Imperial College London

ProfessorPaulAylin

Faculty of MedicineSchool of Public Health

Professor of Epidemiology and Public Health
 
 
 
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Contact

 

p.aylin Website

 
 
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Location

 

Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
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382 results found

Beaney T, Clarke J, Salman D, Woodcock T, Majeed F, Barahona M, Aylin Pet al., 2023, Identifying potential biases in code sequences in primary care electronic healthcare records: a retrospective cohort study of the determinants of code frequency, BMJ Open, ISSN: 2044-6055

Journal article

Woodcock T, Greenfield G, Lalvani A, Majeed A, Aylin Pet al., 2023, Patient outcomes following emergency admission to hospital for COVID-19 compared with influenza: retrospective cohort study, Thorax, Vol: 78, Pages: 706-712, ISSN: 0040-6376

Background We examine differences in posthospitalisation outcomes, and health system resource use, for patients hospitalised with COVID-19 during the UK’s first pandemic wave in 2020, and influenza during 2018 and 2019.Methods This retrospective cohort study used routinely collected primary and secondary care data. Outcomes, measured for 90 days follow-up after discharge were length of stay in hospital, mortality, emergency readmission and primary care activity.Results The study included 5132 patients admitted to hospital as an emergency, with COVID-19 and influenza cohorts comprising 3799 and 1333 patients respectively. Patients in the COVID-19 cohort were more likely to stay in hospital longer than 10 days (OR 3.91, 95% CI 3.14 to 4.65); and more likely to die in hospital (OR 11.85, 95% CI 8.58 to 16.86) and within 90 days of discharge (OR 7.92, 95% CI 6.20 to 10.25). For those who survived, rates of emergency readmission within 90 days were comparable between COVID-19 and influenza cohorts (OR 1.07, 95% CI 0.89 to 1.29), while primary care activity was greater among the COVID-19 cohort (incidence rate ratio 1.30, 95% CI 1.23 to 1.37).Conclusions Patients admitted for COVID-19 were more likely to die, more likely to stay in hospital for over 10 days and interact more with primary care after discharge, than patients admitted for influenza. However, readmission rates were similar for both groups. These findings, while situated in the context of the first wave of COVID-19, with the associated pressures on the health system, can inform health service planning for subsequent waves of COVID-19, and show that patients with COVID-19 interact more with healthcare services as well as having poorer outcomes than those with influenza.

Journal article

Beaney T, Clarke J, Alboksmaty A, Flott K, Fowler A, Benger J, Aylin P, Elkin S, Darzi A, Neves Aet 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, Vol: 40, Pages: 460-465, 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.

Journal article

Clarke J, Beaney T, Alboksmaty A, Flott K, Ashrafian H, Fowler A, Benger JR, Aylin P, Elkin S, Neves AL, Darzi Aet al., 2023, Factors associated with enrolment into a national COVID-19 pulse oximetry remote monitoring programme in England: a retrospective observational study, The Lancet: Digital Health, Vol: 5, Pages: e194-e205, ISSN: 2589-7500

BACKGROUND: Hypoxaemia is an important predictor of severity in individuals with COVID-19 and can present without symptoms. The COVID Oximetry @home (CO@h) programme was implemented across England in November, 2020, providing pulse oximeters to higher-risk people with COVID-19 to enable early detection of deterioration and the need for escalation of care. We aimed to describe the clinical and demographic characteristics of individuals enrolled onto the programme and to assess whether there were any inequalities in enrolment. METHODS: This retrospective observational study was based on data from a cohort of people resident in England recorded as having a positive COVID-19 test between Oct 1, 2020, and May 3, 2021. The proportion of participants enrolled onto the CO@h programmes in the 7 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: CO@h programme sites were reported by NHS England as becoming operational between Nov 21 and Dec 31, 2020. 1 227 405 people resident in 72 CCGs had a positive COVID-19 test between the date of programme implementation and May 3, 2021, of whom 19 932 (1·6%) were enrolled onto the CO@h programme. Of those enrolled, 14 441 (72·5%) were aged 50 years or older or were identified as clinically extremely vulnerable (ie, having a high-risk medical condition). Higher odds of enrolment onto the CO@h programme were found in older individuals (adjusted odds ratio 2·21 [95% CI 2·19-2·23], p<0·001, for those aged 50-64 years; 3·48 [3·33-3·63], p<0·001, for those aged 65-79 years; and 2·50 [2·34-2·68], p<0·001, for those aged ≥80 years), in individuals of non-White ethnicity (1·3

Journal article

Woodcock T, Novov V, Skirrow H, Butler J, Lovett D, Adeleke Y, Blair M, Saxena S, Majeed F, Aylin Pet al., 2023, Health and socio-demographic characteristics associated with uptake of seasonal influenza vaccination amongst pregnant women: retrospective cohort study, British Journal of General Practice, Vol: 73, Pages: e148-e155, ISSN: 0960-1643

Pregnant women are at increased risk from influenza, yet maternal influenza vaccination levels remain suboptimal. This study aimed to estimate associations between socio-demographic and health characteristics and seasonal influenza vaccination uptake among pregnant women and understand trends over time to inform interventions to improve vaccine coverage. A retrospective cohort study using linked electronic health records of women in North West London with at least one pregnancy overlapping with an influenza season between September 2010 and February 2020. We used a multivariable mixed-effects logistic regression model to identify associations between characteristics of interest and primary outcome of influenza vaccination. 451,954 pregnancies, among 260,744 women, were included. In 85,376 (18.9%) pregnancies women were vaccinated against seasonal influenza. Uptake increased from 8.4% in 2010/11 to 26.3% in 2018/19, dropping again to 21.1% in 2019/20. Uptake was lowest among women: aged 15-19 years (12%) or over 40 years (15%; OR 1.17, 95% CI 1.10 to 1.24); of Black ethnicity (14.1%; OR 0.55, 95% CI 0.53 to 0.57), or unknown ethnicity (9.9%; OR 0.42, 95% CI 0.39 to 0.46), lived in more deprived areas (OR least vs most deprived 1.16, 95% CI 1.11 to 1.21), or with no known risk factors for severe influenza. Seasonal influenza vaccine uptake in pregnant women increased in the past decade, prior to the COVID-19 pandemic, but remained suboptimal. We recommend approaches to reducing health inequalities should focus on women of Black ethnicity, younger and older women, and women living in areas of greater socio-economic deprivation.

Journal article

Ahmad R, Gordon AC, Aylin P, Redhead J, Holmes A, Evans DPet al., 2022, Effective knowledge mobilisation: creating environments for quick generation, dissemination, and use of evidence., The BMJ, Vol: 379, Pages: 1-5, ISSN: 1759-2151

Journal article

Piggin M, Johnson H, Papadimitriou D, Glampson B, Aylin P, Mayer Eet al., 2022, Insight Report: Digital health online public involvement session on using artificial intelligence to improve health and care in North West London, Insight Report: Digital health online public involvement session on using artificial intelligence to improve health and care in North West London

Summary report on the views of members of the public on using Artificial intelligence as part ofbuilding the digital healthcare programme of research in North West London.

Report

Alboksmaty A, Beaney T, Elkin S, Clarke J, Darzi A, Aylin P, Neves ALet al., 2022, Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19, European Journal of Public Health, Vol: 32, Pages: 1-1, ISSN: 1101-1262

ContextA surge of COVID cases globally is often portrayed as “very likely”, which overwhelms health systems and challenges their capacities. A mitigation strategy is seen by remotely monitoring COVID patients in out-of-hospital settings to determine the risk of deterioration.Description of the problemWe need an indicator to enable remote monitoring of COVID patients at home that can be measured by a handy tool; pulse oximetry which measures peripheral blood oxygen saturation (SpO2). Evidence shows that SpO2 is a reliable indicator of deterioration among COVID patients. The UK initiated a national programme (COVID Oximetry @ Home (CO@H)) to assess the theory. The concept can be potentially applied in other countries in various settings. As part of CO@H, we conducted a systematic review of the evidence on the safety and effectiveness of pulse oximetry in remote monitoring of COVID patients.ResultsOur review confirms the safety and potential effectiveness of pulse oximetry in remote home monitoring among COVID patients. We identified 13 research projects involving 2,908 participants that assessed the proposed strategy. Evidence shows the need to monitor at-rest and post-exertional SpO2. At-rest SpO2 of ≤ 92% or a decrease of 5% or more in post-exertional SpO2 should indicate care escalation. The recommended method for measuring at-rest SpO2 is after 5-10 min of rest, and assessing post-exertional SpO2 is after conducting a 1-min sit-to-stand test. We could not find explicit evidence on the impact on health service use compared with other models of care.LessonsRemote monitoring of COVID patients could alleviate the pressure on health systems and save hospital resources. Monitoring SpO2 by pulse oximetry can be widely applied, including in resource-limited settings, as the tool is affordable, reliable, and easy to use.Key messages• Adopting relevant health technologies in remote patient monitoring is critical to combat the pandemic.• Pu

Journal article

Bottle A, Neale FK, Foley KA, Viner RM, Kenny S, Aylin P, Saxena S, Hargreaves DSet al., 2022, Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study, BMJ OPEN, Vol: 12, ISSN: 2044-6055

Journal article

Warner M, Burn S, Stoye G, Aylin PP, Bottle A, Propper Cet al., 2022, Socioeconomic deprivation and ethnicity inequalities in disruption to NHS hospital admissions during the COVID-19 pandemic: a national observational study, BMJ Quality & Safety, Vol: 31, Pages: 590-598, ISSN: 2044-5415

Introduction Hospital admissions in many countries fell dramatically at the onset of the COVID-19 pandemic. Less is known about how care patterns differed by patient groups. We sought to determine whether areas with higher levels of socioeconomic deprivation or larger ethnic minority populations saw larger falls in emergency and planned admissions in England.Methods We conducted a national observational study of hospital care in the English National Health Service (NHS) in 2019–2020. Weekly volumes of elective (planned) and emergency admissions in 2020 compared with 2019 were calculated for each census area. Multiple linear regression analysis was used to estimate the reductions in volumes for areas in different quintiles of socioeconomic deprivation and ethnic minority populations after controlling for national time trends and local area composition.Results Between March and December 2020, there were 35.5% (3.0 million) fewer elective admissions and 22.0% (1.2 million) fewer emergency admissions with a non-COVID-19 primary diagnosis than in 2019. Areas with the largest share of ethnic minority populations experienced a 36.7% (95% CI 24.1% to 49.3%) larger reduction in non-primary COVID-19 emergency admissions compared with those with the smallest. The most deprived areas experienced a 10.1% (95% CI 2.6% to 17.7%) smaller reduction in non-COVID-19 emergency admissions compared with the least deprived. These patterns are not explained by differential prevalence of COVID-19 cases by area.Conclusions Even in a healthcare system founded on the principle of equal access for equal need, the impact of COVID-19 on NHS hospital care for non-COVID patients has not been spread evenly by ethnicity and deprivation in England. While we cannot conclusively determine the mechanisms behind these differences, they risk exacerbating prepandemic health inequalities.Data availability statementData may be obtained from a third party and are not publicly available.

Journal article

Zhu J, Holmes A, 2022, Changing patterns of bloodstream infections in the community and acute care across two COVID-19 epidemic waves: a retrospective analysis using data linkage, Clinical Infectious Diseases, Vol: 75, Pages: e1082-e1091, ISSN: 1058-4838

BackgroundWe examined the epidemiology of community- and hospital-acquired bloodstream infections (BSIs) in COVID-19 and non-COVID-19 patients across two epidemic waves.MethodsWe analysed blood cultures of patients presenting and admitted to a London hospital group between January 2020 and February 2021. We reported BSI incidence, as well as changes in sampling, case mix, healthcare capacity, and COVID-19 variants.Results34,044 blood cultures were taken. We identified 1,047 BSIs; 653 (62.4%) community-acquired and 394 (37.6%) hospital-acquired. Important changes in patterns were seen. Among community-acquired BSIs, Escherichia coli BSIs remained lower than pre-pandemic level during COVID-19 waves, however peaked following lockdown easing in May 2020, deviating from the historical trend of peaking in August. The hospital-acquired BSI rate was 100.4 per 100,000 patient-days across the pandemic, increasing to 132.3 during the first wave and 190.9 during the second, with significant increase seen in elective inpatients. Patients who developed a hospital-acquired BSI, including those without COVID-19, experienced 20.2 excess days of hospital stay and 26.7% higher mortality, higher than reported in pre-pandemic literature. In intensive care, the BSI rate was 421.0 per 100,000 patient-ICU days during the second wave, compared to 101.3 pre-COVID. The BSI incidence in those infected with the SARS-CoV-2 Alpha variant was similar to that seen with earlier variants.ConclusionsThe pandemic and national responses have impacted the patterns of community- and hospital-acquired BSIs, in COVID-19 and non-COVID-19 patients. Factors driving the observed patterns are complex. Infection surveillance needs to consider key aspects of pandemic response and changes in healthcare access and practice.

Journal article

Bottle R, Faitna P, Brett S, Aylin Pet al., 2022, Factors associated with, and variations in, COVID-19 hospital death rates in England’s first two waves: observational study, BMJ Open, Vol: 12, Pages: 1-11, ISSN: 2044-6055

Objectives:To assess patient- and hospital-level predictors of death and variation in death rates following admission for COVID-19 in England’s first two waves after accounting for random variation. To quantify the correlation between hospitals’ first and second wave death rates.Design:Observational study using administrative data.Setting:Acute non-specialist hospitals in England.Participants:All patients admitted with a primary diagnosis of COVID-19.Primary and secondary outcomes:In-hospital death.Results:Hospital Episode Statistics (HES) data were extracted for all acute hospitals in England for COVID-19 admissions for March 2020 to March 2021. In wave one (March-July 2020) there were 74,484 admissions and 21,883 deaths (crude rate 29.4%); in wave two (August 2020 to March 2021) there were 165,642 admissions and 36,040 deaths (21.8%). Wave two patients were younger, with more hypertension and obesity but lower rates of other comorbidities. Mortality improved for all ages; in wave two it peaked in December 2020 at 24.2% (lower than wave one’s peak) but halved by March 2021. In multiple multilevel modelling combining HES with hospital-level data from Situational Reports, wave two and wave one variables significantly associated with death were mostly the same. The median odds ratio for wave one was just 1.05 and for wave two was 1.07. At 99.8% control limits, 3% of hospitals were high and 7% were low funnel plot outliers in wave one; these figures were 9% and 12% for wave two. Four hospitals were (low) outliers in both waves. The correlation between hospitals’ adjusted mortality rates between waves was 0.45 (p<0.0001). Length of stay was similar in each wave.Conclusions:England’s first two COVID-19 waves were similar regarding predictors and moderate inter-hospital variation. Despite the challenges, variation in death rates and length of stay between hospitals was modest and might be accounted for by unobserved patient factors.

Journal article

Hanna GB, Mackenzie H, Miskovic D, Ni M, Wyles S, Aylin P, Parvaiz A, Cecil T, Gudgeon A, Griffith J, Robinson JM, Selvasekar C, Rockall T, Acheson A, Maxwell-Armstrong C, Jenkins JT, Horgan A, Cunningham C, Lindsay I, Arulampalam T, Motson RW, Francis NK, Kennedy RH, Coleman MG, Lapco programet al., 2022, Laparoscopic colorectal surgery outcomes improved after national training program (LAPCO) for specialists in England, Annals of Surgery, Vol: 275, Pages: 1149-1155, ISSN: 0003-4932

OBJECTIVE: To examine the impact of The National Training Programme for Laparoscopic Colorectal Surgery (Lapco) on the rate of laparoscopic surgery and clinical outcomes of cases performed by Lapco surgeons after completion of training. SUMMERY BACKGROUND DATA: Lapco provided competency-based supervised clinical training for specialist colorectal surgeons in England. METHODS: We compared the rate of laparoscopic surgery, mortality and morbidity for colorectal cancer resections by Lapco delegates and non-Lapco surgeons in 3-year periods preceding and following Lapco using difference in differences analysis. The changes in the rate of post-Lapco laparoscopic surgery with the Lapco sign-off competency assessment and in-training global assessment scores were examined using risk-adjusted cumulative sum to determine their predictive clinical validity with predefined competent scores of 3 and 5 respectively. RESULTS: 108 Lapco delegates performed 4586 elective colorectal resections pre-Lapco and 5115 post-Lapco while non-Lapco surgeons performed 72930 matched cases. Lapco delegates had a 37.8% increase in laparoscopic surgery which was greater than non-Lapco surgeons by 20.9% (95% CI, 18.5 to 23.3, p<0.001) with a relative decrease in 30-day mortality by -1.6% (95% CI, -3.4 to -0.2, p = 0.039) and 90-day mortality by -2.3% (95% CI, -4.3 to -0.4, p = 0.018). The change point of risk-adjusted cumulative sum was 3.12 for competency assessment tool and 4.74 for global assessment score whereas laparoscopic rate increased from 44% to 66% and 40% to 56% respectively. CONCLUSIONS: Lapco increased the rate of laparoscopic colorectal cancer surgery and reduced mortality and morbidity in England. In-training competency assessment tools predicted clinical performance after training.

Journal article

Dewa LH, Pappa S, Greene T, Cooke J, Mitchell L, Hadley M, Di Simplicio M, Woodcock T, Aylin Pet al., 2022, The Association Between Sleep Disturbance and Suicidality in Psychiatric Inpatients Transitioning to the Community: Protocol for an Ecological Momentary Assessment Study, JMIR RESEARCH PROTOCOLS, Vol: 11, ISSN: 1929-0748

Journal article

Dewa L, Pappa S, Greene T, Cooke J, Mitchell L, Hadley M, Di Simplicio M, Woodcock T, Aylin Pet al., 2022, The Association Between Sleep Disturbance and Suicidality inPsychiatric Inpatients Transitioning to the Community: Protocolfor an Ecological Momentary Assessment Study, JMIR Research Protocols, Vol: 11, Pages: 1-12, ISSN: 1929-0748

Background:Patients are at high risk of suicidal behaviour and death by suicide immediately followingdischarge from an inpatient psychiatric hospital. Furthermore, there is a high prevalence ofsleep problems in inpatient settings which is associated with worse outcomes followinghospitalisation. However, it is unknown whether poor sleep is associated with suicidalityfollowing initial hospital discharge.Objective:Our study objective is to describe the ecological momentary assessment (EMA) studyprotocol that aims to examine the relationship between sleep and suicidality in dischargedpatients.Methods:Our study will use EMA design using a wearable device to examine the sleep-suiciderelationship during the transition from acute inpatient care to the community. Prospectivelydischarged inpatients aged 18-35 with a mental disorder (n=50) will be assessed foreligibility and recruited across two sites. Data on suicidal ideation, behaviour and imagery,non-suicidal self-harm and imagery, defeat, entrapment, and hopelessness, affect and sleepwill be collected on the Pro-Diary V wrist-worn electronic watch for up to 14 days. Objectivesleep and daytime activity will be measured using the inbuilt MotionWare software.Questionnaires will be administered face-to-face at baseline and follow-up while data willalso be collected on the acceptability and feasibility of using the Pro-Diary V watch tomonitor the transition following discharge. The study has been, and will continue to be, coproduced with young people with experience of being in an inpatient setting and suicidality.Results:South Birmingham Research Ethics Committee (Ref: 21/WM/0128) approved the study onJune 28th 2021. We expect to see a relationship between poor sleep and post-dischargesuicidality. Results will be available in 2022.DiscussionThis protocol describes the first co-produced EMA study to examine the relationshipbetween sleep and suicidality, and to apply the IMV model in young patients transitioningfrom psychiatric

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

Nakubulwa M, Junghans C, Novov V, Lyons-Amos C, Lovett D, Majeed A, Aylin P, Woodcock Tet al., 2022, Factors associated with accessing long-term adult social care in people aged 75 and over: a retrospective cohort study., Age and Ageing, Vol: 51, Pages: 1-9, ISSN: 0002-0729

BACKGROUND: An ageing population and limited resources have put strain on state provision of adult social care (ASC) in England. With social care needs predicted to double over the next 20 years, there is a need for new approaches to inform service planning and development, including through predictive models of demand. OBJECTIVE: Describe risk factors for long-term ASC in two inner London boroughs and develop a risk prediction model for long-term ASC. METHODS: Pseudonymised person-level data from an integrated care dataset were analysed. We used multivariable logistic regression to model associations of demographic factors, and baseline aspects of health status and health service use, with accessing long-term ASC over 12 months. RESULTS: The cohort comprised 13,394 residents, aged ≥75 years with no prior history of ASC at baseline. Of these, 1.7% became ASC clients over 12 months. Residents were more likely to access ASC if they were older or living in areas with high socioeconomic deprivation. Those with preexisting mental health or neurological conditions, or more intense prior health service use during the baseline period, were also more likely to access ASC. A prognostic model derived from risk factors had limited predictive power. CONCLUSIONS: Our findings reinforce evidence on known risk factors for residents aged 75 or over, yet even with linked routinely collected health and social care data, it was not possible to make accurate predictions of long-term ASC use for individuals. We propose that a paradigm shift towards more relational, personalised approaches, is needed.

Journal article

Deputy M, Sahnan K, Worley G, Patel K, Balinskaite V, Bottle A, Aylin P, Burns EM, Hart A, Faiz Oet al., 2022, The use of, and outcomes for, inflammatory bowel disease services during the Covid-19 pandemic: a nationwide observational study, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 55, Pages: 836-846, ISSN: 0269-2813

Journal article

Dewa L, Lawrance E, Roberts L, Brooks-Hall E, Ashrafian H, Fontana G, Aylin Pet al., 2021, Quality social connection as an active ingredient in digital interventions for young people with depression and anxiety: systematic scoping review and meta-analysis, Journal of Medical Internet Research, Vol: 23, Pages: 1-22, ISSN: 1438-8871

BackgroundDisrupted social connections may negatively impact youth mental health. In contrast, sustained quality social connections (QSC) can improve mental health outcomes. However, few studies have examined how these quality connections impact depression and anxiety outcomes within digital interventions, and conceptualisation is limited.ObjectiveThe study aim was to conceptualise, appraise and synthesise evidence on quality social connection within digital interventions (D-QSC) and the impact on depression and anxiety outcomes for young people (14-24).MethodsA systematic scoping review and meta-analysis was conducted using the Johanna Briggs Institute methodological frameworks and guided by experts with lived experience. Reporting was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Medline, Embase, PsycInfo and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched against a comprehensive combination of key concepts on 24th June 2020. Search concepts included young people, digital intervention, depression/anxiety, and social connection. Google was also searched. One reviewer independently screened abstracts/titles and full-text and 10% were screened by a second reviewer. A narrative synthesis was used to structure findings on indicators of D-QSC and mechanisms that facilitate the connection. Indicators of D-QSC from included studies were synthesised to produce a conceptual framework. Results5715 publications were identified and 42 were included. Of these, there were 23,319 participants. Indicators that D-QSC was present varied and included relatedness, having a sense of belonging and connecting to similar people. However, despite the variation, most of the indicators were associated with improved outcomes for depression and anxiety. Negative interactions, loneliness and feeling ignored indicated D-QSC was not present. In ten applicable studies, a meta-an

Journal article

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

<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

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

<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

Balinskaite V, Bottle A, Aylin P, 2021, Capacity planning for acute hospital inpatient care and adult critical care in England: a descriptive study using hospital administrative data, Annual National Conference on Public Health Science dedicated to New Research in UK Public Health, Publisher: ELSEVIER SCIENCE INC, Pages: 22-22, ISSN: 0140-6736

Conference paper

Piggin M, Johnson H, Papadimitriou D, Mayet J, Glampson B, Aylin P, Mayer Eet al., 2021, Insight Report: Digital health online public involvement session on building our digital healthcare programme in North West London, Insight Report: Digital health online public involvement session on building our digital healthcare programme in North West London

Summary report on the views of members of the public on building the digital healthcare programme of research in North West London.

Report

Piggin M, Johnson H, Papadimitriou D, Kaura A, Quint J, Glampson B, Mayer E, Aylin Pet al., 2021, Insight Report: Digital health online public involvement session on using real world evidence to improve health and care in North West London, Insight Report: Digital health online public involvement session on using real world evidence to improve health and care in North West London

Summary report on the views of members of the public on real world evidence studies undertaken aspart of building the digital healthcare programme of research in North West London

Report

Dewa L, Pappa S, Greene T, Cooke J, Mitchell L, Hadley M, Di Simplicio M, Woodcock T, Aylin Pet al., 2021, SWAY: Sleep disturbance as an early warning sign of suicidality in psychiatric inpatients transitioning to the community: an ecological momentary assessment study protocol

Working paper

Dewa LH, Pappa S, Greene T, Cooke J, Mitchell L, Hadley M, Di Simplicio M, Woodcock T, Aylin Pet al., 2021, The Association Between Sleep Disturbance and Suicidality in Psychiatric Inpatients Transitioning to the Community: Protocol for an Ecological Momentary Assessment Study (Preprint)

<sec> <title>BACKGROUND</title> <p>Patients are at high risk of suicidal behavior and death by suicide immediately following discharge from inpatient psychiatric hospitals. Furthermore, there is a high prevalence of sleep problems in inpatient settings, which is associated with worse outcomes following hospitalization. However, it is unknown whether poor sleep is associated with suicidality following initial hospital discharge.</p> </sec> <sec> <title>OBJECTIVE</title> <p>Our study objective is to describe a protocol for an ecological momentary assessment (EMA) study that aims to examine the relationship between sleep and suicidality in discharged patients.</p> </sec> <sec> <title>METHODS</title> <p>Our study will use an EMA design based on a wearable device to examine the sleep-suicide relationship during the transition from acute inpatient care to the community. Prospectively discharged inpatients 18 to 35 years old with mental disorders (N=50) will be assessed for eligibility and recruited across 2 sites. Data on suicidal ideation, behavior, and imagery; nonsuicidal self-harm and imagery; defeat, entrapment, and hopelessness; affect; and sleep will be collected on the Pro-Diary V wrist-worn electronic watch for up to 14 days. Objective sleep and daytime activity will be measured using the inbuilt MotionWare software. Questionnaires will be administered face-to-face at baseline and follow up, and data will also be collected on the acceptability and feasibility of using the Pro-Diary V watch to monitor the transition following discharge. The study has been, and will continue to be, coproduced with young people with experience of being in an inpatient settin

Journal article

Vollmer MAC, Radhakrishnan S, Kont MD, Flaxman S, Bhatt SJ, Costelloe C, Honeyford K, Aylin P, Cooke G, Redhead J, Sanders A, Mangan H, White PJ, Ferguson N, Hauck K, Perez Guzman PN, Nayagam Set al., 2021, The impact of the COVID-19 pandemic on patterns of attendance at emergency departments in two large London hospitals: an observational study, BMC Health Services Research, Vol: 21, Pages: 1-9, ISSN: 1472-6963

Background Hospitals in England have undergone considerable change to address the surgein demand imposed by the COVID-19 pandemic. The impact of this on emergencydepartment (ED) attendances is unknown, especially for non-COVID-19 related emergencies.Methods This analysis is an observational study of ED attendances at the Imperial CollegeHealthcare NHS Trust (ICHNT). We calibrated auto-regressive integrated moving averagetime-series models of ED attendances using historic (2015-2019) data. Forecasted trendswere compared to present year ICHNT data for the period between March 12, 2020 (whenEngland implemented the first COVID-19 public health measure) and May 31, 2020. Wecompared ICHTN trends with publicly available regional and national data. Lastly, wecompared hospital admissions made via the ED and in-hospital mortality at ICHNT duringthe present year to the historic 5-year average.Results ED attendances at ICHNT decreased by 35% during the period after the firstlockdown was imposed on March 12, 2020 and before May 31, 2020, reflecting broadertrends seen for ED attendances across all England regions, which fell by approximately 50%for the same time frame. For ICHNT, the decrease in attendances was mainly amongst thoseaged <65 years and those arriving by their own means (e.g. personal or public transport) andnot correlated with any of the spatial dependencies analysed such as increasing distance frompostcode of residence to the hospital. Emergency admissions of patients without COVID-19after March 12, 2020 fell by 48%; we did not observe a significant change to the crudemortality risk in patients without COVID-19 (RR 1.13, 95%CI 0.94-1.37, p=0.19).Conclusions Our study findings reflect broader trends seen across England and give anindication how emergency healthcare seeking has drastically changed. At ICHNT, we findthat a larger proportion arrived by ambulance and that hospitalisation outcomes of patientswithout COVID-19 did not differ from previous years. The ext

Journal article

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