24 results found
Dick A, Pinder R, Ember T, et al., 2019, Reducing allogenic blood transfusion in paediatric scoliosis surgery – reporting fifteen years of a multidisciplinary, evidence based quality improvement project, Global Spine Journal, Vol: 9, Pages: 843-849, ISSN: 2192-5682
Study Design:Retrospective review of prospectively collected spinal surgery and transfusion databases.Objectives:To evaluate the efficacy of a care pathway developed at our institution since 2003 with a focus on reducing the need for blood transfusions in children undergoing scoliosis correction surgery. The care pathway includes nurse-led clinics facilitating preoperative hemoglobin optimization, intraoperative cell salvage, the use of tranexamic acid, and a transfusion criteria awareness program.Methods:Retrospective review of our institution’s prospectively recorded spinal surgery and transfusion databases including all cases of scoliosis surgery in patients 18 years and younger between 2001 and 2015.Results:A total of 1039 procedures were included in the analysis. Overall, 24.4% of patients received a transfusion. The proportion of patients transfused was 89.2% in 2001-2003, 39.6% in 2004-2006, 16.5% in 2007-2009, 15.6% in 2010-2012, and 20.1% in 2013-2015. The volume of blood products transfused in those undergoing transfusion was 9.1 units in 2001-2003, 4.8 units in 2004-2006, 5.0 units in 2007-2009, 2.3 units in 2010-2012, and 2.1 units in 2013-2015. A multivariate logistic regression demonstrated adjusted odds ratios for the probability of receiving any transfusion of 5.45 (95% confidence interval 3.62-8.11) for patients with neuromuscular diagnoses and 11.17 (5.02-24.86) for those undergoing combined anterior and posterior surgical approach.Conclusions:We have demonstrated over a 15-year period that the introduction of a multifaceted, multidisciplinary pathway can dramatically and sustainably reduce the need for blood transfusions and their attendant risks in pediatric scoliosis surgery. This data lends weight to the adoption of such a care pathway in pediatric scoliosis surgery.
Sharpe CA, Poots A, Watt H, et al., 2019, An observational study to examine how Cumulative Impact Zones influence alcohol availability from different types of licensed outlets in an inner London Borough, BMJ Open, Vol: 9, Pages: 1-8, ISSN: 2044-6055
OBJECTIVES: Cumulative Impact Zones (CIZs) are a widely implemented local policy intended to restrict alcohol availability in areas proliferated with licensed outlets. Limited previous research has questioned their effectiveness and suggested they may play a more nuanced role in shaping local alcohol environments. This study evaluates the association between CIZ implementation and the number of licence applications made and the number issued, relative to a control region. DESIGN: A quantitative observational study.SETTING: The inner London Borough of Southwark, which currently enforces three CIZs. POPULATION: Licence applications received by Southwark Council’s Licensing Authority between 1 April 2006 and 31 March 2017 (N = 1254).INTERVENTIONS: CIZ implementation. PRIMARY OUTCOME MEASURES: Five outlet types were categorised and evaluated: Drinking Establishments, Eateries, Takeaways, Off Sales, and Other Outlets. Primary outcome measures were the number of applications received and the number of licences issued. These were analysed using Poisson regression of counts over time.RESULTS: Across all CIZs, implementation was associated with greater increases in the number of eateries in CIZ regions (IRR = 1.58, 95% CI: 1.02 – 2.52, P = 0.04) and number of takeaway venues (IRR = 3.89, 95% CI: 1.32 – 11.49, P = 0.01), relative to the control area. No discernible association was found for the remaining outlet types. Disaggregating by area indicated a 10-fold relative increase in the number of new eateries in Peckham CIZ (IRR = 10.38, 95% CI: 1.39 – 77.66, P = 0.02) and a four-fold relative increase in the number of newly licensed takeaways in Bankside CIZ (IRR = 4.38, 95% CI: 1.20 – 15.91, P = 0.03).CONCLUSIONS: Cumulative Impact Zones may be useful as policy levers to shape local alcohol environments to support the licensing goals of specific geographical areas and diversify the night-time economy.
Green K, Cooke O'Dowd N, Watt H, et al., 2019, Prescribing trends of gabapentin, pregabalin and oxycodone; a secondary analysis of primary care prescribing patterns in England, BJGP Open, ISSN: 2398-3795
BackgroundThe risk of iatrogenic harm from prescription drug use, misuse and abuse of drugssuch as gabapentin, pregabalin and oxycodone is substantial. In recent years, deathsassociated with these drugs in England have increased.AimsTo characterise general practice prescribing trends for gabapentin, pregabalin andoxycodone – termed dependence forming medicines (DFM) – in England and describepotential drivers of unwarranted variation.Design and SettingThis study is a retrospective secondary analysis of open source, publicly availablegovernment data from various sources pertaining to primary care demographics andprescriptions.MethodsThis study used five consecutive years (April 2013 – March 2018) of aggregate datato investigate longitudinal trends of prescribing and variation in prescribing trends atpractice and clinical commissioning group (CCG) level.ResultsAnnual prescriptions of gabapentin, pregabalin and oxycodone have increased eachyear over the period. Variation in prescribing trends were associated with GP practicedeprivation quintile, where the most deprived GP practices prescribe 313% (p<0.001)and 238% (p<0.001) greater volumes of gabapentin and pregabalin per person thanpractices in the least deprived quintile. The highest prescribing CCGs of each of thesedrugs were predominantly in northern and eastern regions of England.ConclusionsSubstantial increases in gabapentin, pregabalin and oxycodone prescriptions areconcerning and will increase iatrogenic harm from drug-related morbidity and mortality.More research is needed to understand the large variation in prescribing between general practices; and to develop and implement interventions to reduce unwarrantedvariation and increase the appropriateness of prescribing of these drugs.
Boshari T, Sharpe C, Poots A, et al., 2018, Public health and alcohol licensing policy in local government: an observational study of licensed premises and alcohol-related violence in London, UK, Public Health Science 2018, Publisher: Elsevier, Pages: S12-S12, ISSN: 0140-6736
Sharpe C, Tang S, Hogan G, et al., 2018, Developing the role of public health in responding to mental health and wellbeing needs after mass casualty incidents: experience at London Bridge and Borough Market, June, 2017, Public Health Science 2018, Publisher: Elsevier, Pages: S14-S14, ISSN: 0140-6736
Sharpe CA, Poots AJ, Watt H, et al., 2018, Controlling alcohol availability through local policy: an observational study to evaluate Cumulative Impact Zones in a London borough, Journal of Public Health, Vol: 40, Pages: e260-e268, ISSN: 1741-3842
BackgroundCumulative impact zones (CIZs) are a discretionary policy lever available to local government, used to restrict the availability of alcohol in areas deemed already saturated. Despite little evidence of their effect, over 200 such zones have been introduced. This study explores the impact of three CIZs on the licensing of venues in the London Borough of Southwark.MethodsUsing 10 years of licensing data, we examined changes in the issuing of licences on the introduction of three CIZs within Southwark, relative to control areas. The number of licence applications made (N = 1110), the number issued, and the proportion objected to, were analysed using negative binomial regression.ResultsIn one area tested, CIZ implementation was associated with 119% more licence applications than control areas (incidence rate ratios (IRR) = 2.19, 95% confidence intervals (CI): 1.29–3.73, P = 0.004) and 133% more licences granted (IRR = 2.33, 95% CI: 1.31–4.16, P = 0.004). No significant effect was found for the other two areas. CIZs were found to have no discernible effect on the relative proportion of licence applications receiving objections.ConclusionsCIZs are proposed as a key lever to limit alcohol availability in areas of high outlet density. We found no evidence that CIZ establishment reduced the number of successful applications in Southwark.
Pinder RJ, Ferguson J, Moller H, 2016, Minority ethnicity patient satisfaction and experience: the results of the National Cancer Patient Experience Survey in England, BMJ Open, Vol: 6, ISSN: 2044-6055
OBJECTIVES: The study sought to explore the differential patient satisfaction reported by cancerpatients from ethnic minority backgrounds, examining patient-reported experience of interacting withmedical and nursing staff.SETTING: As a secondary analysis, we collated data collected over two consecutive annual rounds ofthe National Cancer Patient Experience Survey (NCPES) between September 2012 and November2013.PARTICIPANTS: There were 138,878 responses from 155 hospital trusts across the National HealthService in England, representing a response rate of 63.9% based on the total identified cohort ofpatients receiving cancer care over those two years.OUTCOMES: We used the results of the annual survey, that sought to assess overall patientsatisfaction along with patient experience of interacting with clinical nurse specialists, hospital doctorsand ward nurses.RESULTS: Ethnic minority patients reported lower satisfaction and less positive experiences of careoverall. While some of this difference appeared related to demographic and socioeconomic variation,ethnic minority patients remained less positive than those in the White British group after statisticaladjustment. Ethnic minority patients also reported lower confidence in, and less understanding of,health care professionals including clinical nurse specialists, doctors and ward nurses.CONCLUSION: Given the diversity of the British population, as well as the clustering of ethnicminority patients in certain urban areas, a better understanding of the expectations and additionalneeds of ethnic minority patients is required to improve their experience of and satisfaction withcancer care.
Ashiru-Oredope D, Budd EL, Bhattacharya A, et al., 2016, Implementation of antimicrobial stewardship interventions recommended by national toolkits in primary and secondary healthcare sectors in England: TARGET and Start Smart Then Focus., J Antimicrob Chemother, Vol: 71, Pages: 1408-1414
OBJECTIVES: To assess and compare the implementation of antimicrobial stewardship (AMS) interventions recommended within the national AMS toolkits, TARGET and Start Smart Then Focus, in English primary and secondary healthcare settings in 2014, to determine the prevalence of cross-sector engagement to drive AMS interventions and to propose next steps to improve implementation of AMS. METHODS: Electronic surveys were circulated to all 211 clinical commissioning groups (CCGs; primary sector) and to 146 (out of the 159) acute trusts (secondary sector) in England. Response rates were 39% and 63% for the primary and secondary sectors, respectively. RESULTS: The majority of CCGs and acute trusts reported reviewing national AMS toolkits formally or informally (60% and 87%, respectively). However, only 13% of CCGs and 46% of acute trusts had developed an action plan for the implementation of these toolkits. Only 5% of CCGs had antimicrobial pharmacists in post; however, the role of specialist antimicrobial pharmacists continued to remain embedded within acute trusts, with 83% of responding trusts having an antimicrobial pharmacist at a senior grade. CONCLUSIONS: The majority of healthcare organizations review national AMS toolkits; however, implementation of the toolkits, through the development of action plans to deliver AMS interventions, requires improvement. For the first time, we report the extent of cross-sector and multidisciplinary collaboration to deliver AMS interventions in both primary and secondary care sectors in England. Results highlight that further qualitative and quantitative work is required to explore mutual benefits and promote best practice. Antimicrobial pharmacists remain leaders for implementing AMS interventions across both primary and secondary healthcare sectors.
Pinder RJ, Berry D, Sallis A, et al., 2015, Antibiotic prescribing and behaviour change in healthcare settings: literature review and behavioural analysis, London, UK, Publisher: Department of Health & Public Health England, 2014719
The Annual Report of the Chief Medical Officer published in March 2013 highlighted the threat posed by antibiotic resistance to the UK.This report is part of the response to that call to action. It proposes new and enhanced interventions that have the potential to reduce the risk of antibiotic resistance. These interventions are grounded in behavioural science, underpinned by a thorough review of the evidence, and have robust theoretical foundations for their mechanism of action.
Pinder RJ, 2014, The NHS in England: An Introduction for Junior Doctors, Publisher: The Codex Project, ISBN: 978-1-910046-05-0
Pinder RJ, Greaves FE, Aylin PP, et al., 2013, Staff perceptions of quality of care: an observational study of the NHS Staff Survey in hospitals in England, BMJ QUALITY & SAFETY, Vol: 22, Pages: 563-570, ISSN: 2044-5415
Healy C, Greig AVH, Murphy AD, et al., 2013, Prospective Randomized Controlled Trial: Fibrin Sealant Reduces Split Skin Graft Donor-Site Pain, PLASTIC AND RECONSTRUCTIVE SURGERY, Vol: 132, Pages: 139E-146E, ISSN: 0032-1052
Pinder RJ, Greenberg N, Boyko EJ, et al., 2012, Profile of two cohorts: UK and US prospective studies of military health, INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, Vol: 41, Pages: 1272-1282, ISSN: 0300-5771
Pinder RJ, Iversen AC, Kapur N, et al., 2012, Self-harm and attempted suicide among UK Armed Forces personnel: Results of a cross-sectional survey, INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY, Vol: 58, Pages: 433-439, ISSN: 0020-7640
Pinder RJ, Murphy D, Iversen AC, et al., 2011, Social exclusion amongst UK veterans based on measures of employment, 22nd International Conference on Epidemiology in Occupational Medicine (EPICOH)
Objectives: For some individuals leaving the Armed Forces, the return to civilian life can be problematic. Social exclusion describes a process of detachment from normal participation in the activities of society. This study aims to identify risk factors associated with social exclusion amongst ex-service personnel, using measures of employment. Methods: A telephone study of serving and ex-serving personnel (n=821) drawn from the King’s cohort study of UK military personnel (n=10272), asked those who had left the military questions regarding their employment history and experiences since leaving the military. A composite variable was formed using employment measures, which identified a socially excluded group. These individuals were compared to a group in stable employment. Results: 215 ex-service personnel were included. 35 (7.5%) were unemployed at the time of interview. 78 (29.3%) were classified as socially excluded. Two groups were identified as being at highest risk of social exclusion: those leaving after a shorter period of service (adjusted odds ratio (OR) 0.89, 95% confidence interval (CI) 0.79-0.99), and those leaving after completing a full term of service (adjusted OR 14.05, 95% CI 2.78-71.06). Those with symptoms of post-traumatic stress disorder were less likely to experience social exclusion (adjusted OR 0.20, 95% CI 0.06-0.67). Conclusions: Military service is a positive experience for the majority, however a small group of individuals who are compulsorily discharged for completing their term of service or for other reasons, fare worse in the context of social exclusion as measured by employment.
Lyle S, Pinder RJ, Mallinson C, 2011, A multi-disciplinary approach to improving blood transfusion practice in paediatric scoliosis correction surgery, Association of Surgical Trainees Annual Conerence 2011
Introduction: Spinal correction surgery is associated with significant perioperative blood loss, often necessitating transfusion. Given the potential risks of blood transfusion we have introduced a pathway with the aim of reducing transfusion requirements. Method: A Spinal Surgery Care Pathway was developed. Its implementation involved a multi-disciplinary programme of several different interventions: nurse-led clinics allowing pre-operative haemoglobin levels to be optimised; intra operative cell-salvage, and a transfusion criteria awareness programme. The records of all paediatric patients undergoing spinal correction surgery between 2000 and 2010 were reviewed: haemoglobin levels; blood products administered; demographic and surgical details were recorded. Results: Data from 466 patients were analysed: 166 from before introduction of the pathway and 300 after. The proportion of patients undergoing transfusion dropped from 69.3% to 16.7% (p <0.0001), risk ratio 0.24 (95% CI 0.18 - 0.32). Where transfusion was required, the mean volume transfused fell from 8.2 to 4.5 units (p<0.001). Discussion: Implementation of this multifaceted pathway has significantly reduced blood product requirements. In addition to the reduction in morbidity this is likely to have implications upon length of stay and cost. We propose that other units undertaking such surgery consider the use of a similar pathway.
Pinder RJ, Fear NT, Wessely S, et al., 2010, Mental Health Care Provision in the U.K. Armed Forces, MILITARY MEDICINE, Vol: 175, Pages: 805-810, ISSN: 0026-4075
Power C, Saour S, Geh J, et al., 2009, Fibrin Glue spray reduces split skin graft donor site morbidity, 15th World Congress of the International Conference for Plastic Reconstructive and Aesthetic Surgery
Pattanayak R, Pinder RJ, Mallinson C, 2009, Audit of blood usage in spinal correction surgery- Guy's and St Thomas' Experience, Association of Paediatric Anaesthetists Annual Scientific Meeting, 2009
Pinder RJ, Murphy D, Hatch SL, et al., 2009, A mixed method analysis of the perceptions of themedia by members of the British Forces during the Iraq War, Armed Forces and Society, Vol: 36, Pages: 131-152
Little is known about service personnel’s perceptions of the media’s coverage of war and its impact on the personnel and their families. Using data collected from a major cohort study of the British Armed Forces, this article examines perceptions of the coverage of the Iraq War among British personnel deployed during the 2003 invasion of Iraq (Operation Telic 1). It draws on the theories of media’s effects and gauges whether hostile media effect or assimilation bias effect takes precedence. The authors qualitatively analyzed the responses of 200 military personnel regarding their perceptions of the media and supplemented this by further quantitative analysis. This led the authors to identify concerns that the media coverage was unsuitable, inaccurate, and too immediate; however, in some cases, coverage was considered beneficial. The importance of the family to those deployed and the extent to which media coverage can affect morale make the military family an important media audience.
Chandler AG, Pinder RJ, Netsch T, et al., 2008, Correction of misaligned slices in multi-slice cardiovascular magnetic resonance using slice-to-volume registration, JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE, Vol: 10, ISSN: 1097-6647
Rubin GJ, Page L, Morgan O, et al., 2007, Public information needs after the poisoning of Alexander Litvinenko with polonium-210 in London: cross sectional telephone survey and qualitative analysis, BRITISH MEDICAL JOURNAL, Vol: 335, Pages: 1143-1146B, ISSN: 0959-8146
Chandler AG, Pinder RJ, Netsch T, et al., 2006, Correction of misaligned slices in multi-slice MR cardiac examinations using slice-to-volume registration, IEEE International Symposium on Biomedical Imaging, Pages: 474-477
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