Publications
121 results found
Philip R, Beaney T, Appelbaum N, et al., 2021, Variation in hypertension clinical practice guidelines: a global comparison, BMC Medicine, Vol: 19, ISSN: 1741-7015
BackgroundHypertension is the largest single contributor to the global burden of disease, affecting an estimated 1.39 billion people worldwide. Clinical practice guidelines (CPGs) can aid in the effective management of this common condition, however, inconsistencies exist between CPGs, and the extent of this is unknown. Understanding the differences in CPG recommendations across income settings may provide an important means of understanding some of the global variations in clinical outcomes related to hypertension.AimsThis study aims to analyse the variation between hypertension CPGs globally. It aims to assess the variation in three areas: diagnostic threshold and staging, treatment and target blood pressure (BP) recommendations in hypertension.MethodsA search was conducted on the MEDLINE repository to identify national and international hypertension CPGs from 2010 to May 2020. An additional country-specific grey-literature search was conducted for all countries and territories of the world as identified by the World Bank. Data describing the diagnosis, staging, treatment and target blood pressure were extracted from CPGs, and variations between CPGs for these domains were analysed.ResultsForty-eight CPGs from across all World Bank income settings were selected for analysis. Ninety-six per cent of guidelines defined hypertension as a clinic-based BP of ≥140/90 mmHg, and 87% of guidelines recommended a target BP of < 140/90 mmHg. In the pharmacological treatment of hypertension, eight different first-step, 17 different second-step and six different third-step drug recommendations were observed. Low-income countries preferentially recommended diuretics (63%) in the first-step treatment, whilst high-income countries offered more choice between antihypertensive classes. Forty-four per cent of guidelines, of which 71% were from higher-income contexts recommended initiating treatment with dual-drug therapy at BP 160/100 mmHg or higher.C
Ellenga-Mbolla B, Makani-Bassakouahou J, Landa CK, et al., 2021, May Measurement Month 2019: an analysis of blood pressure screening results from Republic of the Congo, European Heart Journal Supplements, Vol: 23, Pages: B49-B51, ISSN: 1520-765X
The aim of this study was to determine the proportion with hypertension among an opportunistic sample of the population of the Republic of the Congo. Screening was conducted during the period from 15 May to 15 June 2019. Participants included, consenting persons 18 years of age and over, from five cities: Brazzaville, Pointe-Noire, Oyo, Owando, and Ouesso. In total, 3157 participants were screened as part of the campaign. The mean age was 44.7 years (SD: ±14.9), and 47% were male. Based on the total participants, 881 (27.9%) were overweight and 447 (14.2%) were obese. A total of 583 (18.5%) participated in MMM 2017 or 2018 screenings. The proportion with hypertension was 33.5% (n = 1057), 42.6% of those were aware and 37.3% were taking antihypertensive medication. Of the participants on treatment, 62.4% were controlled (<140/90 mmHg). Overall, 23.3% of patients with hypertension were controlled. After imputation, the proportions with hypertension were 30.1% (n = 1475) according to standardized age and sex. Obesity (P < 0.001) and alcohol intake (P < 0.001) were associated with higher BP compared with normal weight and non-drinkers, respectively. With regards to the social disparities of the different regions of Congo, large scale screening is necessary, in order to report the real situation of hypertension. This will improve the overall management policy for this condition in our country.
Hernandez-Hernandez R, Poulter NR, Guzman-Franolic ML, et al., 2021, May Measurement Month 2019: an analysis of blood pressure screening results from Venezuela, Latin America, EUROPEAN HEART JOURNAL SUPPLEMENTS, Vol: 23, Pages: B151-B153, ISSN: 1520-765X
Jese NB, Knez J, Dolenc P, et al., 2021, May Measurement Month 2019: an analysis of blood pressure screening results from Slovenia, European Heart Journal Supplements, Vol: 23, Pages: B131-B133, ISSN: 1520-765X
Accounting for an estimated 10.4 million deaths each year, arterial hypertension is a worldwide epidemic. However, it is a treatable condition that can be readily recognized with cost-effective blood pressure (BP) measurements. Alongside continuous improvements in BP control and treatment, worldwide strategies aim to achieve a high level of hypertension awareness. May Measurement Month (MMM) is a global campaign initiated by the International Society of Hypertension to raise awareness of high BP. Slovenia began with yearly cost-free BP measurements and awareness campaigns in 2005 when World Hypertension Day was announced by the World Hypertension League and in 2017, we joined the MMM initiative. In May 2019, we performed a cross-sectional survey following the standardized MMM protocol. Healthcare personnel obtained BP measurements in a sample of adult subjects (≥18 years) across all regions of the country, mostly in healthcare facilities and pharmacies. In total, 4974 individuals (61.1% female), with a mean age of 59.6 years, were screened. After multiple imputation for missing data, 3037 (61.1%) participants had hypertension. Of individuals not receiving antihypertensive medication, 973 (33.4%) were hypertensive. Of those who reported receiving antihypertensives, 1110 (53.8%) had uncontrolled BP. MMM19 was the largest BP screening campaign undertaken in Slovenia so far. We again identified a substantial number of participants with possible hypertension and uncontrolled BP despite taking antihypertensive medication, which were then referred to their general practitioners or dedicated hypertension centres for further evaluation and management. Taken together, our findings underline the importance of opportunistic screening programmes.
Patil M, Jose AP, More A, et al., 2021, May Measurement Month 2019: an analysis of blood pressure screening results from India (vol 23, pg B73, 2021), European Heart Journal Supplements, Vol: 23, Pages: B161-B161, ISSN: 1520-765X
Haj Amor S, Beaney T, Saidi O, et al., 2021, May Measurement Month 2019: an analysis of blood pressure screening results from Tunisia., European Heart Journal Supplements, Vol: 23, Pages: B144-B146, ISSN: 1520-765X
We performed a May Measurement Month (MMM) screening campaign among adult volunteers aged 18 years old and over in Tunisia. The objective was to raise awareness, and to estimate the prevalence, awareness, treatment, and control of hypertension, one of the main cardiovascular risk factors. Following the MMM protocol, three blood pressure (BP) measurements were taken by physicians and standard interviewing procedures were used to record medical history, socio-demographic, and cardiovascular disease risk factors. Hypertension was defined as a systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or treatment with antihypertensive medication. From 11 271 adults screened, the prevalence of hypertension was 38.1%. Among those with hypertension, 72.5% were aware of their diagnosis, and 67.5% were treated. BP control was achieved in only 38.2% of all those with hypertension. The study highlights the magnitude of hypertension in Tunisia. There is an urgent need for implementing a comprehensive integrated population-based intervention programme to ameliorate the growing problem of hypertension.
Memon F, Beaney T, Clarke J, et al., 2021, May Measurement Month 2019: an analysis of blood pressure screening results from Pakistan-South Asia, EUROPEAN HEART JOURNAL SUPPLEMENTS, Vol: 23, Pages: B117-B119, ISSN: 1520-765X
Chan C, Sounderajah V, Daniels E, et al., 2021, The Reliability and Quality of YouTube Videos as a Source of Public Health Information Regarding COVID-19 Vaccination: Cross-sectional Study (Preprint)
<sec> <title>BACKGROUND</title> <p>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.</p> </sec> <sec> <title>OBJECTIVE</title> <p>This study aimed to evaluate the reliability and quality of information on COVID-19 vaccination in YouTube videos.</p> </sec> <sec> <title>METHODS</title> <p>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.</p> </sec> <sec> <title>RESULTS</title> <p>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 o
Denning M, Goh ET, Tan B, et al., 2021, Determinants of burnout and other aspects of psychological well-being in healthcare workers during the Covid-19 pandemic: A multinational cross-sectional study, PLoS One, Vol: 16, Pages: 1-18, ISSN: 1932-6203
The Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19. From 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression. Of 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 1.49–2.95), nurse (OR 1.38; 95% CI 1.04–1.84), and ‘other clinical’ (OR 2.02; 95% CI 1.45–2.82); being redeployed (OR 1.27; 95% CI 1.02–1.58), bottom quartile SAQ score (OR 2.43; 95% CI 1.98–2.99), anxiety (OR 4.87; 95% CI 3.92–6.06) and depression (OR 4.06; 95% CI 3.04–5.42). Significant factors inversely correlated with burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51–0.82) and top quartile SAQ score (OR 0.30; 95% CI 0.22–0.40). Significant factors associated with anxiety and depression, included burnout, gender, safety attitudes and job role. Our findings demonstrate a significant burden of burnout, anxiety, and depression amongst healthcare workers. A strong association was seen between SARS-CoV-2 testing, safety attitudes, gende
Vaghela U, Rabinowicz S, Bratsos P, et al., 2021, Using a secure, continually updating, web source processing pipeline to support the real-time data synthesis and analysis of scientific literature: development and validation study, Journal of Medical Internet Research, Vol: 23, Pages: 1-14, ISSN: 1438-8871
Background:The scale and quality of the global scientific response to the COVID-19 pandemic have unquestionably saved lives. However, the COVID-19 pandemic has also triggered an unprecedented “infodemic”; the velocity and volume of data production have overwhelmed many key stakeholders such as clinicians and policy makers, as they have been unable to process structured and unstructured data for evidence-based decision making. Solutions that aim to alleviate this data synthesis–related challenge are unable to capture heterogeneous web data in real time for the production of concomitant answers and are not based on the high-quality information in responses to a free-text query.Objective:The main objective of this project is to build a generic, real-time, continuously updating curation platform that can support the data synthesis and analysis of a scientific literature framework. Our secondary objective is to validate this platform and the curation methodology for COVID-19–related medical literature by expanding the COVID-19 Open Research Dataset via the addition of new, unstructured data.Methods:To create an infrastructure that addresses our objectives, the PanSurg Collaborative at Imperial College London has developed a unique data pipeline based on a web crawler extraction methodology. This data pipeline uses a novel curation methodology that adopts a human-in-the-loop approach for the characterization of quality, relevance, and key evidence across a range of scientific literature sources.Results:REDASA (Realtime Data Synthesis and Analysis) is now one of the world’s largest and most up-to-date sources of COVID-19–related evidence; it consists of 104,000 documents. By capturing curators’ critical appraisal methodologies through the discrete labeling and rating of information, REDASA rapidly developed a foundational, pooled, data science data set of over 1400 articles in under 2 weeks. These articles provide COVID-19–re
Golestaneh AK, Clarke J, Appelbaum N, et al., 2021, The Factors Influencing Clinician Use of Hypertension Guidelines in Different Resource Settings: a Qualitative Study Investigating Clinicians’ Perspectives and Experiences., Publisher: BioMed Central
<h4>Background: </h4> Hypertension 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 reasons for preferential use of certain hypertension guidelines. <h4>Methods: </h4>: A 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. Thematic analysis was used. <h4>Results: </h4> Three main themes emerged, each a level at which clinicians perceived influencing factors to be operating: health system, healthcare worker and patient. Within each theme, influencing factors were described as barriers to and facilitators of guideline use. Variation in themes occurred across income settings. Influencing factors at the health system level were accessibility of equipment and medications, workforce, and access to healthcare 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 subthemes. Patient centred influences 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. <h4>Conclusio
Pi L, Expert P, Clarke JM, et al., 2021, Electronic health record enabled track and trace in an urban hospital network: implications for infection prevention and control
<jats:title>ABSTRACT</jats:title><jats:p>Healthcare-associated infections represent one of the most significant challenges for modern medicine as they can significantly impact patients’lives. Carbapenemase-producing Enterobacteriaceae (CPE) pose the greatest clinical threat, given the high levels of resistance to carbapenems, which are considered as agents of ‘last resort’ against life-threatening infections. Understanding patterns of CPE infection spreading in hospitals is paramount to design effective infection control protocols to mitigate the presence of CPE in hospitals. We used patient electronic health records from three urban hospitals to: i) track microbiologically confirmed carbapenemase producing<jats:italic>Escherichia coli</jats:italic>(CP-Ec) carriers and ii) trace the patients they shared place and time with until their identification. We show that yearly contact networks in each hospital consistently exhibit a core-periphery structure, highlighting the presence of a core set of wards where most carrier-contact interactions occured before being distributed to peripheral wards. We also identified functional communities of wards from the general patient movement network. The contact networks projected onto the general patient movement community structure showed a comprehensive coverage of the hospital. Our findings highlight that infections such as CP-Ec infections can reach virtually all parts of hospitals through first-level contacts.</jats:p>
Sounderajah V, Clarke J, Yalamanchili S, et al., 2021, A national survey assessing public readiness for digital health strategies against COVID-19 within the United Kingdom, Scientific Reports, Vol: 11, Pages: 1-24, ISSN: 2045-2322
There is concern that digital public health initiatives used in the management of COVID-19 may marginalise certain population groups. There is an overlap between the demographics of groups at risk of digital exclusion (older, lower social grade, low educational attainment and ethnic minorities) and those who are vulnerable to poorer health outcomes from SARS-CoV-2. In this national survey study (n=2040), we assessed how the UK population; particularly these overlapping groups, reported their preparedness for digital health strategies. We report, with respect to using digital information to make health decisions, that those over 60 are less comfortable (net comfort: 57%) than those between 18-39 (net comfort: 78%) and lower social grades are less comfortable (net comfort: 63%) than higher social grades (net comfort: 75%). With respect to a preference for digital over non-digital sources in seeking COVID-19 health information, those over 60 (net preference: 21%) are less inclined than those between 18-39 (net preference: 60%) and those of low educational attainment (net preference: 30%) are less inclined than those of high educational attainment (net preference: 52%). Lastly, with respect to distinguishing reliable digital COVID-19 information, lower social grades (net confidence: 55%) are less confident than higher social grades (net confidence: 68%) and those of low educational attainment (net confidence: 51%) are less confident than those of high educational attainment (net confidence: 71%). All reported differences are statistically significant (p<0.01) following multivariate regression modelling. This study suggests that digital public health approaches to COVID-19 have the potential to marginalise groups who are concurrently at risk of digital exclusion and poor health outcomes from SARS-CoV-2.
Clarke J, Atwell S, Skordis J, et al., 2021, The Good Work Monitor, Online
Clarke J, Flott K, Crespo R, et al., 2020, Assessing the Safety of Home Oximetry for Covid-19: A multi-site retrospective observational study
<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>To determine the safety and effectiveness of home oximetry monitoring pathways safe for Covid-19 patients in the English NHS</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>This was a retrospective, multi-site, observational study of home oximetry monitoring for patients with suspected or proven Covid-19</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>This study analysed patient data from four Covid-19 home oximetry pilot sites in North West London, Slough, South Tees and Watford across primary and secondary care settings.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>1338 participants were enrolled in a home oximetry programme at one of the four pilot sites. Participants were excluded if primary care data and oxygen saturations are rest at enrolment were not available. 908 participants were included in the analysis.</jats:p></jats:sec><jats:sec><jats:title>Interventions</jats:title><jats:p>Home oximetry monitoring was provided to participants with a known or suspected diagnosis of Covid-19. Participants were enrolled following attendance to accident and emergency departments, hospital admission or referral through primary care services.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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 patien
Clarke J, Murray A, Markar S, et al., 2020, A new geographic model of care to manage the post-COVID-19 elective surgery aftershock in England: a retrospective observational study, BMJ Open, Vol: 10, Pages: 1-9, ISSN: 2044-6055
Objectives The suspension of elective surgery during the COVID pandemic is unprecedented and has resulted in record volumes of patients waiting for operations. Novel approaches that maximise capacity and efficiency of surgical care are urgently required. This study applies Markov Multiscale Community Detection (MMCD), an unsupervised graph-based clustering framework, to identify new surgical care models based on pooled waiting lists delivered across an expanded network of surgical providers. DesignRetrospective observational study using Hospital Episode Statistics.SettingPublic and private hospitals providing surgical care to National Health Service (NHS) patients in England. ParticipantsAll adult patients resident in England undergoing NHS-funded planned surgical procedures between 1st April 2017 and 31st March 2018. Main outcome measuresThe identification of the most common planned surgical procedures in England (High Volume Procedures – HVP) and proportion of low, medium and high-risk patients undergoing each HVP. The mapping of hospitals providing surgical care onto optimised groupings based on patient usage data.ResultsA total of 7,811,891 planned operations were identified in 4,284,925 adults during the one-year period of our study. The 28 most common surgical procedures accounted for a combined 3,907,474 operations (50.0% of the total). 2,412,613 (61.7%) of these most common procedures involved ‘low risk’ patients. Patients travelled an average of 11.3 km for these procedures. Based on the data, MMCD partitioned England into 45, 16 and 7 mutually exclusive and collectively exhaustive natural surgical communities of increasing coarseness. The coarser partitions into 16 and 7 surgical communities were shown to be associated with balanced supply and demand for surgical care within communities.ConclusionsPooled waiting lists for low risk elective procedures and patients across integrated, expanded natural surgical community networks have the pot
Mason SE, Scott AJ, Markar SR, et al., 2020, Insights from a global snapshot of the change in elective colorectal practice due to the COVID-19 pandemic, PLoS One, Vol: 15, Pages: 1-13, ISSN: 1932-6203
BackgroundThere is a need to understand the impact of COVID-19 on colorectal cancer care globally and determine drivers of variation.ObjectiveTo evaluate COVID-19 impact on colorectal cancer services globally and identify predictors for behaviour change.DesignAn online survey of colorectal cancer service change globally in May and June 2020.ParticipantsAttending or consultant surgeons involved in the care of patients with colorectal cancer.Main outcome measuresChanges in the delivery of diagnostics (diagnostic endoscopy), imaging for staging, therapeutics and surgical technique in the management of colorectal cancer. Predictors of change included increased hospital bed stress, critical care bed stress, mortality and world region.Results191 responses were included from surgeons in 159 centers across 46 countries, demonstrating widespread service reduction with global variation. Diagnostic endoscopy was reduced in 93% of responses, even with low hospital stress and mortality; whilst rising critical care bed stress triggered complete cessation (p = 0.02). Availability of CT and MRI fell by 40–41%, with MRI significantly reduced with high hospital stress. Neoadjuvant therapy use in rectal cancer changed in 48% of responses, where centers which had ceased surgery increased its use (62 vs 30%, p = 0.04) as did those with extended delays to surgery (p<0.001). High hospital and critical care bed stresses were associated with surgeons forming more stomas (p<0.04), using more experienced operators (p<0.003) and decreased laparoscopy use (critical care bed stress only, p<0.001). Patients were also more actively prioritized for resection, with increased importance of co-morbidities and ICU need.ConclusionsThe COVID-19 pandemic was associated with severe restrictions in the availability of colorectal cancer services on a global scale, with significant variation in behaviours which cannot be fully accounted for by hospital burden or mortality.
Lam K, Clarke J, Purkayastha S, et al., 2020, Uptake and accessibility of surgical robotics in England, International Journal of Medical Robotics and Computer Assisted Surgery, Vol: 17, Pages: 1-7, ISSN: 1478-5951
BackgroundThe distribution, utilisation and accessibility of surgical robotics in England is unknown.MethodsA nationwide Freedom of Information (FOI) request was sent to all acute National Health Service (NHS) trusts. Accessibility was assessed for 32 843 Lower Super Output Areas in England.ResultsAll 149 acute NHS trusts responded to the FOI request. Sixty‐one robots are distributed between 48 trusts. The number of robots and robotic procedures has increased annually. Urological procedures comprise 84.2% of robotic procedures. Procedure volume varies between robotic centres ranging from 1 to 683 in 2018. Over 2.4 million people have a travel time of over 1 hour to their nearest robotic centre.DiscussionNational accessibility to robotic services and case volumes are variable and does not represent good value for the NHS. A national robotic surgery registry could improve the quality of robotic surgery and is needed to dynamically assess national provision of this technology.
Denning M, Goh ET, Scott A, et al., 2020, What has been the impact of Covid-19 on Safety Culture? A case study from a large metropolitan teaching hospital, International Journal of Environmental Research and Public Health, Vol: 17, Pages: 1-14, ISSN: 1660-4601
Covid-19 has placed an unprecedented demand on healthcare systems worldwide. A positive safety culture is associated with improved patient safety and in turn patient outcomes. To date, no study has evaluated the impact of Covid-19 on safety culture. The Safety Attitudes Questionnaire (SAQ) was used to investigate safety culture at a large UK healthcare trust during Covid-19. Findings were compared with baseline data from 2017. Incident reporting from the year preceding the pandemic was also examined. SAQ scores of doctors and 'other clinical staff', were relatively higher than the nursing group. During Covid-19, on univariate regression analysis, female gender, age 40-49 years, non-white ethnicity, and nursing job role were all associated with lower SAQ scores. Training and support for redeployment were associated with higher SAQ scores. On multivariate analysis, non-disclosed gender (-0.13), non-disclosed ethnicity (-0.11), nursing role (-0.15), and support (0.29) persisted to significance. A significant decrease (p<0.003) was seen in error reporting after the onset of the Covid-19 pandemic. This is the first study to investigate SAQ during Covid-19. Differences in SAQ scores were observed during Covid-19 between professional groups when compared to baseline. Reductions in incident reporting were also seen. These changes may reflect perception of risk, changes in volume or nature of work. High-quality support for redeployed staff may be associated with improved safety perception during future pandemics.
Sounderajah V, Clarke J, Yalamanchili S, et al., 2020, Bridging the Digital Divide: A National Survey Assessing Public Readiness for Digital Health Strategies Against COVID-19 within the United Kingdom
<jats:title>Abstract</jats:title> <jats:p>Digital health technologies are a major feature of contemporary public health strategies, particularly in relation to the COVID-19 pandemic. However, digital initiatives risk excluding vulnerable groups, thereby propagating poor health outcomes. We assessed how groups at higher risk from COVID-19 report their relationships with key digital health initiatives in the United Kingdom. We found that those who are female, over 60 and of a lower social group are less confident in using digital information to make health decisions. Those over 40, from lower social groups and of lower educational attainment use digital resources less often in seeking COVID-19 health information. Lastly, those over 60, from lower social groups and of lower educational attainment are less confident in distinguishing reliable digital COVID-19 information. This suggests that a ‘digital first’ model of COVID-19 pandemic management may exacerbate existing digital and health inequalities by reinforcing barriers to health information and public health services.</jats:p>
Beaney T, Clarke JM, Coronini-Cronberg S, 2020, Who is responsible? Defining a hospital catchment population in the English National Health Service
There is a growing emphasis on National Health Service hospitals in England promoting population health. Patients can access any hospital, making it complex to define the population a hospital is responsible for. Defining this 'catchment' population is fundamental to provide a population denominator from which to evaluate service provision such as unmet need and the effect of prevention initiatives. Using Chelsea and Westminster Hospital NHS Foundation Trust (CWFT), a large hospital in London as a case study, methods to define the population that has potential to attend the hospital were compared.Inpatient, outpatient and emergency attendances were identified using Hospital Episode Statistics from 1st April 2017-31st March 2018. Lower Layer Super Output Areas (LSOAs), consisting of 1,500 people on average, were used as the geographic unit. Catchment populations were constructed using 3 different methods. Under First-Past-The-Post (FPTP), LSOAs were allocated if a greater proportion of patients attended CWFT than any other hospital trust. Under 30% Proportional Flow (30PF), LSOAs were allocated if more than 30% of patients attended CWFT, while under Stratified Proportional Allocation (SPA), patients were assigned in accordance with the proportion from each LSOA that attended CWFT, by gender and 5-year age strata.Under FPTP, 30PF and SPA, a total of 303, 326 and 10,636 LSOAs were assigned to CWFT, respectively, with corresponding populations of 530,980, 569,682, and 484,249 and median ages of 36, 36 and 29 years. Under FPTP, the catchment area did not overlap with that of any other hospital, while under 30PF, 13.2% of the LSOAs were also allocated to another hospital catchment. Maps were constructed for FPTP and 30PF.The 3 methods produced different catchment populations, with differing characteristics. Understanding the relative merits of each method has implications for hospitals in how they engage in and evaluate population health.Engagement in and evaluation of pu
Beaney T, Clarke JM, Jain V, et al., 2020, Excess mortality: the gold standard in measuring the impact of COVID-19 worldwide?, Journal of the Royal Society of Medicine, Vol: 113, Pages: 329-334, ISSN: 0141-0768
Markar SR, Clarke J, Kinross J, et al., 2020, Practice patterns of diagnostic upper gastrointestinal endoscopy during the initial COVID-19 outbreak in England., The Lancet Gastroenterology and Hepatology, Vol: 5, Pages: 804-805, ISSN: 2468-1253
Martin G, Koiza L, Kooner A, et al., 2020, Protecting healthcare workers during the COVID-19 pandemic with new technologies: acceptability, feasibility and impact of the HoloLens2™ mixed reality headset across multiple clinical settings, Journal of Medical Internet Research, Vol: 22, Pages: 1-9, ISSN: 1438-8871
Background: The COVID-19 pandemic has led to rapid acceleration in the deployment of new digital technologies to improve both accessibility and quality of care, and to protect staff. Mixed reality technology is the latest iteration of telemedicine innovation and is logical next step in the move towards the provision of digitally supported clinical care and medical education. The technology has the potential to revolutionise care both during and after the COVID-19 pandemic.Objective:This pilot project sought to deploy the HoloLens2™ mixed reality (MR) device to support the delivery of remote care in COVID-19 hospital environments.Methods:A prospective observational nested cohort evaluation of the HoloLens2™ was undertaken across three distinct clinical clusters in a UK teaching hospital. Data pertaining to staff exposure to high-risk COVID-19 environments and PPE use were collected, and assessments of acceptability and feasibility conducted.Results:The deployment of HoloLens2™ led to a 51·5% reduction in time exposed to harm for staff looking after COVID-19 patients (3·32 vs. 1·63 hours/day/staff member, p=0·002), and a 83·1% reduction in the amount of PPE used (178 vs. 30 items/round/day, p=0·017). This represents 222.98hrs reduced staff exposure to COVID-19, and 3,100 fewer items of PPE used each week across the three clusters evaluated. The majority of staff using the device agreed it was easy to set up and comfortable to wear, improved the quality of care and decision making, and led to better teamwork and communication. 89·3% of users felt that their clinical team was safer when using the HoloLens2™.Conclusions:New technologies have a role in minimising exposure to nosocomial infection, optimising the use of PPE and enhancing aspects of care. Deploying such technologies at pace requires context specific information security, infection control, and user experience and workflow integration to
Clarke J, Beaney T, Majeed A, et al., 2020, Identifying Naturally Occurring Communities of Primary Care Providers in the English National Health Service in London, AcademyHealth Annual Research Meeting (ARM), Publisher: WILEY, Pages: 107-108, ISSN: 0017-9124
Markar SR, Martin G, Penna M, et al., 2020, Changing the paradigm of surgical research during a pandemic, Annals of Surgery, Vol: 272, Pages: e170-e171, ISSN: 0003-4932
The COVID-19 pandemic has led to a paradigm shift in how we manage surgical patients. Assuch, there is an immediate need to adapt the traditional model of surgical research in order tocreate pragmatic studies with adaptive designs in order to rapidly disseminate key knowledgeamongst the global surgical community.
Clarke J, Beaney T, Majeed A, et al., 2020, METHODS RESEARCH : Identifying Naturally Occurring Communities of Primary Care Providers in the English National Health Service in London, Health services research, Vol: 55, Pages: 107-108, ISSN: 0017-9124
<h4>Research Objective</h4> Primary care networks (PCNs) are a new organizational hierarchy with wide‐ranging responsibilities introduced in the NHS Long Term Plan. The vision is that they represent “natural” communities of primary care practices (PCPs) with boundaries that make sense to practices, other health care providers, and local communities. Our study aims to identify natural communities of PCPs based on patient registration patterns using network analysis methods and unsupervised clustering to create catchments for these communities. <h4>Study Design</h4> We used a series of novel methods for unsupervised graph clustering. A cosine similarity matrix was constructed representing similarities between each PCP to each other, based on registration of patients in each Lower Super Output Area (LSOA)—a geographic division similar to census block groups. Unsupervised graph partitioning using Markov multiscale community detection was conducted to identify communities of PCPs. Catchment areas for each PCN were assigned based on the majority attendance from an LSOA. <h4>Population Studied</h4> Patients resident in and attending PCPs in London identified from Hospital Episode Statistics from 2017 to 2018. <h4>Principal Findings</h4> 3,428,322 unique patients attended 1,334 GPs in 4,835 LSOAs in London. Our model grouped 1,291 PCPs (96·8%) and 4,721 LSOAs (97·6%), into 165 mutually exclusive PCNs. The median PCN list size was 53,490, with a lower quartile of 38,079 patients and an upper quartile of 72,982 patients. A median of 70·1% of patients attended a GP within their allocated PCN, ranging from 44·6% to 91·4%. <h4>Conclusions</h4> With PCNs expected to take a role in population health management and with community providers expected to reconfigure around them, it is vital we recognize how PCNs represent their communities. We find that stable, representati
Warren L, Clarke J, Darzi A, 2020, Measuring the Scale of Hospital Health Record System Fragmentation in, AcademyHealth Annual Research Meeting (ARM), Publisher: WILEY, Pages: 43-44, ISSN: 0017-9124
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Clarke J, Beaney T, Majeed A, et al., 2020, Identifying naturally occurring communities of primary care providers in the English National Health Service in London, BMJ Open, Vol: 10, Pages: 1-7, ISSN: 2044-6055
Objectives - Primary Care Networks (PCNs) are a new organisational hierarchy with wide-ranging responsibilities introduced in the National Health Service (NHS) Long Term Plan. The vision is that they represent ‘natural’ communities of general practices (GP practices) working together at scale and covering a geography that make sense to practices, other healthcare providers and local communities. Our study aims to identify natural communities of GP practices based on patient registration patterns using Markov Multiscale Community Detection, an unsupervised network-based clustering technique to create catchments for these communities.Design - Retrospective observational study using Hospital Episode Statistics – patient-level administrative records of inpatient, outpatient and emergency department attendances to hospital.Setting – General practices in the 32 Clinical Commissioning Groups of Greater London Participants - All adult patients resident in and registered to a GP practices in Greater London that had one or more outpatient encounters at NHS hospital trusts between 1st April 2017 and 31st March 2018.Main outcome measures The allocation of GP practices in Greater London to PCNs based on the registrations of patients resident in each Lower Super Output Area (LSOA) of Greater London. The population size and coverage of each proposed PCN. Results - 3,428,322 unique patients attended 1,334 GPs in 4,835 LSOAs in Greater London. Our model grouped 1,291 GPs (96.8%) and 4,721 LSOAs (97.6%), into 165 mutually exclusive PCNs. The median PCN list size was 53,490, with a lower quartile of 38,079 patients and an upper quartile of 72,982 patients. A median of 70.1% of patients attended a GP within their allocated PCN, ranging from 44.6% to 91.4%.Conclusions - With PCNs expected to take a role in population health management and with community providers expected to reconfigure around them, it is vital we recognise how PCNs represent their communities. O
Scott A, Tan BYQ, Huak CY, et al., 2020, Determinants of Burnout and Other Aspects of Psychological Well-Being in Healthcare Workers During the COVID-19 Pandemic: A Multinational Cross-Sectional Study
<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>From 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 1.49-2.95), nurse (OR 1.38; 95% CI 1.04-1.84), and ‘other clinical’ (OR 2.02; 95% CI 1.45-2.82); being redeployed (OR 1.27; 95% CI 1.02-1.58), bottom quartile SAQ score (OR 2.43; 95% CI 1.98-2.99), anxiety (OR 4.87; 95% CI 3.92-6.06) and depression (OR 4.06; 95% CI 3.04-5.42). Factors significantly protective for burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51-0.82) and top quartile SAQ score (OR 0.30; 95% CI 0.22-0.40). Significant factors associated with anx
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