Publications
113 results found
Beaney T, Clarke J, Alboksmaty A, et al., 2023, Evaluating the impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in patients with COVID-19 assessed in Emergency Departments in England: a retrospective matched cohort study, Emergency Medicine Journal, ISSN: 1472-0205
Background:To identify the impact of a national pulse oximetry remote monitoring programme for COVID-19 (COVID Oximetry @home; CO@h) on health service use and mortality in patients attending Emergency Departments (EDs).Methods:We conducted a retrospective matched cohort study of patients enrolled onto the CO@h pathway from EDs in England. We included all patients with a positive COVID-19 test from 1st October 2020 to 3rd May 2021 who attended ED from three days before to ten days after the date of the test. All patients who were admitted or died on the same or following day to the first ED attendance within the time window were excluded. In the primary analysis, participants enrolled onto CO@h were matched using demographic and clinical criteria to participants who were not enrolled. Five outcome measures were examined within 28 days of first ED attendance: i) death from any cause; ii) any subsequent ED attendance; iii) any emergency hospital admission; iv) critical care admission; and v) length of stay.Results:15,621 participants were included in the primary analysis, of whom 639 were enrolled onto CO@h and 14,982 were controls. Odds of death were 52% lower in those enrolled (95% CI: 7%-75% lower) compared to those not enrolled on CO@h. Odds of any ED attendance or admission were 37% (95% CI: 16-63%) and 59% (95% CI: 16-63%) higher, respectively, in those enrolled. Of those admitted, those enrolled had 53% (95% CI: 7%-76%) lower odds of critical care admission. There was no significant impact on length of stay.Conclusions:These findings indicate that for patients assessed in ED, pulse oximetry remote monitoring may be a clinically effective and safe model for early detection of hypoxia and escalation. However, possible selection biases might limit the generalisability to other populations.
Clarke J, Beaney T, Alboksmaty A, et al., 2022, Identifying factors associated with enrolment into a national COVID-19 pulse oximetry remote monitoring programme in England: a retrospective observational study, The Lancet Digital Health, ISSN: 2589-7500
Background:Hypoxaemia is an important predictor of severity in patients with COVID-19 and may present without symptoms. The COVID-19 Oximetry @home (CO@h) programme was implemented across England from November 2020 providing pulse oximeters to higher risk people with COVID-19 to enable early detection of deterioration and escalation of care. However, the equity of access to the programme was unknown.Methods:This was a retrospective observational study. The proportion of patients enrolled onto CO@h programmes in the seven days before and 28 days after a positive COVID-19 test was calculated for each Clinical Commissioning Group (CCG) in England. Two-level hierarchical multivariable logistic regression with random intercepts for each CCG was run to identify factors predictive of being enrolled onto the CO@h programme. Findings:A total of 1,215,405 residents in 72 CCGs had a positive COVID-19 test between the date of programme implementation and the 3rd May 2021, of whom 19,932 (1·6%) were enrolled onto a CO@h programme. Of those enrolled, 14,441 (72·5%) were aged 50 years or more or were identified as clinically extremely vulnerable (CEV). Of all those aged 50 years or more or identified as CEV, 2·9% were enrolled. Higher odds of enrolment onto the CO@h programme were found in older patients, of non-White ethnicity, from more socioeconomically deprived areas, who were overweight (adjusted odds ratio (aOR) 1·31 [95% CI 1·26-1·37], p<0·001) or obese (aOR 1·69 [95% CI 1·63-1·77], p<0·001) or those identified as having a high-risk medical condition (aOR 1·58 [95% CI 1·51-1·65], p<0·001). Interpretation:Nationally, uptake of the CO@h programme was low with use of clinical judgement in determining eligibility. Preferential enrolment to the pulse oximetry monitoring programme was observed in people known to be at the highest risk of developing severe COVID-19. Fu
Beaney T, Clarke J, 2022, Home oxygen monitoring and therapy: learning from the pandemic, Current Opinion in Critical Care
Beaney T, Kerr G, Hayhoe B, et al., 2022, Comparing registered and resident populations in Primary Care Networks in England: an observational study, BJGP Open, Vol: 6, ISSN: 2398-3795
BackgroundPrimary Care Networks (PCNs) were established in England in 2019 and will play a key role in providing care at a neighbourhood level within Integrated Care Systems (ICSs).AimTo identify PCN ‘catchment’ areas and compare the overlap between registered and resident populations of PCNs.Design and SettingObservational study using publicly available data on the number of people within each Lower Layer Super Output Area (LSOA) registered to each General Practice (GP) in England in April 2021.MethodLSOAs were assigned to the PCN to which the majority of residents were registered. The PCN catchment population was defined as the total number of people resident in all LSOAs assigned to that PCN. We compared PCN catchment populations to the population of people registered to a GP practice in each PCN.ResultsIn April 2021, 6,506 GP practices were part of 1,251 PCNs. 56.1% of PCNs had between 30,000 and 50,000 registered patients. There was a strong correlation (0.91) between the total registered population size and catchment population size. We found significant variation in the percentage of residents in each LSOA registered to a GP practice within the same PCN catchment, and strong associations with both urban-rural status and socioeconomic deprivation.ConclusionThere exists significant variation across England in the overlap between registered and resident (catchment) populations in PCNs which may impact on integration of care in some areas. There was less overlap in urban and more deprived areas which could exacerbate existing health inequalities.
Alboksmaty A, Beaney T, Elkin S, et al., 2022, Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19, EUROPEAN JOURNAL OF PUBLIC HEALTH, Vol: 32, ISSN: 1101-1262
Li E, Clarke J, Ashrafian H, et al., 2022, Impact of electronic health record interoperability on safety and quality of care in high-income countries: A systematic review, Journal of Medical Internet Research, Vol: 24, Pages: 1-15, ISSN: 1438-8871
Background: Electronic health records (EHR) and poor systems interoperability are well-known issues in the use of health information technologies worldwide in most high-income countries. Despite the abundance of literature exploring their relationship, its practical implications on patient safety and quality of care remain unclear.Objective: To examine how EHR interoperability affects patient safety, or other dimensions of care quality, in high-income healthcare settings. Methods: A systematic search was conducted using four online medical journal repositories and grey literature sources. Publications included were published in English between 2010-2022, pertaining to EHR use, interoperability, and patient safety or care quality in high-income settings. Screening was completed by three researchers in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Risk of bias assessments was performed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) and the Cochrane Risk of Bias 2 (RoB2) tools. Findings were presented as a narrative synthesis and mapped based on the Institute of Medicine’s framework for healthcare quality.Results: Twelve studies met the inclusion criteria to be included in our review. Findings were categorised into six common outcome measure categories: patient safety events, medication safety, data accuracy and errors, care effectiveness, productivity, and cost-savings. EHR interoperability was found to positively influence medication safety, reduce patient safety events, and lower costs. Improvements to time-savings and clinical workflow are mixed. However, true measures of effect are difficult to determine with certainty due to the heterogeneity in outcome measures used and notable variation in study quality.Conclusion: The benefits of EHR interoperability on the quality and safety of care remain unclear and reflect the extensive heterogeneity in the interventions, designs, and outcome
Gujjuri RR, Clarke JM, Elliott JA, et al., 2022, Predicting Long-term Survival and Time-to-recurrence After Esophagectomy in Patients With Esophageal Cancer, Annals of Surgery, Vol: Publish Ahead of Print, ISSN: 0003-4932
Jain V, Clarke J, Beaney T, 2022, Association between democratic governance and excess mortality during the COVID-19 pandemic: an observational study, JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, Vol: 76, Pages: 853-860, ISSN: 0143-005X
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Koldeweij C, Appelbaum N, Rodriguez Gonzalvez C, et al., 2022, Mind the gap: Mapping variation between national and local clinical practice guidelines for acute paediatric asthma from the United Kingdom and the Netherlands, PLoS One, Vol: 17, ISSN: 1932-6203
BACKGROUND: Clinical practice guidelines (CPGs) aim to standardize clinical care. Increasingly, hospitals rely on locally produced guidelines alongside national guidance. This study examines variation between national and local CPGs, using the example of acute paediatric asthma guidance from the United Kingdom and the Netherlands. METHODS: Fifteen British and Dutch local CPGs were collected with the matching national guidance for the management of acute asthma in children under 18 years old. The drug sequences, routes and methods of administration recommended for patients with severe asthma and the tone of recommendation across both types of CPGs were schematically represented. Deviations from national guidance were measured. Variation in recommended doses of intravenous salbutamol was examined. CPG quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II. RESULTS: British and Dutch national CPGs differed in the recommended drug choices, sequences, routes and methods of administration for severe asthma. Dutch national guidance was more rigidly defined. Local British CPGs diverged from national guidance for 23% of their recommended interventions compared to 8% for Dutch local CPGs. Five British local guidelines and two Dutch local guidelines differed from national guidance for multiple treatment steps. Variation in second-line recommendations was greater than for first-line recommendations across local CPGs from both countries. Recommended starting doses for salbutamol infusions varied by more than tenfold. The quality of the sampled local CPGs was low across all AGREE II domains. CONCLUSIONS: Local CPGs for the management of severe acute paediatric asthma featured substantial variation and frequently diverged from national guidance. Although limited to one condition, this study suggests that unmeasured variation across local CPGs may contribute to variation of care more broadly, with possible effects on healthcare quality.
Sivan M, Greenhalgh T, Darbyshire JL, et al., 2022, LOng COvid Multidisciplinary consortium Optimising Treatments and services acrOss the NHS (LOCOMOTION): protocol for a mixed-methods study in the UK, BMJ OPEN, Vol: 12, ISSN: 2044-6055
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Beaney T, Neves AL, Alboksmaty A, et al., 2022, Trends and associated factors for Covid-19 hospitalisation and fatality risk in 2.3 million adults in England, Nature Communications, Vol: 13, Pages: 1-9, ISSN: 2041-1723
The Covid-19 mortality rate varies between countries and over time but the extent to which this is explained by the underlying risk in those infected is unclear. Using data on all adults in England with a positive Covid-19 test between 1st October 2020 and 30th April 2021 linked to clinical records, we examined trends and risk factors for hospital admission and mortality. Of 2,311,282 people included in the study, 164,046 (7.1%) were admitted and 53,156 (2.3%) died within 28 days of a positive Covid-19 test. We found significant variation in the case hospitalisation and mortality risk over time, which remained after accounting for the underlying risk of those infected. Older age groups, males, those resident in areas of greater socioeconomic deprivation, and those with obesity had higher odds of admission and death. People with severe mental illness and learning disability had the highest odds of admission and death. Our findings highlight both the role of external factors in Covid-19 admission and mortality risk and the need for more proactive care in the most vulnerable groups.
Beaney T, Clarke J, Alboksmaty A, et al., 2022, Population level impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in the people with COVID-19 in England: a national analysis using a stepped wedge design, Emergency Medicine Journal, Vol: 39, ISSN: 1472-0205
BackgroundTo identify the population level impact of a national pulse oximetry remote monitoring programme for COVID-19 (COVID Oximetry @home; CO@h) in England on mortality and health service use.MethodsWe conducted a retrospective cohort study using a stepped wedge pre- and post- implementation design, including all 106 Clinical Commissioning Groups (CCGs) in England implementing a local CO@h programme. All symptomatic people with a positive COVID-19 polymerase chain reaction test result from 1st October 2020 to 3rd May 2021, and who were aged ≥65 years or identified as clinically extremely vulnerable were included. Care home residents were excluded. A pre-intervention period before implementation of the CO@h programme in each CCG was compared to a post-intervention period after implementation. Five outcome measures within 28 days of a positive COVID-19 test: i) death from any cause; ii) any ED attendance; iii) any emergency hospital admission; iv) critical care admission; and v) total length of hospital stay.Results217,650 people were eligible and included in the analysis. Total enrolment onto the programme was low, with enrolment data received for only 5,527 (2.5%) of the eligible population. The period of implementation of the programme was not associated with mortality or length of hospital stay. The period of implementation was associated with increased health service utilisation with a 12% increase in the odds of ED attendance (95% CI: 6%-18%) and emergency hospital admission (95% CI: 5%-20%) and a 24% increase in the odds of critical care admission in those admitted (95% CI: 5%-47%). In a secondary analysis of CO@h sites with at least 10% or 20% of eligible people enrolled, there was no significant association with any outcome measure. ConclusionAt a population level, there was no association with mortality before and after the implementation period of the CO@h programme, and small increases in health service utilisation were observed. However, lower than
Alboksmaty A, Beaney T, Elkin S, et al., 2022, Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19: a systematic review, The Lancet Digital Health, Vol: 4, Pages: e279-e289, ISSN: 2589-7500
The COVID-19 pandemic has led health systems to increase the use of tools for monitoring and triaging patients remotely. This study aims to assess the effectiveness and safety of pulse oximetry in Remote Patient Monitoring (RPM) of COVID-19 patients at home. We conducted a systematic review, searching five databases, Medline, Embase, Global Health, medRxiv, and bioRxiv, from inception to April 15, 2021. We included feasibility studies, clinical trials, observational studies, including preprints. We found 561 studies, of which 13 were included in our synthesis. The final studies were all observational cohorts and involved a total of 2,908 participants. A meta-analysis was not feasible due to the heterogeneity of the outcomes reported in the included studies. Our review confirmed the safety and potential of using pulse oximetry in monitoring COVID-19 patients at home. It can potentially save hospital resources for those who may benefit most from care escalation. However, we could not identify explicit evidence on the impact on health outcomes compared with other monitoring models that have not used pulse oximetry. Based on our findings, we make 11 recommendations and three measures for setting up an RPM system using pulse oximetry.
Clarke J, Beaney T, Majeed A, 2022, UK scales back routine covid-19 surveillance, BMJ: British Medical Journal, Vol: 376, Pages: 1-2, ISSN: 0959-535X
Gujjuri R, Clarke J, Elliot J, et al., 2022, 36Predicting Long-Term Survival and Time-to-Recurrence After Oesophagectomy in Patients with Oesophageal Cancer, ASiT Surgical Innovation Summit - Future Surgery Show, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Kwakye MA, Raj S, York T, 2022, 36Predicting Long-Term Survival and Time-to-Recurrence After Oesophagectomy in Patients with Oesophageal Cancer, ASiT Surgical Innovation Summit - Future Surgery Show, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
O'Brien N, van Dael J, Clarke J, et al., 2022, Addressing racial and ethnic inequities in data-driven health technologies, Publisher: Institute of Global Health Innovation, Imperial College London
Schindler DJ, Clarke J, Barahona M, 2022, Multiscale mobility patterns and the restriction of human movement
From the perspective of mobility, the COVID-19 pandemic constituted a naturalexperiment of enormous reach in space and time that accelerated both thesharing of mobility data sets and the study of a severe mobility shock. Here,we study the multiscale structure of UK mobility in data collected before andduring the first COVID-19 lockdown using anonymised 'Facebook Movement maps'between UK locations. We analyse the pre-lockdown UK mobility graph withunsupervised multiscale community detection to extract inherent flowcommunities at different levels of coarseness and the selection of robustscales is performed using a novel algorithm. Our results show that themultiscale flow communities broadly agree with the NUTS administrative regionsbut better capture the patterns of mobility. We then find that the impositionof lockdown reverted mobility towards the local, small-scale flow communities,and, as restrictions were lifted, mobility patterns expanded back towards thecoarser flow communities, thus providing empirical evidence for asemi-hierarchical intrinsic organisation of human mobility at different scales.
Beaney T, Clarke J, Grundy E, et al., 2022, A Picture of Health: determining the core population served by an urban NHS hospital trust and understanding the key health needs, BMC Public Health, Vol: 22, ISSN: 1471-2458
Background: NHS hospitals do not have clearly defined geographic populations to whom they provide care, with patients able to attend any hospital. Identifying a core population for a hospital trust, particularly those in urban areas where there are multiple providers and high population churn, is critical to understanding local key health needs especially given the move to integrated care systems. This can enable effective planning and delivery of preventive interventions and community engagement, rather than simply treating those presenting to services. In this article we describe a practical method for identifying a hospital’s catchment population based on where potential patients are most likely to reside, and describe that population’s size, demographic and social profile, and the key health needs. Methods: A 30% proportional flow method was used to identify a catchment population using an acute trust in West London as an example. Records of all hospital attendances between 1st April 2017 and 31st March 2018 were analysed using Hospital Episode Statistics. Any Lower Layer Super Output Areas where 30% or more of residents who attended any hospital for care did so at the example trust were assigned to the catchment area. Publicly available local and national datasets were then applied to identify and describe the population’s key health needs. Results: A catchment comprising 617,709 people, of an equal gender-split (50.4% male) and predominantly working age (15 to 64 years) population was identified. 39.6% of residents identify as being from Black and Minority Ethnic (BAME) groups, a similar proportion that report being born abroad, and over 85 languages are spoken. Health indicators were estimated, including: a healthy life expectancy difference of over twenty years; bowel cancer screening coverage of 48.8%; chlamydia diagnosis rates of 2,136 per 100,000; prevalence of visible dental decay among five-year-olds of 27.9%. Conclusions: We define
Beaney T, Clarke J, Woodcock T, et al., 2021, Patterns of healthcare utilisation in children and young people: a retrospective cohort study using routinely collected healthcare data in Northwest London, BMJ Open, Vol: 11, Pages: 1-14, ISSN: 2044-6055
ObjectivesWith a growing role for health services in managing population health, there is a need for early identification of populations with high need. Segmentation approaches partition the population based on demographics, long-term conditions (LTCs) or healthcare utilisation but have mostly been applied to adults. Our study uses segmentation methods to distinguish patterns of healthcare utilisation in children and young people (CYP) and to explore predictors of segment membership.DesignRetrospective cohort study.SettingRoutinely collected primary and secondary healthcare data in Northwest London from the Discover database.Participants378,309 CYP aged 0-15 years registered to a general practice in Northwest London with one full year of follow-up.Primary and secondary outcome measuresAssignment of each participant to a segment defined by seven healthcare variables representing primary and secondary care attendances, and description of utilisation patterns by segment. Predictors of segment membership described by age, sex, ethnicity, deprivation and LTCs.ResultsParticipants were grouped into six segments based on healthcare utilisation. Three segments predominantly used primary care; two moderate utilisation segments differed in use of emergency or elective care, and a high utilisation segment, representing 16,632 (4.4%) children accounted for the highest mean presentations across all service types. The two smallest segments, representing 13.3% of the population, accounted for 62.5% of total costs. Younger age, residence in areas of higher deprivation, and presence of one or more LTCs were associated with membership of higher utilisation segments, but 75.0% of those in the highest utilisation segment had no LTC.ConclusionsThis article identifies six segments of healthcare utilisation in CYP and predictors of segment membership. Demographics and LTCs may not explain utilisation patterns as strongly as in adults which may limit the use of routine data in predicting ut
Gujjuri RR, Clarke JM, Elliot JA, et al., 2021, Development and validation of multivariate prediction model of long-term survival after oesophagectomy in patients with oesophageal cancer, UGI Congress, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Beaney T, Neves AL, Alboksmaty A, et al., 2021, Trends and associated factors for Covid-19 hospitalisation and fatality risk in 2.3 million adults in England, Publisher: Cold Spring Harbor Laboratory
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The Covid-19 case fatality ratio varies between countries and over time but it is unclear whether variation is explained by the underlying risk in those infected. This study aims to describe the trends and risk factors for admission and mortality rates over time in England.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>In this retrospective cohort study, we included all adults (≥18 years) in England with a positive Covid-19 test result between 1<jats:sup>st</jats:sup> October 2020 and 30<jats:sup>th</jats:sup> April 2021. Data were linked to primary and secondary care electronic health records and death registrations. Our outcomes were i) one or more emergency hospital admissions and ii) death from any cause, within 28 days of a positive test. Multivariable multilevel logistic regression was used to model each outcome with patient risk factors and time.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>2,311,282 people were included in the study, of whom 164,046 (7.1%) were admitted and 53,156 (2.3%) died within 28 days. There was significant variation in the case hospitalisation and mortality risk over time, peaking in December 2020-February 2021, which remained after adjustment for individual risk factors. Older age groups, males, those resident in more deprived areas, and those with obesity had higher odds of admission and mortality. Of risk factors examined, severe mental illness and learning disability had the highest odds of admission and mortality.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In one of the largest studies of nationally representative Covid-19 risk factors, case hospitalisation and mortality risk varied significantly over
Appelbaum N, Clarke J, 2021, Ideal body weight calculations: fit for purpose in modern anaesthesia?, EUROPEAN JOURNAL OF ANAESTHESIOLOGY, Vol: 38, Pages: 1211-1214, ISSN: 0265-0215
Beatty JW, Clarke JM, Sounderajah V, et al., 2021, Impact of the COVID-19 pandemic on emergency adult surgical patients and surgical services: an international multi-center cohort study and department survey., Annals of Surgery, Vol: 274, Pages: 904-912, ISSN: 0003-4932
OBJECTIVES: The PREDICT study aimed to determine how the COVID-19 pandemic affected surgical services and surgical patients and to identify predictors of outcomes in this cohort. BACKGROUND: High mortality rates were reported for surgical patients with COVID-19 in the early stages of the pandemic. However, the indirect impact of the pandemic on this cohort is not understood, and risk predictors are yet to be identified. METHODS: PREDICT is an international longitudinal cohort study comprising surgical patients presenting to hospital between March and August 2020, conducted alongside a survey of staff redeployment and departmental restructuring. A subgroup analysis of 3176 adult emergency patients, recruited by 55 teams across 18 countries is presented. RESULTS: Among adult emergency surgical patients, all-cause in-hospital mortality (IHM) was 3 6%, compared to 15 5% for those with COVID-19. However, only 14 1% received a COVID-19 test on admission in March, increasing to 76 5% by July.Higher Clinical Frailty Scale scores (CFS >7 aOR 18 87), ASA grade above 2 (aOR 4 29), and COVID-19 infection (aOR 5 12) were independently associated with significantly increased IHM.The peak months of the first wave were independently associated with significantly higher IHM (March aOR 4 34; April aOR 4 25; May aOR 3 97), compared to non-peak months.During the study, UK operating theatre capacity decreased by a mean of 63 6% with a concomitant 27 3% reduction in surgical staffing. CONCLUSION: The first wave of the COVID-19 pandemic significantly impacted surgical patients, both directly through co-morbid infection and indirectly as shown by increasing mortality in peak months, irrespective of COVID-19 status.Higher CFS scores and ASA grades strongly predict outcomes in surgical patients and are an important risk assessment tool during the pandemic.
Beaney T, Clarke J, Alboksmaty A, et al., 2021, Population level impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in the people with covid-19 in England: a national analysis using a stepped wedge design, Publisher: Cold Spring Harbor Laboratory
<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>To identify the population level impact of a national pulse oximetry remote monitoring programme for covid-19 (COVID Oximetry @home; CO@h) in England on mortality and health service use.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Retrospective cohort study using a stepped wedge pre- and post-implementation design.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>All Clinical Commissioning Groups (CCGs) in England implementing a local CO@h programme.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>217,650 people with a positive covid-19 polymerase chain reaction test result and symptomatic, from 1<jats:sup>st</jats:sup> October 2020 to 3<jats:sup>rd</jats:sup> May 2021, aged ≥65 years or identified as clinically extremely vulnerable. Care home residents were excluded.</jats:p></jats:sec><jats:sec><jats:title>Interventions</jats:title><jats:p>A pre-intervention period before implementation of the CO@h programme in each CCG was compared to a post-intervention period after implementation.</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>Five outcome measures within 28 days of a positive covid-19 test: i) death from any cause; ii) any A&E attendance; iii) any emergency hospital admission; iv) critical care admission; and v) total length of hospital stay.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Implementation of the programme was not associated with mortality or length of hospital stay. Implementation was associated with increased health service utilisation with a 12% increa
Beaney T, Clarke J, Alboksmaty A, et al., 2021, Evaluating the impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in patients with covid-19 assessed in Accident and Emergency departments in England: a retrospective matched cohort study
<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>To identify the impact of a national pulse oximetry remote monitoring programme for covid-19 (COVID Oximetry @home; CO@h) on health service use and mortality in patients attending Accident and Emergency (A&E) departments.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Retrospective matched cohort study of patients enrolled onto the CO@h pathway from A&E.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>National Health Service (NHS) A&E departments in England.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>All patients with a positive covid-19 test from 1<jats:sup>st</jats:sup>October 2020 to 3<jats:sup>rd</jats:sup>May 2021 who attended A&E from three days before to ten days after the date of the test. All patients who were admitted or died on the same or following day to the first A&E attendance within the time window were excluded.</jats:p></jats:sec><jats:sec><jats:title>Interventions</jats:title><jats:p>Participants enrolled onto CO@h were matched using demographic and clinical criteria to participants who were not enrolled.</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>Five outcome measures were examined within 28 days of first A&E attendance: i) death from any cause; ii) any subsequent A&E attendance; iii) any emergency hospital admission; iv) critical care admission; and v) length of stay.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>15,621 participants were included in the primary analysis, of whom 639 were enrolled onto
Beaney T, Clarke J, Jain V, 2021, Measuring the Toll of the COVID-19 Pandemic in Rural Bangladesh, JAMA NETWORK OPEN, Vol: 4, ISSN: 2574-3805
Koldeweij C, Clarke J, Nijman J, et al., 2021, CE accreditation and barriers to CE marking of paediatric drug calculators for mobile devices: a scoping review and qualitative analysis, Journal of Medical Internet Research, Vol: 23, Pages: 1-13, ISSN: 1438-8871
Background:Paediatric drug calculators (PDCs) intended for clinical use qualify as medical devices under the Medical Device Directive and the Medical Device Regulation. The extent to which they comply with European standards on quality and safety is unknown.Objective:Determine the number of PDCs available as mobile applications for use in the Netherlands that bear a CE mark and explore the factors influencing the CE marking of such devices among application developers.Methods:A scoping review of the Google Play and App stores was conducted to identify PDCs available for download in the Netherlands. CE accreditation of the sampled applications was determined by consulting the application landing pages on application stores, by screening the United Kingdom Medicines and Healthcare products Regulatory Agency online registry of medical devices and by surveying application developers. The barriers to CE accreditation were also explored through a survey of application developers.Results:Out of 632 screened applications, 74 were eligible, including 60 paediatric drug dosage calculators and 14 infusion rate calculators. One application was CE marked. Of the twenty (34%) respondents to the survey, eight considered their application not to be a medical device based on its intent of use or functionality. Three developers had not aimed to make their application available for use in Europe. Other barriers that may explain the limited CE accreditation of sampled PDC applications included poor awareness of European regulations among developers and a lack of restrictions when placing PDCs in application stores.Conclusions:The compliance of paediatric drug calculators with European standards on medical devices is poor. This puts clinicians and their patients at risk of medical errors resulting from the largely unrestricted use of these applications.
Jones MD, Clarke J, Feather C, et al., 2021, Use of pediatric injectable medicines guidelines and associated medication administration errors: a human reliability analysis, Annals of Pharmacotherapy, Vol: 55, Pages: 1333-1340, ISSN: 1060-0280
Background:In a recent human reliability analysis (HRA) of simulated pediatric resuscitations, ineffective retrieval of preparation and administration instructions from online injectable medicines guidelines was a key factor contributing to medication administration errors (MAEs).Objective:The aim of the present study was to use a specific HRA to understand where intravenous medicines guidelines are vulnerable to misinterpretation, focusing on deviations from expected practice (discrepancies) that contributed to large-magnitude and/or clinically significant MAEs.Methods:Video recordings from the original study were reanalyzed to identify discrepancies in the steps required to find and extract information from the NHS Injectable Medicines Guide (IMG) website. These data were combined with MAE data from the same original study.Results:In total, 44 discrepancies during use of the IMG were observed across 180 medication administrations. Of these discrepancies, 21 (48%) were associated with an MAE, 16 of which (36% of 44 discrepancies) made a major contribution to that error. There were more discrepancies (31 in total, 70%) during the steps required to access the correct drug webpage than there were in the steps required to read this information (13 in total, 30%). Discrepancies when using injectable medicines guidelines made a major contribution to 6 (27%) of 22 clinically significant and 4 (15%) of 27 large-magnitude MAEs.Conclusion and Relevance:Discrepancies during the use of an online injectable medicines guideline were often associated with subsequent MAEs, including those with potentially significant consequences. This highlights the need to test the usability of guidelines before clinical use.
Koldeweij C, Clarke J, Rodriguez Gonzalvez C, et al., 2021, Mind the gap: Mapping Variation between National and Local Clinical Practice Guidelines for Acute Paediatric Asthma from the United Kingdom and the Netherlands
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Clinical practice guidelines (CPGs) aim to standardize clinical care. Increasingly, hospitals rely on locally produced guidelines alongside national guidance. This study examines variation between national and local CPGs, using the example of acute paediatric asthma guidance from the United Kingdom and the Netherlands.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Fifteen British and Dutch local CPGs were collected with the matching national guidance for the management of acute asthma in children under 18 years old. The drug sequences, routes and methods of administration recommended for patients with severe asthma and the tone of recommendation across both types of CPGs were schematically represented. Deviations from national guidance were measured. Variation in recommended doses of intravenous salbutamol was examined.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>British and Dutch national CPGs differed in the recommended drug choices, sequences, routes and methods of administration for severe asthma. Dutch national guidance was more rigidly defined. Local British CPGs diverged from national guidance for 23% of their recommended interventions compared to 8% for Dutch local CPGs. Five British local guidelines and two Dutch local guidelines differed from national guidance for multiple treatment steps. Variation in second-line recommendations was greater than for first-line recommendations across local CPGs from both countries. Recommended starting doses for salbutamol infusions varied by more than tenfold.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Local CPGs for the management of severe acute paediatric asthma featured substantial variation and frequently diverged
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