29 results found
El-Osta A, Hennessey C, Pilot C, et al., 2021, A digital solution to streamline access to smoking cessation interventions in England; findings from a primary care pilot (STOPNOW study), Public Health in Practice, Vol: 2, ISSN: 2666-5352
Objectives:Despite the proven efficacy of several smoking cessation medications that have been shown to improve long-term abstinence rates, approximately two-thirds of smokers report not having used medication in their most recent quit attempt. A main barrier could be delayed access to pharmacological interventions. This study investigated the utility of a primary care linked online portal to streamline timely access to pharmacological support to patients who want to quit smoking by making an asynchronous request for treatment to their general practitioner.Study design:Prospective cohort study.Methods:An online portal with added functionality was developed, which allowed patients with a unique link to make an asynchronous request for treatment. Two GP practices identified a total of 4337 eligible patients who received an SMS or email invite to engage with an online portal including an electronic survey to capture information about smoking behaviours and to request treatment. Portal informatics and patient level data were analysed to measure the efficacy of the online system in reducing the time between making a formal request to treatment and access to pharmacological support. The primary outcome measure was the time between making a formal request for treatment and access to pharmacological support from a designated community pharmacy.Results:323 patients (7.4%) initiated the survey, but only 56 patients completed the survey and made a formal request for treatment. 94% of participants did not return to use the portal to make a second or follow-up request for treatment. Only 3 participants completed the 12-week pathway. A total of 75 medication items were prescribed and collected by 56 patients. The time difference between the formal request to treatment and GP review ranged between 20 h and 1 week. The time difference between approval of prescription by the GP and access to medication was 5 days ± 2.1 days (range = 1.9–7.0 days).Conclusion:The widespre
Powell RA, Kendall K, Cislaghi B, et al., 2021, Self-care, social norms and anomie during COVID-19: from contestation of the greater good to building future normative resilience in the UK, Journal of Epidemiology and Community Health, Vol: 75, Pages: 925-926, ISSN: 0143-005X
El-Osta A, Webber I, Alaa A, et al., 2021, What is the suitability of clinical vignettes in benchmarking the performance of online symptom checkers? An audit study, BMJ Open, ISSN: 2044-6055
Symington E, El-Osta A, Birrell F, 2021, Supported self-care is integral to lifestyle medicine: Can virtual group consultations promote them both?, Lifestyle Medicin Journal, Vol: 2, Pages: 1-5, ISSN: 2688-3740
WHO, 2021, WHO Guideline on Self-Care Interventions for Health and Well-Being, https://www.ncbi.nlm.nih.gov/books/NBK572699/
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 worker. 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.Worldwide, an estimated shortage of 18 million health workers is anticipated by 2030, a record 130 million people are currently in need of humanitarian assistance, and disease outbreaks are a constant global threat. At least 400 million people worldwide lack access to the most essential health services, and every year 100 million people are plunged into poverty because they have to pay for health care out of their own pockets. There is an urgent need to find innovative strategies that go beyond the conventional health sector response.While “self-care” is not a new term or concept, self-care interventions have the potential to increase choice, when they are accessible and affordable, and they can also provide more opportunities for individuals to make informed decisions regarding their health and health care. In humanitarian settings, for example, due to lack of or limited health infrastructure and medical services in the crisis-affected areas
Harris M, Kreindler J, El-Osta A, et al., 2021, Safe management of full-capacity live/mass events in COVID19 will require mathematical, epidemiological and economic modelling, Journal of the Royal Society of Medicine, Vol: 114, Pages: 290-294, ISSN: 0141-0768
Donnat C, Bunbury F, Liu D, et al., 2021, Predicting COVID-19 transmission to inform the management of mass events: a model-based approach, JMIR Public Health and Surveillance, ISSN: 2369-2960
Background:Modelling COVID-19 transmission at live events and public gatherings is essential to control the probability of subsequent outbreaks and communicate to participants their personalised risk. Yet, despite the fast-growing body of literature on COVID transmission dynamics, current risk models either neglect contextual information on vaccination rates or disease prevalence or do not attempt to quantitatively model transmission.Objective:This paper attempts to bridge this gap by providing informative risk metrics for live public events, along with a measure of their uncertainty.Methods:Building upon existing models, our approach ties together three main components: (a) reliable modelling of the number of infectious cases at the time of the event, (b) evaluation of the efficiency of pre-event screening, and (c) modelling of the event’s transmission dynamics and their uncertainty along using Monte Carlo simulations.Results:We illustrate the application of our pipeline for a concert at the Royal Albert Hall and highlight the risk’s dependency on factors such as prevalence, mask wearing, or event duration. We demonstrate how this event held on three different dates (August 20th 2020, January 20th 2021, and March 20th 2021) would likely lead to transmission events that are similar to community transmission rates (0.06 vs 0.07, 2.38 vs 2.39, and 0.67 vs 0.60, respectively). However, differences between event and background transmissions substantially widen in the upper tails of the distribution of number of infections (as denoted by their respective 99th quantiles: 1 vs 1, 19 vs 8, and 6 vs 3 for our three dates), further demonstrating that sole reliance on vaccination and antigen testing to gain entry would likely significantly underestimate the tail risk of the event.Conclusions:Despite the unknowns surrounding COVID-19 transmission, our estimation pipeline opens the discussion on contextualized risk assessment by combining the best tools at hand to as
Donnat C, Bunbury F, Kreindler J, et al., 2021, A Predictive Modelling Framework for COVID-19 Transmission to Inform the Management of Mass Events, Journal of Medical Internet Research, ISSN: 1438-8871
El-Osta A, Alaa A, Karki M, et al., 2021, Assessing implementation levels of the WHO consolidated guideline on self-care interventions in policy and practice (In Kenya, Nigeria & Uganda)
El-Osta A, Alaa A, Webber I, et al., 2021, How is the COVID-19 lockdown impacting the mental health of parents of school-age children in the United Kingdom? A cross-sectional online survey, BMJ Open, Vol: 11, Pages: 1-11, ISSN: 2044-6055
ObjectiveInvestigate the impact of the COVID-19 lockdown on feelings of loneliness and social isolation in parents of school-age childrenDesignCross sectional online survey of parents of primary and secondary school-age childrenSettingCommunity settingParticipants 1214 parents of school-age children in the United KingdomMethodsAn online survey explored the impact of lockdown on the mental health of parents with school-age children, and in particular about feelings of social isolation and loneliness. Associations between the UCLA three-item Loneliness Scale (UCLATILS), the Direct Measure of Loneliness (DMOL) and the characteristics of the study participants were assessed using ordinal logistic regression modelsMain outcome measuresSelf-reported measures of social isolation and loneliness using UCLATILS and DMOL.Results Half of respondents felt they lacked companionship, 45% had feelings of being left out, 58% felt isolated and 46% felt lonely. The factors that were associated with higher levels of loneliness on UCLATILS were female gender, parenting a child with special needs, lack of a dedicated space for distance learning, disruption of sleep patterns and low levels of physical activity during the lockdown. Factors associated with a higher DMOL were female gender, single-parenting, parenting a child with special needs, unemployment, low physical activity, lack of a dedicated study-space and disruption of sleep patterns during the lockdown.ConclusionsThe COVID-19 lockdown has increased feelings of social isolation and loneliness among parents of school-age children. Two modifiable health seeking lifestyle behaviours (increased levels of physical activity and the maintenance of good sleep hygiene practices) were identified as key factors in reducing feelings of social isolation and loneliness during lockdown.
Bloom C, Ramsey H, Alter M, et al., 2020, Qualitative study of practices and challenges of stepping down asthma medication in primary care across the UK, Journal of Asthma and Allergy, Vol: 13, Pages: 429-437, ISSN: 1178-6965
Background: Guidelines recommend that asthma treatment should be stepped down to the minimally effective dose that achieves symptom control to prevent medication side effects and reduce unnecessary costs. Little is known about the practice of stepping down and the challenges in primary care, where most asthma patients are managed.Objective: To explore views, experiences, barriers and ideas, of doctors, nurses and pharmacists working in primary care, related to step down of asthma medication.Methods: Primary care practitioners from across the UK participated in a survey and/or semi-structured interview. Questions explored four main areas: how asthma medication is reviewed, views on asthma guidelines, perceived barriers faced by healthcare workers and facilitators of stepping down. Qualitative content analysis enabled data coding of interview transcripts to identify major themes.Results: A total of 274 participants responded to the survey, 29 participated in an interview (12 doctors, 9 nurses, and 8 pharmacists), working in GP practices from across the UK. Nearly half of the survey participants infrequently step down asthma medication (doctors=42.7%, nurses=46.3%). Four major themes related to barriers to stepping down were (i) lack of awareness of the need to step down, (ii) inertia to step down, driven by low confidence in ability, fear of consequences, and concern for who is responsible for stepping down, (iii) self-efficacy of ability to step down, influenced by lack of clear, applied guidance and limited training, and (iv) feasibility of step down, driven by a lack of systematic acceptance of stepping down and time. Strategies proposed to reduce overtreatment included education and training, improved gathering of evidence and guidance, and integrating step down into routine asthma care.Conclusion: Failure to implement this guideline recommendation into everyday asthma management is influenced by several contributing factors. Future directions should include addre
Wang C, Bakhet M, Roberts D, et al., 2020, The efficacy of microlearning in improving self-care capability: a systematic review of the literature, PUBLIC HEALTH, Vol: 186, Pages: 286-296, ISSN: 0033-3506
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, 2017, Dementia care Kilburn pie
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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