Publications
409 results found
Faitna P, Hargreaves DS, Neale FK, et al., 2024, The impact of the COVID-19 pandemic on 397,631 elective dental admissions among the under-25s in England: a retrospective study, Journal of Public Health, ISSN: 1741-3842
Faitna P, Harwood R, Kenny SE, et al., 2024, Impact of the COVID-19 pandemic on the clinical management trends for acute appendicitis among the under-25s: a retrospective study, Archives of Disease in Childhood: Education and Practice Edition, Vol: 109, Pages: 339-346, ISSN: 0003-9888
OBJECTIVE: To describe the COVID-19 pandemic's impact on acute appendicitis management on children and young people (CYP). DESIGN: Retrospective cohort study. SETTING: All English National Health Service hospitals. PATIENTS: Acute appendicitis admissions (all, simple, complex) by CYP (under-5s, 5-9s, 10-24s). EXPOSURE: Study pandemic period: February 2020-March 2021. Comparator pre-pandemic period: February 2015-January 2020. MAIN OUTCOME MEASURES: Monthly appendicectomy and laparoscopic appendicectomy rate trends and absolute differences between pandemic month and the pre-pandemic average. Proportions of appendicitis admissions comprising complex appendicitis by hospital with or without specialist paediatric centres were compared. RESULTS: 101 462 acute appendicitis admissions were analysed. Appendicectomy rates fell most in April 2020 for the 5-9s (-18.4% (95% CI -26.8% to -10.0%)) and 10-24s (-28.4% (-38.9% to -18.0%)), driven by reductions in appendicectomies for simple appendicitis. This was equivalent to -54 procedures (-68.4 to -39.6) and -512 (-555.9 to -467.3) for the 5-9s and 10-24s, respectively. Laparoscopic appendicectomies fell in April 2020 for the 5-9s (-15.5% (-23.2% to -7.8%)) and 10-24s (-44.8% (-57.9% to -31.6%) across all types, which was equivalent to -43 (-56.1 to 30.3) and -643 (-692.5 to -593.1) procedures for the 5-9s and 10-24s, respectively. A larger proportion of complex appendicitis admissions were treated within trusts with specialist paediatric centres during the pandemic. CONCLUSIONS: For CYP across English hospitals, a sharp recovery followed a steep reduction in appendicectomy rates in April 2020, due to concerns with COVID-19 transmission. This builds on smaller-sized studies reporting the immediate short-term impacts.
Bottle A, Kristensen PK, 2024, Variation in quality of care between hospitals: how to identify learning opportunities., BMJ Qual Saf
Plumb W, Casale G, Bottle A, et al., 2024, Clinical pathway clustering using surrogate likelihoods and replayability validation, Winter Simulation Conference 2023, Publisher: ACM / IEEE, Pages: 1220-1231
Modelling clinical pathways from Electronic Health Records (EHRs) can optimize resources and improvepatient care, but current methods for generating pathway models using clustering have limitations includingscalability and fidelity of the clusters. We propose a novel pathway modelling approach using MaximumLikelihood (ML) data clustering on Markov chain representations of clinical pathways. Our method iscalibrated to produce clusters with low inter-cluster variability across the pathways. We use machine learningwith Stochastic Radial Basis Functions (SRBF) kernels for surrogate optimization to handle non-convexityand propose an incremental optimization method to improve scalability. We also define a methodologybased on novel replayability scores to help analysts compare the fidelity of alternative clustering results.Results show that our ML method produces clusters that have higher fidelity in terms of replayability scoresthan k-means based clustering and in capturing queueing contention, which is important for bottleneckidentification in healthcare.
Selinger C, Bottle A, Lamb CA, et al., 2024, 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 Gastroenterology, ISSN: 2041-4137
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 100000 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.
Jayasooriya N, Pollok RC, Blackwell J, et al., 2023, Adherence to 5-aminosalicylic acid maintenance treatment in young people with ulcerative colitis: a retrospective cohort study in primary care, British Journal of General Practice, Vol: 73, Pages: e850-e857, ISSN: 0960-1643
Background: Maintenance treatment with 5-aminosalicylic acid (5-ASA) is recommended in ulcerative colitis (UC), but accurate estimates of discontinuation and adherence in adolescents transitioning to young adulthood are lacking.Aim: To determine rates and risk factors for discontinuation and adherence to oral 5-ASA in adolescents and young adults 1 year following diagnosis of UC.Design and setting: Observational cohort study using the UK Clinical Practice Research Datalink among adolescents and young adults (aged 10–24 years) diagnosed with UC between 1 January 1998 and 1 May 2016.Method: Time to oral 5-ASA discontinuation (days) and adherence rates (proportion of days covered) were calculated during the first year of treatment using Kaplan–Meier survival analysis. Cox regression models were built to estimate the impact of sociodemographic and health-related risk factors.Results: Among 607 adolescents and young adults starting oral 5-ASA maintenance treatment, one-quarter (n = 152) discontinued within 1 month and two- thirds (n = 419) within 1 year. Discontinuation was higher among those aged 18–24 years (74%) than younger age groups (61% and 56% in those aged 10–14 and 15–17 years, respectively). Adherence was lower among young adults than adolescents (69% in those aged 18–24 years versus 80% in those aged 10–14 years). Residents in deprived versus affluent postcodes were more likely to discontinue treatment (adjusted hazard ratio [aHR] 1.46, 95% confidence interval [CI] = 1.10 to 1.92). Early corticosteroid use for an acute flare lowered the likelihood of oral 5-ASA discontinuation (aHR 0.68, 95% CI = 0.51 to 0.90).Conclusion: The first year of starting long-term therapies in adolescents and young adults diagnosed with UC is a critical window for active follow-up of maintenance treatment, particularly in those aged 18–24 years and those living in deprived postcodes.
Williams R, Morris A, Gupta V, et al., 2023, Predictors of positive patient reported outcomes from ‘Early Intervention in Psychosis’ – a national cross-sectional study, BMJ Mental Health, Vol: 26, Pages: 1-7, ISSN: 2755-9734
BackgroundThe components of care delivered by Early Intervention in Psychosis (EIP) services vary, but the impact on patient experience is unknown. ObjectiveTo investigate associations between components of care provided by EIP services in England and patient-reported outcomes.Methods2374 patients from EIP services in England were surveyed during the National Clinical Audit of Psychosis. Participants were asked about the care they received, and completed the ‘Patient Global Impressions’ scale (rating whether their mental health had improved), and ‘Friends and Family Test’ (rating whether they would recommend their service). Information about service structure was obtained from service providers. We analysed associations between outcomes and components of care using multilevel regression. FindingsThe majority of participants were likely to recommend the treatment they had received (89.8%), and felt that their mental health had improved (89.0%). Participants from services where care coordinators had larger caseloads were less likely to recommend their care. Participants were more likely to recommend their care if they had been offered cognitive behavioural therapy for psychosis, family therapy or targeted interventions for carers. Participants were more likely to report that their mental health had improved if they had been offered cognitive behavioural therapy for psychosis or targeted interventions for carers. ConclusionsSpecific components of EIP care were associated with improved patient reported outcomes. Psychosocial interventions and carer support may be particularly important in optimising outcomes for patients.Clinical ImplicationsThese findings emphasise the need for small caseload sizes and comprehensive packages of treatment in EIP services.
Ward JL, Harwood R, Kenny S, et al., 2023, Pediatric Hospitalizations and ICU Admissions Due to COVID-19 and Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 in England, JAMA PEDIATRICS, ISSN: 2168-6203
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Lai HTM, Chang K, Sharabiani MTA, et al., 2023, Twenty-year trajectories of cardio-metabolic factors among people with type 2 diabetes by dementia status in England: a retrospective cohort study, European Journal of Epidemiology, Vol: 38, Pages: 733-744, ISSN: 0393-2990
To assess 20-year retrospective trajectories of cardio-metabolic factors preceding dementia diagnosis among people with type 2 diabetes (T2D). We identified 227,145 people with T2D aged > 42 years between 1999 and 2018. Annual mean levels of eight routinely measured cardio-metabolic factors were extracted from the Clinical Practice Research Datalink. Multivariable multilevel piecewise and non-piecewise growth curve models assessed retrospective trajectories of cardio-metabolic factors by dementia status from up to 19 years preceding dementia diagnosis (dementia) or last contact with healthcare (no dementia). 23,546 patients developed dementia; mean (SD) follow-up was 10.0 (5.8) years. In the dementia group, mean systolic blood pressure increased 16-19 years before dementia diagnosis compared with patients without dementia, but declined more steeply from 16 years before diagnosis, while diastolic blood pressure generally declined at similar rates. Mean body mass index followed a steeper non-linear decline from 11 years before diagnosis in the dementia group. Mean blood lipid levels (total cholesterol, LDL, HDL) and glycaemic measures (fasting plasma glucose and HbA1c) were generally higher in the dementia group compared with those without dementia and followed similar patterns of change. However, absolute group differences were small. Differences in levels of cardio-metabolic factors were observed up to two decades prior to dementia diagnosis. Our findings suggest that a long follow-up is crucial to minimise reverse causation arising from changes in cardio-metabolic factors during preclinical dementia. Future investigations which address associations between cardiometabolic factors and dementia should account for potential non-linear relationships and consider the timeframe when measurements are taken.
Pollok R, Jayasooriya N, Baillie S, et al., 2023, Letter: delays to diagnosis of IBD-Challenges requiring a systematic approach. Authors' reply, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 57, Pages: 1479-1479, ISSN: 0269-2813
Zhang X, Ellis A, Ioannides AE, et al., 2023, Survey-identified Experiences of Pre-diagnosis and Diagnosis Processes Amongst Patients With COPD, Asthma, Interstitial Lung Disease and Bronchiectasis, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Pollok R, Baillie S, Jayasooriya N, et al., 2023, Letter: diagnostic delay in inflammatory bowel disease-Authors' reply, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 57, Pages: 1205-1206, ISSN: 0269-2813
Parnham JC, Vrinten C, Rado MK, et al., 2023, Multistate transition modelling of e-cigarette use and cigarette smoking among youth in the UK, LANCET CHILD & ADOLESCENT HEALTH, Vol: 7, Pages: 297-297, ISSN: 2352-4642
Jayasooriya N, Baillie S, Blackwell J, et al., 2023, Systematic review with meta-analysis: Time to diagnosis and the impact of delayed diagnosis on clinical outcomes in inflammatory bowel disease, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 57, Pages: 635-652, ISSN: 0269-2813
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- Citations: 11
Williams R, Penington E, Gupta V, et al., 2023, Predictors of positive outcomes from 'Early Intervention in Psychosis': protocol for a national retrospective cohort study., Front Psychiatry, Vol: 14, ISSN: 1664-0640
BACKGROUND: Psychotic disorders are severe and prevalent mental health conditions associated with long-term disability, reduced quality of life, and substantial economic costs. Early Intervention in Psychosis (EIP) services aim to provide timely and comprehensive treatment for psychotic disorders, and EIP service input is associated with improved outcomes. However, there is limited understanding of the specific components of EIP care that contribute to these improvements. There is significant nationwide variability in the commissioning and delivery of EIP, with individuals receiving different packages of components from different services. In this study, we seek to explore associations between EIP components and clinically significant outcomes, in order to understand the mechanisms underlying improved psychosis care. METHODS: This national retrospective cohort study will utilize data from the 2019 National Clinical Audit of Psychosis (NCAP), examining the care received by 10,560 individuals treated by EIP services in England. Exposure data from the NCAP, capturing the components of care delivered by EIP services, will be linked with outcome data from routine NHS Digital datasets over a three-year follow-up period. This will be the first study to use this method to examine this population in England. The primary outcomes will be surrogate measures of relapse of psychosis (hospital admission and referral to community-based crisis intervention services). Secondary outcomes include duration of admissions, emergency hospital attendances, episodes of detention under the Mental Health Act, and all-cause mortality. We will use multilevel regression to examine associations between exposures and outcome events. We will handle missing data using appropriate imputation techniques. DISCUSSION: This study aims to provide valuable insights into the long-term effects of variations in EIP service delivery. The study involves a large, diverse cohort including individuals treated by e
Bottle A, Liddle A, 2022, Hip fracture in the COVID-19 era: what can we say about care and patient outcomes?, BMJ Quality & Safety, Vol: 32, Pages: 244-246, ISSN: 2044-5423
Bottle A, Newson R, Faitna P, et al., 2022, Risk prediction of mortality for patients with heart failure in England: observational study in primary care, ESC HEART FAILURE, ISSN: 2055-5822
Karsanji U, Lawson CA, Bottle A, et al., 2022, DESCRIBING LONG-TERM OUTCOMES AND THE ASSOCIATION WITH BOTH RECEIVING A DIAGNOSIS AND TIME TO DIAGNOSIS IN ADULTS PRESENTING WITH BREATHLESSNESS: A UK RETROSPECTIVE STUDY USING ELECTRONIC HEALTHCARE RECORDS, Winter Meeting of the British-Thoracic-Society (BTS), Publisher: BMJ PUBLISHING GROUP, Pages: A179-A180, ISSN: 0040-6376
Foley KA, Maile EJ, Bottle A, et al., 2022, How did the covid-19 pandemic affect lower respiratory tract infections in young children in England?, EUROPEAN JOURNAL OF PUBLIC HEALTH, Vol: 32, ISSN: 1101-1262
Mauricaite R, Le Calvez K, Brodbelt A, et al., 2022, GLIOCOVA: PREDICTORS OF POST-OPERATIVE COMPLICATIONS, 30 DAY MORTALITY AND READMISSION AFTER FIRST SURGICAL INTERVENTION IN BRAIN TUMOUR PATIENTS IN ENGLAND BETWEEN 2013-2018, Annual Meeting of the British-Neuro-Oncology-Society (BNOS), Publisher: OXFORD UNIV PRESS INC, Pages: 8-8, ISSN: 1522-8517
Vamos EP, Lai H, Sharabiani M, et al., 2022, Cardio-metabolic factors and risk of dementia in people with type 2 diabetes in England: a large retrospective cohort study, DUK, Publisher: SPRINGER, Pages: S402-S403, ISSN: 0012-186X
Lai H, Sharma A, Chang K, et al., 2022, COMPARISON OF SEX-SPECIFIC HISTORICAL CARDIOMETABOLIC TRAJECTORIES IN T2D PATIENTS BY DEMENTIA STATUS IN ENGLAND, DUK, Publisher: BMJ PUBLISHING GROUP, Pages: A1-A2, ISSN: 0143-005X
Bottle A, Neale FK, Foley KA, et al., 2022, Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study, BMJ OPEN, Vol: 12, ISSN: 2044-6055
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Warner M, Burn S, Stoye G, et al., 2022, Socioeconomic deprivation and ethnicity inequalities in disruption to NHS hospital admissions during the COVID-19 pandemic: a national observational study, BMJ Quality & Safety, Vol: 31, Pages: 590-598, ISSN: 2044-5415
Introduction Hospital admissions in many countries fell dramatically at the onset of the COVID-19 pandemic. Less is known about how care patterns differed by patient groups. We sought to determine whether areas with higher levels of socioeconomic deprivation or larger ethnic minority populations saw larger falls in emergency and planned admissions in England.Methods We conducted a national observational study of hospital care in the English National Health Service (NHS) in 2019–2020. Weekly volumes of elective (planned) and emergency admissions in 2020 compared with 2019 were calculated for each census area. Multiple linear regression analysis was used to estimate the reductions in volumes for areas in different quintiles of socioeconomic deprivation and ethnic minority populations after controlling for national time trends and local area composition.Results Between March and December 2020, there were 35.5% (3.0 million) fewer elective admissions and 22.0% (1.2 million) fewer emergency admissions with a non-COVID-19 primary diagnosis than in 2019. Areas with the largest share of ethnic minority populations experienced a 36.7% (95% CI 24.1% to 49.3%) larger reduction in non-primary COVID-19 emergency admissions compared with those with the smallest. The most deprived areas experienced a 10.1% (95% CI 2.6% to 17.7%) smaller reduction in non-COVID-19 emergency admissions compared with the least deprived. These patterns are not explained by differential prevalence of COVID-19 cases by area.Conclusions Even in a healthcare system founded on the principle of equal access for equal need, the impact of COVID-19 on NHS hospital care for non-COVID patients has not been spread evenly by ethnicity and deprivation in England. While we cannot conclusively determine the mechanisms behind these differences, they risk exacerbating prepandemic health inequalities.Data availability statementData may be obtained from a third party and are not publicly available.
Bottle A, Browne J, 2022, Outsourcing care to the private sector: some reassuring evidence on patient outcomes, BMJ QUALITY & SAFETY, Vol: 31, Pages: 486-488, ISSN: 2044-5415
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Foley K, Maile E, Bottle R, et al., 2022, Impact of covid-19 on primary care contacts with children and young people aged 0-24 years in England; longitudinal trends study 2015-2020, British Journal of General Practice, ISSN: 0960-1643
Background: The NHS response to covid-19 altered provision and access to primary care.Aim: To examine the impact of covid-19 on general practitioner (GP) contacts with children and young people in England. Design and Setting: Longitudinal trends analysis using electronic health records from the Clinical Practice Research Datalink Aurum database.Methods: We included all children and young people younger than 25 years registered with a GP. We compared the number of total, remote and face-to-face contacts during the first UK lockdown (March to June 2020) with the mean contacts for comparable weeks from 2015 to 2019.Results: We examined 47 607 765 GP contacts with 4 307 120 million children and young people. GP contacts fell 41% during the first lockdown compared with previous years. Children aged 1-14 had greater falls in total contacts (>50%) compared with infants and 15-24s. Face-to-face contacts fell by 88% with the greatest falls occurring among children aged 1-14 (> 90%). Remote contacts more than doubled, increasing most in infants (over 2.5 fold). Total contacts for respiratory illnesses fell by 74% whereas contacts for common non-transmissible conditions shifted largely to remote, mitigating the total fall (31%). Conclusion: During the covid-19 pandemic, children and young people’s contact with GPs fell, particularly for face-to-face assessment. This may be explained by a lower incidence of respiratory illnesses due to fewer social contacts and changing health seeking behaviour. The large shift to remote contacts mitigated total falls in contacts for some age groups and for common non-transmissible conditions.
Bottle R, Faitna P, Brett S, et al., 2022, Factors associated with, and variations in, COVID-19 hospital death rates in England’s first two waves: observational study, BMJ Open, Vol: 12, Pages: 1-11, ISSN: 2044-6055
Objectives:To assess patient- and hospital-level predictors of death and variation in death rates following admission for COVID-19 in England’s first two waves after accounting for random variation. To quantify the correlation between hospitals’ first and second wave death rates.Design:Observational study using administrative data.Setting:Acute non-specialist hospitals in England.Participants:All patients admitted with a primary diagnosis of COVID-19.Primary and secondary outcomes:In-hospital death.Results:Hospital Episode Statistics (HES) data were extracted for all acute hospitals in England for COVID-19 admissions for March 2020 to March 2021. In wave one (March-July 2020) there were 74,484 admissions and 21,883 deaths (crude rate 29.4%); in wave two (August 2020 to March 2021) there were 165,642 admissions and 36,040 deaths (21.8%). Wave two patients were younger, with more hypertension and obesity but lower rates of other comorbidities. Mortality improved for all ages; in wave two it peaked in December 2020 at 24.2% (lower than wave one’s peak) but halved by March 2021. In multiple multilevel modelling combining HES with hospital-level data from Situational Reports, wave two and wave one variables significantly associated with death were mostly the same. The median odds ratio for wave one was just 1.05 and for wave two was 1.07. At 99.8% control limits, 3% of hospitals were high and 7% were low funnel plot outliers in wave one; these figures were 9% and 12% for wave two. Four hospitals were (low) outliers in both waves. The correlation between hospitals’ adjusted mortality rates between waves was 0.45 (p<0.0001). Length of stay was similar in each wave.Conclusions:England’s first two COVID-19 waves were similar regarding predictors and moderate inter-hospital variation. Despite the challenges, variation in death rates and length of stay between hospitals was modest and might be accounted for by unobserved patient factors.
Jayasooriya N, Baillie S, Blackwell J, et al., 2022, IMPACT OF TIME TO DIAGNOSIS ON INFLAMMATORY BOWEL DISEASE OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS, Annual Meeting of the British-Society-of-Gastroenterology (BSG), Publisher: BMJ PUBLISHING GROUP, Pages: A52-A53, ISSN: 0017-5749
Jayasooriya N, Blackwell J, Saxena S, et al., 2022, Antidepressant medication use in Inflammatory Bowel Disease: a nationally representative population-based study, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 55, Pages: 1330-1341, ISSN: 0269-2813
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Lai H, Sharma A, Chang K, et al., 2022, Historical cardiometabolic trajectories in T2D patients by dementia status in England by sex, ethnicity, and deprivation, DUK, Publisher: ELSEVIER IRELAND LTD, ISSN: 0168-8227
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