Imperial College London

Dr Jonathan M Clarke

Faculty of Natural SciencesDepartment of Mathematics

Sir Henry Wellcome Postdoctoral Fellow
 
 
 
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Contact

 

j.clarke Website

 
 
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Location

 

St Marys Multiple BuildingsSt Mary's Campus

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Summary

 

Publications

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99 results found

Li E, Clarke J, Ashrafian H, Darzi A, Neves ALet 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

Journal article

Beaney T, Kerr G, Hayhoe B, Majeed F, Clarke Jet al., 2022, Comparing registered and resident populations in Primary Care Networks in England: an observational study, BJGP Open

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.

Journal article

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

Journal article

Koldeweij C, Appelbaum N, Rodriguez Gonzalvez C, Nijman J, Nijman R, Sinha R, Maconochie I, Clarke Jet 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.

Journal article

Beaney T, Neves AL, Alboksmaty A, Ashrafian H, Flott K, Fowler A, Benger J, Aylin P, Elkin S, Darzi A, Clarke Jet 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.

Journal article

Beaney T, Clarke J, Alboksmaty A, Flott K, Fowler A, Benger J, Aylin P, Elkin S, Neves AL, Darzi Aet 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

Journal article

Alboksmaty A, Beaney T, Elkin S, Clarke J, Darzi A, Aylin P, Neves Aet 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.

Journal article

Clarke J, Beaney T, Majeed A, 2022, UK scales back routine covid-19 surveillance., BMJ, Vol: 376, Pages: o562-o562

Journal article

Gujjuri R, Clarke J, Elliot J, Reynolds J, Markar Set 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

Conference paper

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

Conference paper

O'Brien N, van Dael J, Clarke J, Gardner C, O'Shaughnessy J, Darzi A, Ghafur Set al., 2022, Addressing racial and ethnic inequities in data-driven health technologies, Publisher: Institute of Global Health Innovation, Imperial College London

Report

Schindler D, Clarke J, Barahona M, 2022, Multiscale mobility patterns and the restriction of human mobility under lockdown

Strict lockdown measures have been put in place in many countries around theworld to constrain human mobility in response to the unparalleled challengesposed by the COVID-19 pandemic. Here we apply network-theoretic tools toanalyse a geolocalised dataset of human mobility of 16 million UK Facebookusers from March to July 2020. A special emphasis lies on dynamicalperspectives of network analysis and multi-scale community detection withMarkov Stability analysis is performed to identify signatures for the mobilitycontraction in the UK. Thereby, a new quantitative criterion for the scaleselection in Markov Stability analysis is proposed, which reveals differentscales of mobility in a semi-automated manner. The analysis of the UK mobilitynetwork reveals a pronounced decline of human mobility under COVID-19 andsuggests that local community structure has been strengthened under lockdown.In particular, human mobility does not follow along purely geographic andadministrative lines but the flow-based approach allows for the identificationof intrinsic mobility patterns that may inform future interventions to preventCOVID-19 transmission.

Journal article

Beaney T, Clarke J, Grundy E, Coronini-Cronberg Set 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

Journal article

Beaney T, Clarke J, Woodcock T, McCarthy R, Saravanakumar K, Barahona M, Blair M, Hargreaves Det 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

Journal article

Gujjuri RR, Clarke JM, Elliot JA, Reynolds JV, Markar SRet al., 2021, Development and validation of multivariate prediction model of long-term survival after oesophagectomy in patients with oesophageal cancer, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323

Conference paper

Beaney T, Neves AL, Alboksmaty A, Flott K, Fowler A, Benger JR, Aylin P, Elkin S, Darzi A, Clarke Jet 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

Working paper

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

Journal article

Beatty JW, Clarke JM, Sounderajah V, Acharya A, Rabinowicz S, Martin G, Warren LR, Yalamanchili S, Scott AJ, Burgnon E, Purkayastha S, Markar S, Kinross JM, PANSURG-PREDICT Collaborativeet 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.

Journal article

Beaney T, Clarke J, Alboksmaty A, Flott K, Fowler A, Benger JR, Aylin P, Elkin S, Neves AL, Darzi Aet 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&amp;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

Working paper

Beaney T, Clarke J, Alboksmaty A, Flott K, Fowler A, Benger JR, Aylin P, Elkin S, Darzi A, Neves ALet 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&amp;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&amp;E.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>National Health Service (NHS) A&amp;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&amp;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&amp;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&amp;E attendance: i) death from any cause; ii) any subsequent A&amp;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 ont

Journal article

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

Journal article

Koldeweij C, Clarke J, Nijman J, Feather C, de Wildt S, Appelbaum Net 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.

Journal article

Jones MD, Clarke J, Feather C, Franklin BD, Sinha R, Maconochie I, Darzi A, Appelbaum Net 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.

Journal article

Koldeweij C, Clarke J, Rodriguez Gonzalvez C, Nijman J, Sinha R, Maconochie I, Appelbaum Net 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

Journal article

Clarke J, Flott K, Crespo R, Ashrafian H, Fontana G, Benger J, Darzi A, Elkin Set al., 2021, Assessing the Safety of Home Oximetry for Covid-19: A multi-site retrospective observational study, BMJ Open, Vol: 11, Pages: 1-9, ISSN: 2044-6055

Objectives To determine the safety and effectiveness of home oximetry monitoring pathways safe for Covid-19 patients in the English NHS.Design Retrospective, multi-site, observational study of home oximetry monitoring for patients with suspected or proven Covid-19 Setting This study analysed patient data from four Covid-19 home oximetry pilot sites in England across primary and secondary care settings.Participants A total of 1338 participants were enrolled in a home oximetry programme across four pilot sites. Participants were excluded if primary care data and oxygen saturations are rest at enrolment were not available. Data from 908 participants was included in the analysis. Interventions Home oximetry monitoring was provided to participants with a known or suspected diagnosis of Covid-19. Participants were enrolled following attendance to emergency departments, hospital admission or referral through primary care services. Results Of 908 patients enrolled into four different Covid-19 home oximetry programmes in England, 771 (84.9%) had oxygen saturations at rest of 95% or more, and 320 (35.2%) were under 65 years of age and without comorbidities. 52 (5.7%) presented to hospital and 28 (3.1%) died following enrolment, of which 14 (50%) had Covid-19 as a named cause of death. All-cause mortality was significantly higher in patients enrolled after admission to hospital (OR 8.70 [2.53-29.89]), compared to those enrolled in primary care. Patients enrolled after hospital discharge (OR 0.31 [0.15-0.68]) or emergency department presentation (OR 0.42 [0.20-0.89]) were significantly less likely to present to hospital than those enrolled in primary care. ConclusionsThis study find that home oximetry monitoring can be a safe pathway for Covid-19 patients; and indicates increases in risk to vulnerable groups and patients with oxygen saturations < 95% at enrolment, and in those enrolled on discharge from hospital. Findings from this evaluation have contributed to the national

Journal article

Jain V, Clarke J, Beaney T, 2021, Democratic governance and excess mortality during the COVID-19 pandemic

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Excess mortality has been used to assess the health impact of COVID-19 across countries. Democracies aim to build trust in government and enable checks and balances on decision-making, which may be useful in a pandemic. On the other hand, democratic governments have been criticised as slow to enforce restrictive policies and being overly influenced by public opinion. This study sought to understand whether strength of democratic governance is associated with the variation in excess mortality observed across countries during the pandemic.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Through linking open-access datasets we constructed univariable and multivariable linear regression models investigating the association between country EIU Democracy Index (representing strength of democratic governance on a scale of 0 to 10) and excess mortality rates, from February 2020 to May 2021. We stratified our analysis into high-income and low and middle-income country groups and adjusted for several important confounders.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Across 78 countries, the mean EIU democracy index was 6.74 (range 1.94 to 9.81) and the mean excess mortality rate was 128 per 100,000 (range -55 to 503 per 100,000). A one-point increase in EIU Democracy Index was associated with a decrease in excess mortality of 26.3 per 100,000 (p=0.002), after accounting for COVID-19 cases, age ≥ 65, gender, prevalence of cardiovascular disease, universal health coverage and the strength of early government restrictions. This association was particularly strong in high-income countries (β -47.5, p&lt;0.001) but non-significant in low and middle-income countries (β -10.8, p=0.40).</jats:p></jats:sec><jats:sec&g

Journal article

Golestaneh AK, Clarke JM, Appelbaum N, Gonzalvez CR, Jose AP, Philip R, Poulter NR, Beaney Tet al., 2021, The factors influencing clinician use of hypertension guidelines in different resource settings: a qualitative study investigating clinicians' perspectives and experiences, BMC Health Services Research, Vol: 21, Pages: 1-12, ISSN: 1472-6963

BackgroundHypertension accounts for the greatest burden of disease worldwide, yet hypertension awareness and control rates are suboptimal, especially within low- and middle-income countries. Guidelines can enable consistency of care and improve health outcomes. A small body of studies investigating clinicians’ perceptions and implementation of hypertension guidelines exists, mostly focussed on higher income settings. This study aims to explore how hypertension guidelines are used by clinicians across different resource settings, and the factors influencing their use.MethodsA qualitative approach was employed using convenience sampling and in-depth semi-structured interviews. Seventeen medical doctors were interviewed over video or telephone call from March to August 2020. Two clinicians worked in low-income countries, ten in middle-income countries, and five in high-income countries. Interviews were recorded, transcribed, and coded inductively. Reflexive thematic analysis was used.ResultsThemes were generated at three levels at which clinicians perceived influencing factors to be operating: healthcare worker, healthcare worker interactions with patients, and the wider health system. Within each level, influencing factors were described as barriers to and facilitators of guideline use. Variation in factors occurred across income settings. At the healthcare worker level, usability of guidelines, trust in guidelines, attitudes and views about guidelines’ purpose, and relevance to patient populations were identified as themes. Influencing factors at the health system level were accessibility of equipment and medications, workforce, and access to healthcare settings. Influences at the patient level were clinician perceived patient motivation and health literacy, and access to, and cost of treatment, although these represented doctors’ perceptions rather than patient perceived factors.ConclusionsThis study adds a high level global view to previous studie

Journal article

Van Den Heede K, Chidambaram S, Winter Beatty J, Chander N, Markar S, Tolley NS, Palazzo FF, Kinross JK, Di Marco AN, PanSurg Collaborative and the PREDICT-Endocrine Collaborativeet al., 2021, The PanSurg-PREDICT Study: endocrine surgery during the COVID-19 pandemic, World Journal of Surgery, Vol: 45, Pages: 2315-2324, ISSN: 0364-2313

BACKGROUND: In the midst of the COVID-19 pandemic, patients have continued to present with endocrine (surgical) pathology in an environment depleted of resources. This study investigated how the pandemic affected endocrine surgery practice. METHODS: PanSurg-PREDICT is an international, multicentre, prospective, observational cohort study of emergency and elective surgical patients in secondary/tertiary care during the pandemic. PREDICT-Endocrine collected endocrine-specific data alongside demographics, COVID-19 and outcome data from 11-3-2020 to 13-9-2020. RESULTS: A total of 380 endocrine surgery patients (19 centres, 12 countries) were analysed (224 thyroidectomies, 116 parathyroidectomies, 40 adrenalectomies). Ninety-seven percent were elective, and 63% needed surgery within 4 weeks. Eight percent were initially deferred but had surgery during the pandemic; less than 1% percent was deferred for more than 6 months. Decision-making was affected by capacity, COVID-19 status or the pandemic in 17%, 5% and 7% of cases. Indication was cancer/worrying lesion in 61% of thyroidectomies and 73% of adrenalectomies and calcium 2.80 mmol/l or greater in 50% of parathyroidectomies. COVID-19 status was unknown at presentation in 92% and remained unknown before surgery in 30%. Two-thirds were asked to self-isolate before surgery. There was one COVID-19-related ICU admission and no mortalities. Consultant-delivered care occurred in a majority (anaesthetist 96%, primary surgeon 76%). Post-operative vocal cord check was reported in only 14% of neck endocrine operations. Both of these observations are likely to reflect modification of practice due to the pandemic. CONCLUSION: The COVID-19 pandemic has affected endocrine surgical decision-making, case mix and personnel delivering care. Significant variation was seen in COVID-19 risk mitigation measures. COVID-19-related complications were uncommon. This analysis demonstrates the safety of endocrine surgery during this

Journal article

Li E, Clarke J, Neves AL, Ashrafian H, Darzi Aet al., 2021, Electronic health records, interoperability, and patient safety in health systems of high-income countries: a systematic review protocol, BMJ Open, Vol: 11, ISSN: 2044-6055

Introduction The availability and routine use of electronic health records (EHRs) have become commonplace in healthcare systems of many high-income countries. While there is an ever-growing body ofliterature pertaining to EHR use, evidence surrounding the importance of EHR interoperability and its impact on patient safety remains less clear. There is therefore a need and opportunity to evaluate the evidence available regarding this relationship so as to better inform health informatics development and policies in the years to come. This systematic review aims to evaluate the impact of EHR interoperability on patient safety in health systems of high-income countries. Methods and analysis A systematic literature review will be conducted via a computerised search through four databases: PubMed, Embase, HMIC, and PsycInfo for relevant articles published between 2010 and 2020. Outcomes of interest will include: impact on patient safety, and the broader effects on health systems. Quality of the randomised quantitative studies will be assessed using Cochrane Risk of Bias Tool. Non-randomised papers will be evaluated with the Risk of Bias In Non Randomised Studies - of Interventions (ROBINS-I) tool. Drummond’s Checklist will be utilised for publications pertaining to economic evaluation. The National Institute for Health and Care Excellence (NICE) quality appraisal checklist will be used to assess qualitative studies. A narrative synthesis will be conducted for included studies, and the body of evidence will be summarised in a summary of findings table. Ethics and dissemination This review will summarise published studies with non-identifiable data and thus does not require ethical approval. Findings will be disseminated through preprints, open access peer reviewed publication, and conference presentations

Journal article

Chan C, Sounderajah V, Daniels E, Acharya A, Clarke J, Yalamanchili S, Normahani P, Markar S, Ashrafian H, Darzi Aet al., 2021, The reliability and quality of YouTube videos as a source of public health information regarding COVID-19 vaccination: cross-sectional study, JMIR Public Health and Surveillance, Vol: 7, ISSN: 2369-2960

Background: Recent emergency authorization and rollout of COVID-19 vaccines by regulatory bodies has generated global attention. As the most popular video-sharing platform globally, YouTube is a potent medium for the dissemination of key public health information. Understanding the nature of available content regarding COVID-19 vaccination on this widely used platform is of substantial public health interest.Objective: This study aimed to evaluate the reliability and quality of information on COVID-19 vaccination in YouTube videos.Methods: In this cross-sectional study, the phrases “coronavirus vaccine” and “COVID-19 vaccine” were searched on the UK version of YouTube on December 10, 2020. The 200 most viewed videos of each search were extracted and screened for relevance and English language. Video content and characteristics were extracted and independently rated against Health on the Net Foundation Code of Conduct and DISCERN quality criteria for consumer health information by 2 authors.Results: Forty-eight videos, with a combined total view count of 30,100,561, were included in the analysis. Topics addressed comprised the following: vaccine science (n=18, 58%), vaccine trials (n=28, 58%), side effects (n=23, 48%), efficacy (n=17, 35%), and manufacturing (n=8, 17%). Ten (21%) videos encouraged continued public health measures. Only 2 (4.2%) videos made nonfactual claims. The content of 47 (98%) videos was scored to have low (n=27, 56%) or moderate (n=20, 42%) adherence to Health on the Net Foundation Code of Conduct principles. Median overall DISCERN score per channel type ranged from 40.3 (IQR 34.8-47.0) to 64.3 (IQR 58.5-66.3). Educational channels produced by both medical and nonmedical professionals achieved significantly higher DISCERN scores than those of other categories. The highest median DISCERN scores were achieved by educational videos produced by medical professionals (64.3, IQR 58.5-66.3) and the lowest median scores by indep

Journal article

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