results First, the four proposed KPIs were refined and included time from primary care referral to diagnosis in secondary care, time to treatment recommendation following a diagnosis, appropriate use of steroids and advanced therapies prescreening and assessment. Second, the Delphi consensus reported >85% agreement on the feasibility of local adoption of the QI process and >75% agreement on the utility of benchmarking of the KPIs. Conclusions Through a structured approach, we propose quantifiable KPIs for benchmarking to improve and reduce the individual variation in IBD care across the UK.
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Affiliation(s)
- Mohammed Nabil Quraishi
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Shahida Din
- Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | | | - Fraser Cummings
- Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Shaji Sebastian
- Hull University Teaching Hospitals NHS Trust, Hull, UK
- Hull York Medical School, Hull, UK
| | - Stuart Bloom
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Jimmy K Limdi
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Anjan Dhar
- Department of Gastroenterology, County Durham & Darlington NHS Foundation Trust, Bishop Auckland, UK
| | - R Alexander Speight
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne Newcastle Upon Tyne, UK
| | - Keith Bodger
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | | | - Christopher A Lamb
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne Newcastle Upon Tyne, UK
- Newcastle University, Newcastle upon Tyne, UK
| | - Ian D Arnott
- Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
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Lees CW, Ahmad T, Lamb CA, Powell N, Din S, Cooney R, Kennedy NA, Ainley R, Wakeman R, Selinger CP. Withdrawal of the British Society of Gastroenterology IBD risk grid for COVID-19 severity. Gut 2023; 72:410-412. [PMID: 35512822 DOI: 10.1136/gutjnl-2022-327409] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/26/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Charlie W Lees
- Gastrointestinal Unit, Western General Hospital, Edinburgh, Scotland, UK
| | - Tariq Ahmad
- IBD Research Group, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Christopher Andrew Lamb
- Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Shahida Din
- Gastroenterology, Western General Hospital, Edinburgh, UK
| | | | - Nicholas A Kennedy
- Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK.,University of Exeter, Exeter, Devon, UK
| | - Rachel Ainley
- Crohn's and Colitis UK, Saint Albans, Hertfordshire, UK
| | - Ruth Wakeman
- Crohn's and Colitis UK, Saint Albans, Hertfordshire, UK
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Hawthorne AB, Glatter J, Blackwell J, Ainley R, Arnott I, Barrett KJ, Bell G, Brookes MJ, Fletcher M, Muhammed R, Nevill AM, Segal J, Selinger CP, St. Clair Jones A, Younge L, Lamb CA, Arnott I, Barrett K, Bell G, Bhatnagar G, Blackwell J, Bloom S, Bramwell C, Brookes MJ, Burman A, Cairnes V, Crook KP, Dobson E, Epstein J, Faiz O, Feakins RM, Fletcher M, Garrick V, Keetarut K, Hawthorne AB, Lamb CA, Lee M, Meade U, Muhammed R, Murdock A, Pitney‐Hall N, Rochford A, Rowse G, Sagar P, Segal J, Selinger CP, Sleet S, St. Clair Jones A, Taylor SA, Wakeman R, Weaver S, Younge L. Inflammatory bowel disease patient-reported quality assessment should drive service improvement: a national survey of UK IBD units and patients. Aliment Pharmacol Ther 2022; 56:625-645. [PMID: 35770866 PMCID: PMC9541797 DOI: 10.1111/apt.17042] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/06/2022] [Accepted: 05/09/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Healthcare service provision in inflammatory bowel disease (IBD) is often designed to meet targets set by healthcare providers rather than those of patients. It is unclear whether this meets the needs of patients, as assessed by patients themselves. AIMS To assess patients' experience of IBD and the healthcare they received, aiming to identify factors in IBD healthcare provision associated with perceived high-quality care. METHODS Using the 2019 IBD standards as a framework, a national benchmarking tool for quality assessment in IBD was developed by IBD UK, comprising a patient survey and service self-assessment. RESULTS 134 IBD services and 9757 patients responded. Perceived quality of care was lowest in young adults and increased with age, was higher in males and those >2 years since diagnosis. No hospital services met all the national IBD standards for recommended workforce numbers. Key metrics associated with patient-reported high- quality care were: identification as a tertiary centre, patient information availability, shared decision- making, rapid response to contact for advice, access to urgent review, joint medical/surgical clinics, and access to research (all p < 0.001). Higher numbers of IBD nurse specialists in a service was strongly associated with patients receiving regular reviews and having confidence in self-management and reporting high- quality care. CONCLUSIONS This extensive patient and healthcare provider survey emphasises the importance of aspects of care less often measured by clinicians, such as communication, shared decision- making and provision of information. It demonstrates that IBD nurse specialists are crucial to meeting the needs of people living with IBD.
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Affiliation(s)
- A. Barney Hawthorne
- Department of GastroenterologyCardiff & Vale University Health BoardCardiffUK,Cardiff UniversityCardiffUK
| | | | | | | | - Ian Arnott
- Edinburgh IBD UnitWestern General HospitalEdinburghUK
| | | | | | - Matthew J. Brookes
- Department of GastroenterologyRoyal Wolverhampton NHS TrustWolverhamptonUK,Research Institute in Healthcare ScienceUniversity of WolverhamptonWolverhamptonUK
| | | | - Rafeeq Muhammed
- Department of Paediatric GastroenterologyBirmingham Children's HospitalBirminghamUK
| | - Alan M. Nevill
- Faculty of Health Education and WellbeingUniversity of WolverhamptonWolverhamptonUK
| | - Jonathan Segal
- Department of GastroenterologyImperial College Healthcare NHS TrustLondonUK
| | - Christian P. Selinger
- Department of GastroenterologyLeeds Teaching Hospitals NHS TrustLeedsUK,University of LeedsLeedsUK
| | - Anja St. Clair Jones
- Department of PharmacyBrighton & Sussex University Hospitals NHS TrustBrightonUK
| | - Lisa Younge
- Department of GastroenterologySt Marks HospitalHarrowUK
| | | | - Christopher A. Lamb
- Translational & Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK,Department of GastroenterologyNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
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6
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Spurr L, Tan HL, Wakeman R, Chatwin M, Hughes Z, Simonds A. Psychosocial impact of the COVID-19 pandemic and shielding in adults and children with early-onset neuromuscular and neurological disorders and their families: a mixed-methods study. BMJ Open 2022; 12:e055430. [PMID: 35354630 PMCID: PMC8968110 DOI: 10.1136/bmjopen-2021-055430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM To describe and evaluate the psychosocial impact of the COVID-19 pandemic and measures to reduce the risk of transmission on patients with early-onset neuromuscular and neurological disorders (NMDs) and their families. DESIGN A mixed-methods study in which data were collected between 17 September 2020 and 31 December 2020 using a semi-structured telephone questionnaire developed specifically to meet research aims, and were analysed using quantitative methods and qualitative inductive thematic analysis. PARTICIPANTS Forty questionnaires were completed by patients with NMDs (eg, muscular dystrophies, spinal muscular atrophy) or their parent. 70% (n=28) of patients were male, aged 2-48 years. 90% (n=36) were wheelchair users; 72.5% (n=29) required long-term non-invasive or tracheostomy ventilation. RESULTS Strict adherence to risk mitigation strategies, for example, shielding, were reported at the start of the pandemic. Over half continued some or all measures after official limitations were relaxed. 67.5% (n=27) reported changes to personal care assistance arrangements including temporary cessation of outside carers. Three themes were identified: (1) Concern regarding the health impact of COVID-19; (2) Perceptions of strategies to prevent SARS-CoV-2 transmission; (3) Psychological impact of the COVID-19 pandemic. The level and pervasiveness of frequently reported negative psychological effects, for example, anxiety and fear fluctuated, and were related to the perceived risk of COVID-19, concern about attending hospital, and perceived lack of access to intensive care management if severe COVID-19 infection occurred. Support, particularly from family and healthcare services, were considered to have positive psychosocial effects. CONCLUSIONS Measures to reduce transmission of COVID-19 have greatly affected patients with NMDs and their families. For most, negative psychosocial impacts have and will continue to improve, but this may depend on the incidence of further pandemic waves. Consistent, up-to-date and accessible information on clinical outcomes and risk mitigation must be provided to support patients' physical and mental well-being.
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Affiliation(s)
- Lydia Spurr
- Academic and Clinical Department of Sleep and Ventilation, Royal Brompton Hospital, London, UK
| | - Hui-Leng Tan
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Ruth Wakeman
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Michelle Chatwin
- Academic and Clinical Department of Sleep and Ventilation, Royal Brompton Hospital, London, UK
| | | | - Anita Simonds
- Academic and Clinical Department of Sleep and Ventilation, Royal Brompton Hospital, London, UK
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7
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Alexander JL, Moran GW, Gaya DR, Raine T, Hart A, Kennedy NA, Lindsay JO, MacDonald J, Segal JP, Sebastian S, Selinger CP, Parkes M, Smith PJ, Dhar A, Subramanian S, Arasaradnam R, Lamb CA, Ahmad T, Lees CW, Dobson L, Wakeman R, Iqbal TH, Arnott I, Powell N. SARS-CoV-2 vaccination for patients with inflammatory bowel disease: a British Society of Gastroenterology Inflammatory Bowel Disease section and IBD Clinical Research Group position statement. Lancet Gastroenterol Hepatol 2021; 6:218-224. [PMID: 33508241 PMCID: PMC7834976 DOI: 10.1016/s2468-1253(21)00024-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 02/07/2023]
Abstract
SARS-CoV-2 has caused a global health crisis and mass vaccination programmes provide the best opportunity for controlling transmission and protecting populations. Despite the impressive clinical trial results of the BNT162b2 (Pfizer/BioNTech), ChAdOx1 nCoV-19 (Oxford/AstraZeneca), and mRNA-1273 (Moderna) vaccines, important unanswered questions remain, especially in patients with pre-existing conditions. In this position statement endorsed by the British Society of Gastroenterology Inflammatory Bowel Disease (IBD) section and IBD Clinical Research Group, we consider SARS-CoV-2 vaccination strategy in patients with IBD. The risks of SARS-CoV-2 vaccination are anticipated to be very low, and we strongly support SARS-CoV-2 vaccination in patients with IBD. Based on data from previous studies with other vaccines, there are conceptual concerns that protective immune responses to SARS-CoV-2 vaccination may be diminished in some patients with IBD, such as those taking anti-TNF drugs. However, the benefits of vaccination, even in patients treated with anti-TNF drugs, are likely to outweigh these theoretical concerns. Key areas for further research are discussed, including vaccine hesitancy and its effect in the IBD community, the effect of immunosuppression on vaccine efficacy, and the search for predictive biomarkers of vaccine success.
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Affiliation(s)
- James L Alexander
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK,Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Gordon W Moran
- NIHR Nottingham Biomedical Research Centre at Nottingham University Hospitals and The University of Nottingham, Nottingham, UK
| | - Daniel R Gaya
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK,Department of Medicine, University of Glasgow, Glasgow, UK
| | - Tim Raine
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ailsa Hart
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK,Department of Gastroenterology, St Mark's Hospital, London, UK
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK,Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group University of Exeter, Exeter, UK
| | - James O Lindsay
- Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK,Department of Gastroenterology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Jonathan MacDonald
- Department of Medicine, University of Glasgow, Glasgow, UK,Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jonathan P Segal
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK,Department of Gastroenterology, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Shaji Sebastian
- IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | - Miles Parkes
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Philip J Smith
- Department of Gastroenterology, Liverpool University Hospitals NHS Foundation Trusts, Liverpool, UK
| | - Anjan Dhar
- Department of Gastroenterology, County Durham & Darlington NHS Foundation Trust, Durham, UK
| | - Sreedhar Subramanian
- Department of Gastroenterology, Liverpool University Hospitals NHS Foundation Trusts, Liverpool, UK
| | - Ramesh Arasaradnam
- Department of Gastroenterology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Christopher A Lamb
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK,Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tariq Ahmad
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK,Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group University of Exeter, Exeter, UK
| | - Charlie W Lees
- Institute of Genetic and Molecular Medicine, University of Edinburgh, Edinburgh, UK,Department of Gastroenterology, Western General Hospital, Edinburgh, UK
| | | | | | - Tariq H Iqbal
- Institute of Translational Medicine, University of Birmingham, Birmingham, UK,Department of Gastroenterology, University Hospitals Birmingham, Birmingham, UK
| | - Ian Arnott
- Department of Gastroenterology, Western General Hospital, Edinburgh, UK
| | - Nick Powell
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK,Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK,Correspondence to: Dr Nick Powell, 10th Floor Commonwealth Building, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK
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Johansen A, Liddicoat M, Hannaford J, Wakeman R, Boulton C, Dickinson R. 66INTRODUCING A NATIONAL PROGRAMME OF SCREENING WITH THE 4A TEST TO IDENTIFY DELIRIUM - THE COMMONEST COMPLICATION OF HIP FRACTURE SURGERY. Age Ageing 2019. [DOI: 10.1093/ageing/afy214.03] [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: 11/12/2022] Open
Affiliation(s)
- A Johansen
- National Hip Fracture Database (NHFD), Falls and Fragility Fracture Audit Programme (FFFAP), Royal College of Physicians, London
| | - M Liddicoat
- National Hip Fracture Database (NHFD), Falls and Fragility Fracture Audit Programme (FFFAP), Royal College of Physicians, London
| | - J Hannaford
- National Hip Fracture Database (NHFD), Falls and Fragility Fracture Audit Programme (FFFAP), Royal College of Physicians, London
| | - R Wakeman
- National Hip Fracture Database (NHFD), Falls and Fragility Fracture Audit Programme (FFFAP), Royal College of Physicians, London
| | - C Boulton
- National Hip Fracture Database (NHFD), Falls and Fragility Fracture Audit Programme (FFFAP), Royal College of Physicians, London
| | - R Dickinson
- National Hip Fracture Database (NHFD), Falls and Fragility Fracture Audit Programme (FFFAP), Royal College of Physicians, London
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Abstract
We have studied the outcome of 140 general surgical procedures in 112 patients known or suspected to be infected with human immunodeficiency virus (HIV) or hepatitis B virus. Forty patients had antibodies to HIV. A wide range of surgical procedures was performed, with an overall complication rate of 5.7%. Wound infection, wound haematoma and one unexplained pyrexia were the only complications seen. Some anorectal wounds in patients with HIV antibodies were noted to heal extremely slowly, but the aggressive anorectal sepsis reported by others was not seen. The postoperative course after general surgical procedures was unremarkable in patients with HIV antibodies, and in those suspected of HIV infection, but because anorectal wounds were found to heal slowly, we recommend that anorectal surgery be conservative in patients with HIV antibodies.
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Affiliation(s)
- R Wakeman
- Professorial Surgical Unit, St Stephen's Hospital, London
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10
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Tsang C, Boulton C, Burgon V, Johansen A, Wakeman R, Cromwell DA. Predicting 30-day mortality after hip fracture surgery: Evaluation of the National Hip Fracture Database case-mix adjustment model. Bone Joint Res 2017; 6:550-556. [PMID: 28947603 PMCID: PMC5630992 DOI: 10.1302/2046-3758.69.bjr-2017-0020.r1] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/28/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The National Hip Fracture Database (NHFD) publishes hospital-level risk-adjusted mortality rates following hip fracture surgery in England, Wales and Northern Ireland. The performance of the risk model used by the NHFD was compared with the widely-used Nottingham Hip Fracture Score. METHODS Data from 94 hospitals on patients aged 60 to 110 who had hip fracture surgery between May 2013 and July 2013 were analysed. Data were linked to the Office for National Statistics (ONS) death register to calculate the 30-day mortality rate. Risk of death was predicted for each patient using the NHFD and Nottingham models in a development dataset using logistic regression to define the models' coefficients. This was followed by testing the performance of these refined models in a second validation dataset. RESULTS The 30-day mortality rate was 5.36% in the validation dataset (n = 3861), slightly lower than the 6.40% in the development dataset (n = 4044). The NHFD and Nottingham models showed a slightly lower discrimination in the validation dataset compared with the development dataset, but both still displayed moderate discriminative power (c-statistic for NHFD = 0.71, 95% confidence interval (CI) 0.67 to 0.74; Nottingham model = 0.70, 95% CI 0.68 to 0.75). Both models defined similar ranges of predicted mortality risk (1% to 18%) in assessment of calibration. CONCLUSIONS Both models have limitations in predicting mortality for individual patients after hip fracture surgery, but the NHFD risk adjustment model performed as well as the widely-used Nottingham prognostic tool and is therefore a reasonable alternative for risk adjustment in the United Kingdom hip fracture population.Cite this article: Bone Joint Res 2017;6:550-556.
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Affiliation(s)
- C Tsang
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK and Honorary Lecturer, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK
| | - C Boulton
- Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, 11 St Andrews Place, London NW1 4LE, UK
| | - V Burgon
- Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, 11 St Andrews Place, London NW1 4LE, UK
| | - A Johansen
- Trauma Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
| | - R Wakeman
- Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, 11 St Andrews Place, London NW1 4LE, UK
| | - D A Cromwell
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK and Director of Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK
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Johansen A, Boulton C, Burgon V, Rai S, Wakeman R. 21COGNITIVE IMPAIRMENT - PROFILING ITS IMPLICATIONS FOR PATIENTS WITH HIP FRACTURE. Age Ageing 2017. [DOI: 10.1093/ageing/afx115.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Johansen A, Tsang C, Boulton C, Wakeman R, Moppett I. Understanding mortality rates after hip fracture repair using ASA physical status in the National Hip Fracture Database. Anaesthesia 2017; 72:961-966. [DOI: 10.1111/anae.13908] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 01/05/2023]
Affiliation(s)
- A. Johansen
- University Hospital of Wales; Cardiff UK
- National Hip Fracture Database; Royal College of Physicians; London UK
| | - C. Tsang
- Clinical Effectiveness Unit; Royal College of Surgeons of England; London UK
| | - C. Boulton
- Falls and Fragility Fracture Audit Programme; Royal College of Physicians; London UK
| | - R. Wakeman
- National Hip Fracture Database; Royal College of Physicians; London UK
| | - I. Moppett
- Anaesthesia and Critical Care Section; Division of Clinical Neuroscience; Queen's Medical Centre; University of Nottingham; UK
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Boulton C, Burgon V, Johansen A, Martin F, Rai S, Stanley R, Wakeman R. 121DELIVERING “BEST PRACTICE” FOR PATIENTS WITH HIP FRACTURE - DOES ORTHOGERIATRICIAN ENGAGEMENT WITH NATIONAL CLINICAL AUDIT DATA IMPROVE PERFORMANCE? Age Ageing 2017. [DOI: 10.1093/ageing/afx072.121] [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: 11/13/2022] Open
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Wilson H, Boulton C, Burgon V, Johansen A, Neuburger J, Rai S, Wakeman R. 42USING THE NATIONAL HIP FRACTURE DATABASE TO DEVELOP A CLASSIFICATION OF MODELS OF ORTHOGERIATRIC CARE. Age Ageing 2017. [DOI: 10.1093/ageing/afx055.42] [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: 11/13/2022] Open
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Johansen A, Boulton C, Burgon V, Rai S, Wakeman R. 117HIP FRACTURE: DOES WEEK-DAY OF PRESENTATION AFFECT LENGTH OF STAY? Age Ageing 2017. [DOI: 10.1093/ageing/afx072.117] [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: 11/13/2022] Open
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Johansen A, Boulton C, Burgon V, Neuburger J, Rai S, Wakeman R. 126HIP FRACTURES IN HOSPITAL AND CARE HOMES - USING THE NATIONAL HIP FRACTURE DATABASE (NHFD) TO IDENTIFY A POSSIBLE CARE GAP. Age Ageing 2017. [DOI: 10.1093/ageing/afx072.126] [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: 11/13/2022] Open
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Boulton C, Burgon V, Johansen A, Martin F, Rai S, Stanley R, Wakeman R. 122AVOIDING DELAY IN SURGERY FOR HIP FRACTURE: USING THE NATIONAL HIP FRACTURE DATABASE (NHFD) TO MONITOR AND IMPROVE COMPLIANCE WITH NATIONAL GUIDELINES. Age Ageing 2017. [DOI: 10.1093/ageing/afx072.122] [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: 11/14/2022] Open
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Johansen A, Wakeman R, Boulton C. 48EARLY RETURN TO OWN HOME AFTER HIP FRACTURE IS NOT UNSAFE – EVIDENCE FROM THE NATIONAL HIP FRACTURE DATABASE. Age Ageing 2016. [DOI: 10.1093/ageing/afw030.01] [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: 11/12/2022] Open
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White SM, Moppett IK, Griffiths R, Johansen A, Wakeman R, Boulton C, Plant F, Williams A, Pappenheim K, Majeed A, Currie CT, Grocott MPW. Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2). Anaesthesia 2016; 71:506-14. [DOI: 10.1111/anae.13415] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2016] [Indexed: 12/13/2022]
Affiliation(s)
- S. M. White
- Brighton and Sussex University Hospitals NHS Trust; Brighton East Sussex UK
| | - I. K. Moppett
- Anaesthesia and Critical Care Section; Division of Clinical Neuroscience; University of Nottingham; Queen's Medical Centre Campus; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - R. Griffiths
- Peterborough and Stamford Hospitals NHS Trust; Peterborough UK
| | - A. Johansen
- National Hip Fracture Database, Falls and Fragility Fracture Audit Programme; Clinical Effectiveness and Evaluation Unit; Royal College of Physicians; London UK
| | - R. Wakeman
- National Hip Fracture Database, Falls and Fragility Fracture Audit Programme; Clinical Effectiveness and Evaluation Unit; Royal College of Physicians; London UK
| | - C. Boulton
- National Hip Fracture Database, Falls and Fragility Fracture Audit Programme; Clinical Effectiveness and Evaluation Unit; Royal College of Physicians; London UK
| | - F. Plant
- The Royal National Orthopaedic Hospital; Stanmore Middlesex UK
| | - A. Williams
- Gloucestershire Royal Hospital; Gloucester Gloucestershire UK
| | - K. Pappenheim
- Association of Anaesthetists of Great Britain and Ireland; London UK
| | - A. Majeed
- King Fahad Medical City; Riyadh Saudi Arabia
| | | | - M. P. W. Grocott
- Anaesthesia and Critical Care Medicine; University of Southampton and Southampton NIHR Respiratory Biomedical Research Unit; Southampton UK
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Boulton C, Burgon V, Johansen A, Martin F, Stanley R, Wakeman R, Williams A. 31FALLS AMONG HOSPITAL INPATIENTS USING HIP FRACTURE INCIDENCE TO MONITOR PATIENT SAFETY. Age Ageing 2015. [DOI: 10.1093/ageing/afv106.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Johansen A, Boulton C, Burgon V, Martin F, Stanley R, Wakeman R, Williams A. P-435: Hip fracture following an inpatient fall: using the National Hip Fracture Database (NHFD) to identify the true scale of this challenge. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30532-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Johansen A, Tsang C, Cromwell D, Boulton C, Wakeman R, Burgon V. P-434: Predicting 30 day mortality after hip fracture: validating the use of National Hip Fracture Database (NHFD) data. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30531-3] [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: 11/16/2022]
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Johansen A, Neuberger J, Boulton C, Williams A, Plant F, Wakeman R, Cromwell D, Wilson H, Moran C. 48 * USING THE NATIONAL HIP FRACTURE DATABASE (NHFD) TO PROFILE THE IMPACT OF HIP FRACTURE ON THE NHS. Age Ageing 2014. [DOI: 10.1093/ageing/afu126.1] [Citation(s) in RCA: 3] [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: 11/13/2022] Open
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Affiliation(s)
- R Wakeman
- Basildon University Hospital, Basildon, Essex, England
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Wakeman R. Paris and London in the nineteenth century. J Urban Hist 2001; 27:200-205. [PMID: 18335628 DOI: 10.1177/009614420102700205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Smith GL, Wakeman R, Briggs TW. Radiation exposure of orthopaedic trainees: quantifying the risk. J R Coll Surg Edinb 1996; 41:132-4. [PMID: 8632390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Interest in radiation protection issues has recently grown within the medical profession. Several investigators have examined the radiation exposure of orthopaedic surgeons using X-rays during trauma surgery, and found that doses received are within acceptable limits. These studies however, have been performed over short time-periods or have been confined to single procedures only. In this paper, we report the results of monitoring of the total exposure across all procedures of a group of orthopaedic surgeons over a 4-month period. Doses received were all below the International Commission on Radiological Protection (ICRP) recommended limits. While these results are reassuring, they do not represent grounds for complacency. Continued vigilance will be essential as work practices continue to change. In orthopaedics, in contrast with other specialties, the limiting dose is that to the hands. In view of this finding, extremity dosimetry for surgeons regularly using X-rays in theatre should be considered.
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Affiliation(s)
- G L Smith
- Department of Orthopaedics, Luton and Dunstable Hospital, UK
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Abstract
A case of poliomyelitis-induced paralysis of the puborectalis and external anal sphincter is described. This demonstrates the effect of an exclusively motor deficit of striated muscles controlling fecal continence. The patient has remained continent of feces for 37 years.
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Affiliation(s)
- R Wakeman
- Department of Surgery, St. Stephen's Hospital, London, United Kingdom
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Wakeman R. Supervision is key factor in quality. Hosp Superv Bull 1982:1-4. [PMID: 10257174] [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: 02/12/2023]
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