16 results found
Bakhet M, Ul-Haq Z, Kamalati T, et al., 2020, Blood tests in general practice: the use of routine data to characterise venous blood testing in North West London, 2016–2018, British Journal of General Practice, Vol: 70, ISSN: 0960-1643
Background Laboratory testing is an integral diagnostic tool, contributing to 70% of diagnoses in the NHS today. Its use has been steadily increasing despite estimates that ≤40% of blood tests ordered are unnecessary. Understanding blood-testing patterns is a fundamental step to tackling overuse.Aim To characterise the volume, type, and per patient frequency (PPF) of venous blood testing reported in general practice in North West London, 2016–2018.Method Following ethics clearance, aggregate data of blood tests reported in general practice in North West London between 2016 and 2018 were extracted from the Discover database. Non-venous blood test codes and codes not used within the designated time period were excluded. Codes reporting the same analyte were aggregated. Overall volume and PPF were calculated per analyte.Results Three hundred and thirty-six individual analytes were reported and grouped into 35 recognised panels or groupings. Blood testing increased by 16.5% over the 3-year period. Full blood count, urea and electrolytes, liver function tests, and lipid profile accounted for 80.4% of all venous blood tests. Requests for HbA1c increased by 52.8% and non-HDL cholesterol by 148.7%, whereas glucose decreased by 13.3% and urea by 15.7%. The PPF remained unchanged over the 3-year period at 1.29 blood tests per person per year. The coagulation assay had the highest PPF at 3.0.Conclusion Routine general practice data revealed important trends in blood testing. Trends uncovered can inform innovative and targeted solutions to reduce unnecessary blood testing.
Pang HY, Bakhet M, Gnani S, et al., 2019, Leveraging community assets to tackle social isolation and loneliness: a needs assessment of the London Borough of Hammersmith & Fulham, Imperial SCARU, Publisher: Imperial College Business School, #19IC538
This study is an investigation of factors that influence the routine adoption and diffusion of evidence-based asset-based community development (ABCD) initiatives to combat social isolation and loneliness in the contemporary setting (using LBH&F as a case study)
El-Osta A, Webber D, Majeed A, 2019, The Self-Care Academic Research Unit (SCARU), Imperial College London – Written evidence (INQ0037), The House of Lords Science and Technology Committee Inquiry into Ageing: Science, Technology and Healthy Living, Publisher: UK Parliament
El-Osta A, Webber D, Gnani S, et al., 2019, The Self-Care Matrix: a unifying framework for self-care, Self-Care, Vol: 10, Pages: 38-56, ISSN: 2042-7018
backgroundThere is resurgent interest in the concept and practice of self-care as a means to improve the health, wellness and wellbeing of individuals, and as an avenue to mitigate financial pressures and growing demands on health and social care systems worldwide. An ongoing challenge has been the lack of clarity on the specific nature and entire scope of self-care, coupled to a lack of a universal or widely accepted framework that could support the conceptualisation and study of self-care in its totality, in all settings and from different perspectives.objectivesTo advance a comprehensive yet pragmatic and widely accessible framework to support the conceptualisation of self-care in its totality, in order to facilitate the development, commissioning, evaluation and study of self-care initiatives across a variety of settings.Method and framework developmentA pragmatic review of the academic and lay literature was undertaken to identify extant theories and conceptual models of self-care. Following a content analysis, the models were characterised, and a configuration matrix was constructed to illustrate the key components and main themes of each model. These themes were organised into a number of domains which were grouped together into cardinal dimensions of self-care. The dimensions of self-care were consolidated in an inclusive framework and visually depicted on a schema to illustrate their inter-relationship.resultsWe identified a total of 32 candidate models, theories and frameworks of self-care. Characterising these models led to the identification of various themes and domains. These were found to naturally group into four cardinal dimensions of self-care: (1) Activities, (2) Behaviours, (3) Context, and (4) Environment. A new model was synthesised to illustrate the relationship between each dimension on a configuration matrix resulting in the creation of the Self-Care Matrix (SCM).conclusionThe Self-Care Matrix (SCM) is a useful framework that can be used to
Guideline Development Group GDG, External Review Group ERG, El-Osta A, 2019, WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights, Publisher: WHO
Self-care interventions are among the most promising and exciting new approaches to improve health and well-being, both from a health systems perspective and for people who use these interventions. The World Health Organization (WHO) uses the following working definition of self-care: Self-care is the ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health-care provider. The scope of self-care as described in this definition includes health promotion; disease prevention and control; self-medication; providing care to dependent persons; seeking hospital/specialist/primary care if necessary; and rehabilitation, including palliative care. It includes a range of self-care modes and approaches. While this is a broad definition that includes many activities, it is important for health policy to recognize the importance of self-care, especially where it intersects with health systems and health professionals (Figure 1)...
El-Osta A, Bagkeris E, Coker D, et al., 2019, Workplace health promotion using a digital health programme with monthly telecoaching to improve clinical and lifestyle-related outcomes., Future Healthcare Journal, Vol: 6, Pages: 91-91, ISSN: 2055-3331
AimsTo evaluate the effectiveness of a workplace digital health promotion programme with monthly telecoaching on various lifestyle and clinical outcome measures.MethodsWe recruited 103 participants from an occupational setting in the UK. Participants were assessed at baseline, and 3 and 6 months following intervention to determine the effect of an employer sponsored digital telecoaching intervention on various lifestyle and clinical outcome measures.ResultsA pragmatic sample size of 103 participants from a wide demographic background was recruited at baseline, with 95 participants (92%) completing the programme by 6 months. Almost all participants showed a significant improvement in the health score and 24 secondary outcome measures including HbA1c, blood pressure and reduction in smoking. Linear regression model showed that after adjusting for age and gender, the LiveSmart health score appeared to significantly improve by 6.22 units at 3 months (95% confidence interval (CI) 4.38 to 8.06) and by 7.73 units at 6 months (95% CI 5.75 to 9.71), compared with baseline visit, p<0.001.ConclusionThe LiveSmart digital health promotion programme with monthly coaching was a largely successful intervention programme achieving good traction with participants and significant improvement in a number of key outcomes, including lower HbA1c and reduced salt intake among other clinical and healthy lifestyle-related behaviours. A simplistic approach to modelling suggests that the programme has a good return on investment overall and offers a number of tangible and intangible benefits to the service user and the employer, and in the context of the wider health economy. A larger study with a longer follow-up is recommended to better understand the cost-effectiveness of health promotion interventions in the occupational setting.
Banarsee R, Kelly C, El-Osta A, et al., 2018, Towards a strategic alignment of public health and primary care practices at local levels - the case of severe and enduring mental illness, London Journal of Primary Care, Vol: 10, Pages: 19-23, ISSN: 1757-1472
The rapidly increasing number of people who have long-term conditions requires a system of coordinated support for self-care throughout the NHS. A system to support self-care needs to be aligned to systems that support shared-care and community development, making it easier for the multidisciplinary teams who provide care to also help patients and populations to help themselves. Public health practitioners need to work closely with clinicians to achieve this. The best place to coordinate this partnership is a community-based coordinating hub, or local health community – a geographic area of about 50,000 population where different contributions to self-care can be aligned. A shared vision for both health and disease management is needed to ensure consistent messaging by all. A three tier system of shared care can help to combine vertical and horizontal integration. This paper uses severe and enduring mental illness as an exemplar to anticipate the design of such a system.
El-Osta A, Woringer M, Pizzo E, et al., 2017, Does use of point of care testing improve cost effectiveness of the NHS Health Checks programme in the primary care setting? A cost minimisation analysis, BMJ Open, Vol: 7, ISSN: 2044-6055
Objective: To determine if use of Point of Care Testing (POCT) is less costly than laboratory testing to the NHS in delivering the NHS Heath Check (NHSHC) programme in the primary care setting Design: Observational study and theoretical mathematical model with micro-costing approachSetting: We collected data on NHSHC delivered at 9 general practices (7 using POCT; 2 not using POCT). Participants: We recruited 9 general practices offering NHSHC, and a Pathology Services Laboratory in the same area. Methods: We conducted mathematical modelling with permutations in the following fields: provider type (HCA or nurse), type of test performed (total cholesterol with either lab fasting glucose or HbA1c), consumables costs and variable uptake rates including rate of non-response to invite letter and rate of missed (DNA) appointments. We calculated Total Expected Cost (TEC) per 100 invites, number of NHSHC conducted per 100 invites and costs for completed NHSHC for laboratory and POCT-based pathways. A univariate and probabilistic sensitivity analysis was conducted to account for uncertainty in the input parameters. Main outcome measures: We collected data on cost, volume and type of pathology services performed at seven general practices using POCT and a Pathology Services Laboratory. We collected data on response to the NHSHC invitation letter and DNA rates from two general practices. Results: TEC of using POCT to deliver a routine NHSHC is lower than the laboratory-led pathway with savings of £29 per 100 invited patients up the point of CVD risk-score presentation. Use of POCT can deliver NHSHC in one sitting, whereas the laboratory pathway offers patients several opportunities to DNA appointment. Conclusions: TEC of using POCT to deliver an NHSHC in the primary care setting is lower than the laboratory-led pat
Kumar A, El-Osta A, Hussain AA, et al., 2010, Increased Sequestration of Matrix Metalloproteinases in Ageing Human Bruch's Membrane: Implications for ECM Turnover, INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE, Vol: 51, Pages: 2664-2670, ISSN: 0146-0404
Kumar A, El-Osta A, Hussain AA, et al., 2010, Levels and Binding of Active Matrix Metalloproteinase (MMP) Enzymes in Human Bruch's Membrane, Publisher: ASSOC RESEARCH VISION OPHTHALMOLOGY INC, ISSN: 0146-0404
El-Osta A, 2010, Laser-Mediated Activation of Matrix Metalloproteases (MMPs) Leading to Increased Transport Across Ageing Bruch's Membrane: Implications for Treatment of ARMD, Publisher: ASSOC RESEARCH VISION OPHTHALMOLOGY INC, ISSN: 0146-0404
Jackson TL, Hussain A, Morley AMS, et al., 2008, Scleral Hydraulic Conductivity and Macromolecular Diffusion in Patients with Uveal Effusion Syndrome, INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE, Vol: 49, Pages: 5033-5040, ISSN: 0146-0404
El-Osta AAR, Spalton DJ, Marshall J, 2003, In vitro model for the study of human posterior capsule opacification, J Cataract Refract Surg, Vol: 29, Pages: 1593-1600, ISSN: 0886-3350
Boyce JF, Bhermi GS, Spalton DJ, et al., 2002, Mathematical modeling of the forces between an intraocular lens and the capsule, J Cataract Refract Surg, Vol: 28, Pages: 1853-1859, ISSN: 0886-3350
Bhermi GS, Spalton DJ, El-Osta AA, et al., 2002, Failure of a discontinuous bend to prevent lens epithelial cell migration in vitro., J Cataract Refract Surg, Vol: 28, Pages: 1256-1261, ISSN: 0886-3350
To assess the effect of substrate geometry (discontinuous bend) on lens epithelial cell (LEC) growth in vitro.
El-Osta AA, Bakri R, Bhermi GS, et al., 2001, Growth characteristics of lens epithelial cells isolated from different zones of bovine lenses., Publisher: ASSOC RESEARCH VISION OPHTHALMOLOGY INC, Pages: S882-S882, ISSN: 0146-0404
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