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Ali AM, Loeffler MD, Aylin P, et al., 2021, Timing of Readmissions After Elective Total Hip and Knee Arthroplasty: Does a 30-Day All-Cause Rate Capture Surgically Relevant Readmissions?, JOURNAL OF ARTHROPLASTY, Vol: 36, Pages: 728-733, ISSN: 0883-5403
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Byrne BE, Faiz OD, Bottle A, et al., 2021, A Protocol is not Enough: Enhanced Recovery Program-Based Care and Clinician Adherence Associated with Shorter Stay After Colorectal Surgery, WORLD JOURNAL OF SURGERY, Vol: 45, Pages: 347-355, ISSN: 0364-2313
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- Citations: 8
Blackwell J, Saxena S, Jayasooriya N, et al., 2021, Prevalence and duration of gastrointestinal symptoms before diagnosis of Inflammatory Bowel Disease and predictors of timely specialist review: a population-based study, Journal of Crohn's and Colitis, Vol: 15, Pages: 203-211, ISSN: 1873-9946
Background and AimsLack of timely referral and significant waits for specialist review amongst individuals with unresolved gastrointestinal (GI) symptoms can result in delayed diagnosis of Inflammatory Bowel Disease (IBD).AimsTo determine the frequency and duration of GI symptoms and predictors of timely specialist review before the diagnosis of both Crohn’s Disease (CD) and ulcerative colitis (UC).MethodsCase-control study of IBD matched 1:4 for age and sex to controls without IBD using the Clinical Practice Research Datalink from 1998-2016.ResultsWe identified 19,555 cases of IBD, and 78,114 controls. 1 in 4 cases of IBD reported gastrointestinal symptoms to their primary care physician more than 6 months before receiving a diagnosis. There is a significant excess prevalence of GI symptoms in each of the 10 years before IBD diagnosis. GI symptoms were reported by 9.6% and 10.4% at 5 years before CD and UC diagnosis respectively compared to 5.8% of controls. Amongst patients later diagnosed with IBD, <50% received specialist review within 18 months from presenting with chronic GI symptoms. Patients with a previous diagnosis of irritable bowel syndrome or depression were less likely to receive timely specialist review (IBS: HR=0.77, 95%CI 0.60-0.99, depression: HR=0.77, 95%CI 0.60-0.98).ConclusionsThere is an excess of GI symptoms 5 years before diagnosis of IBD compared to the background population which are likely attributable to undiagnosed disease. Previous diagnoses of IBS and depression are associated with delays in specialist review. Enhanced pathways are needed to accelerate specialist referral and timely IBD diagnosis.
Greenfield G, Blair M, Aylin P, et al., 2021, Characteristics of frequent paediatric users of emergency departments in England: an observational study using routine national data, Emergency Medicine Journal, Vol: 38, Pages: 146-150, ISSN: 1472-0205
BACKGROUND:Frequent attendances of the same users in emergency departments (ED) can intensify workload pressures and are common among children, yet little is known about the characteristics of paediatric frequent users in EDs. AIM:To describe the volume of frequent paediatric attendance in England and the demographics of frequent paediatric ED users in English hospitals. METHOD:We analysed the Hospital Episode Statistics dataset for April 2014-March 2017. The study included 2 308 816 children under 16 years old who attended an ED at least once. Children who attended four times or more in 2015/2016 were classified as frequent users. The preceding and subsequent years were used to capture attendances bordering with the current year. We used a mixed effects logistic regression with a random intercept to predict the odds of being a frequent user in children from different sociodemographic groups. RESULTS:One in 11 children (9.1%) who attended an ED attended four times or more in a year. Infants had a greater likelihood of being a frequent attender (OR 3.24, 95% CI 3.19 to 3.30 vs 5 to 9 years old). Children from more deprived areas had a greater likelihood of being a frequent attender (OR 1.57, 95% CI 1.54 to 1.59 vs least deprived). Boys had a slightly greater likelihood than girls (OR 1.05, 95% CI 1.04 to 1.06). Children of Asian and mixed ethnic groups were more likely to be frequent users than those from white ethnic groups, while children from black and 'other' had a lower likelihood (OR 1.03, 95% CI 1.01 to 1.05; OR 1.04, 95% CI 1.01 to 1.06; OR 0.88, 95% CI 0.86 to 0.90; OR 0.90, 95% CI 0.87 to 0.92, respectively). CONCLUSION:One in 11 children was a frequent attender. Interventions for reducing paediatric frequent attendance need to target infants and families living in deprived areas.
Dewa L, Crandell C, Choong E, et al., 2021, CCopeY: a mixed-methods co-produced study on the mental health status and coping strategies of young people during COVID-19 UK lockdown, Journal of Adolescent Health, ISSN: 1054-139X
PurposeExploring the impact of COVID-19 pandemic on young people’s mental health is an increasing priority. Studies to date are largely surveys and lack meaningful involvement from service users in their design, planning and delivery. The study aimed to examine the mental health status and coping strategies of young people during the first UK COVID-19 lockdown using co-production methodology.MethodsThe mental health status of young people (aged 16-24) in April 2020 was established utilising a sequential explanatory co-produced mixed methods design. Factors associated with poor mental health status including coping strategies were also examined using an online survey and semi-structured interviews.Results30.3% had poor mental health and 10.8% had self-harmed since lockdown. Young people identifying as Black/Black-British ethnicity had the highest increased odds of experiencing poor mental health (odds ratio [OR] 3.688, 95% CI 0.54-25.40). Behavioural disengagement (OR 1.462, 95% CI 1.22-1.76), self-blame (OR 1.307 95% CI 1.10-1.55), and substance use (OR 1.211 95% CI 1.02-1.44) coping strategies, negative affect (OR 1.109, 95% CI 1.07-1.15), sleep problems (OR 0.915 95% CI 0.88-0.95) and conscientiousness personality trait (OR 0.819 95% CI 0.69-0.98) were significantly associated with poor mental health. Three qualitative themes were identified: (1) pre-existing/developed helpful coping strategies employed, (2) mental health difficulties worsened and (3) mental health and non-mental health support needed during and after lockdown.ConclusionPoor mental health is associated with dysfunctional coping strategies. Innovative coping strategies can help other young people cope during and after lockdowns, with digital and school promotion and application.
Jayasooriya N, Saxena SK, Blackwell J, et al., 2021, CHANGING PATTERNS OF ANTIDEPRESSANT MEDICATION USE AMONGST INFLAMMATORY BOWEL DISEASE PATIENTS: A UK POPULATION-BASED STUDY, Publisher: BMJ PUBLISHING GROUP, Pages: A101-A101, ISSN: 0017-5749
Bottle R, Griffiths R, White S, et al., 2020, Periprosthetic fractures: the next fragility fracture epidemic? A national observational study, BMJ Open, Vol: 10, ISSN: 2044-6055
Objectives Periprosthetic fractures have considerable clinical implications for patients and financial implications for healthcare systems. This study aims to determine the burden of periprosthetic fractures of the lower and upper limbs in England and identify any factors associated with differences in treatment and outcome.Design A national, observational study.Setting England.Participants All individuals admitted to hospital with periprosthetic fractures between 1 April 2015 and 31 December 2018.Primary and secondary outcome measures Mortality, length of stay, change in rate of admissions.Methods We analysed Hospital Episode Statistics data using the International Classification of Diseases 10th Revision code M96.6 (Fracture of bone following insertion of orthopaedic implant, joint prosthesis, or bone plate) to identify periprosthetic fractures recorded between April 2013 and December 2018. We determined the demographics, procedures performed, mortality rates and discharge destinations. Patient characteristics associated with having a procedure during the index admission were estimated using logistic regression. The annual rate of increase in admissions was estimated using Poisson regression.Results Between 1 April 2015 and 31 December 2018, there were 13 565 patients who had 18 888 admissions (89.5% emergency) with M96.6 in the primary diagnosis field. There was a 13% year-on-year increase in admissions for periprosthetic fracture in England during that period. Older people, people living in deprived areas and those with heart failure or neurological disorders were less likely to receive an operation. 14.4% of patients did not return home after hospital discharge. The overall inpatient mortality was 4.3% and total 30-day mortality was 3.3%.Conclusions The clinical and operational burden of periprosthetic fractures is considerable and increasing rapidly. We suggest that the management of people with periprosthetic fractures should be undertaken and f
McCabe R, Schmit N, Christen P, et al., 2020, Adapting hospital capacity to meet changing demands during the COVID-19 pandemic, BMC Medicine, Vol: 18, Pages: 1-12, ISSN: 1741-7015
BackgroundTo calculate hospital surge capacity, achieved via hospital provision interventions implemented for the emergency treatment of coronavirus disease 2019 (COVID-19) and other patients through March to May 2020; to evaluate the conditions for admitting patients for elective surgery under varying admission levels of COVID-19 patients.MethodsWe analysed National Health Service (NHS) datasets and literature reviews to estimate hospital care capacity before the pandemic (pre-pandemic baseline) and to quantify the impact of interventions (cancellation of elective surgery, field hospitals, use of private hospitals, deployment of former medical staff and deployment of newly qualified medical staff) for treatment of adult COVID-19 patients, focusing on general and acute (G&A) and critical care (CC) beds, staff and ventilators.ResultsNHS England would not have had sufficient capacity to treat all COVID-19 and other patients in March and April 2020 without the hospital provision interventions, which alleviated significant shortfalls in CC nurses, CC and G&A beds and CC junior doctors. All elective surgery can be conducted at normal pre-pandemic levels provided the other interventions are sustained, but only if the daily number of COVID-19 patients occupying CC beds is not greater than 1550 in the whole of England. If the other interventions are not maintained, then elective surgery can only be conducted if the number of COVID-19 patients occupying CC beds is not greater than 320. However, there is greater national capacity to treat G&A patients: without interventions, it takes almost 10,000 G&A COVID-19 patients before any G&A elective patients would be unable to be accommodated.ConclusionsUnless COVID-19 hospitalisations drop to low levels, there is a continued need to enhance critical care capacity in England with field hospitals, use of private hospitals or deployment of former and newly qualified medical staff to allow some or all elective surge
Greenfield G, Blair M, Aylin P, et al., 2020, Frequent attendances at emergency departments in England, Emergency Medicine Journal, Vol: 37, Pages: 597-599, ISSN: 1472-0205
Background: A small proportion of patients referred to as ‘frequent attenders’ account for a large proportion of hospital activity such as emergency departments (ED) attendances and admissions. There is lack of recent, national estimates of the volume of frequent ED attenders. We aimed to estimate the volume and age distribution of frequent ED attenders in English hospitals.Method: We included all attendances at all major EDs across England in the financial year 2016–2017. Patients who attended 3 times or more were classified as frequent attenders. We used a logistic regression model to predict the odds of being a frequent attender by age group.Results: 14,829,519 attendances were made by 10,062,847 patients who attended at least once. 73.5% of ED attenders attended once and accounted for 49.8% of the total ED attendances. 9.5% of ED attenders attended 3 times or more; they accounted for 27.1% of the ED attendances. While only 1.2% attended 6 times or more, their contribution was 7.6% of the total attendances. Infants and adults aged over 80 years were significantly more likely to be frequent attenders than adults aged 30-59 years (OR=2.11, 95% CI 2.09 to 2.13, OR=2.22, 95% CI 2.20 to 2.23, respectively). The likelihood of hospital admission rose steeply with the number of attendances a patient had.Conclusion: One in ten patients attending the ED are frequent attenders and account for over a quarter of attendances. Emergency care systems should consider better ways of reorganising health services to meet the needs of patients who attend EDs frequently.
Dewa L, Crandell C, Choong E, et al., 2020, CCopeY: a mixed-methods co-produced study on the mental health status and coping strategies of young people during COVID-19 UK lockdown
Ma R, Cecil E, Bottle A, et al., 2020, Impact of a pay-for-performance scheme for long-acting reversible contraceptive (LARC) advice on contraceptive uptake and abortion in British primary care: An interrupted time series study, PLoS Medicine, Vol: 17, Pages: e1003333-e1003333, ISSN: 1549-1277
BackgroundLong-acting reversible contraception (LARC) is among the most effective contraceptive methods, but uptake remains low even in high-income settings. In 2009/2010, a target-based pay-for-performance (P4P) scheme in Britain was introduced for primary care physicians (PCPs) to offer advice about LARC methods to a specified proportion of women attending for contraceptive care to improve contraceptive choice. We examined the impact and equity of this scheme on LARC uptake and abortions.Methods and findingsWe examined records of 3,281,667 women aged 13 to 54 years registered with a primary care clinic in Britain (England, Wales, and Scotland) using Clinical Practice Research Datalink (CPRD) from 2004/2005 to 2013/2014. We used interrupted time series (ITS) analysis to examine trends in annual LARC and non-LARC hormonal contraception (NLHC) uptake and abortion rates, stratified by age and deprivation groups, before and after the P4P was introduced in 2009/2010. Between 2004/2005 and 2013/2014, crude LARC uptake rates increased by 32.0% from 29.6 per 1,000 women to 39.0 per 1,000 women, compared with 18.0% decrease in NLHC uptake. LARC uptake among women of all ages increased immediately after the P4P with step change of 5.36 per 1,000 women (all values are per 1,000 women unless stated, 95% CI 5.26–5.45, p < 0.001). Women aged 20 to 24 years had the largest step change (8.40, 8.34–8.47, p < 0.001) and sustained trend increase (3.14, 3.08–3.19, p < 0.001) compared with other age groups. NLHC uptake fell in all women with a step change of −22.8 (−24.5 to −21.2, p < 0.001), largely due to fall in combined hormonal contraception (CHC; −15.0, −15.5 to −14.5, p < 0.001). Abortion rates in all women fell immediately after the P4P with a step change of −2.28 (−2.98 to −1.57, p = 0.002) and sustained decrease in trend of −0.88 (−1.12 to −0.63, p < 0.001). The largest
Ma R, Cecil E, French R, et al., 2020, Impact of financial incentives for primary care to give long acting reversible contraceptive advice, Publisher: OXFORD UNIV PRESS, ISSN: 1101-1262
Kim D, Hayhoe B, Aylin P, et al., 2020, Health service use by patients with heart failure living in a community setting: a cross-sectional analysis in North West London, British Journal of General Practice, Vol: 70, Pages: e563-e572, ISSN: 0960-1643
Background: The complex nature of heart failure (HF) management, often involving multidimensional care, is widely recognised, but overall health service utilisation by HF patients has not previously been described.Aim: To describe overall health service use by community-dwelling adults with HF.Design and Setting: Cross-sectional analysis of prevalent HF cases between 2015 and 2018 using an administrative dataset covering primary care, secondary care, and ‘other’ (community, mental health, and social care) services in North West London (NWL).Methods: Healthcare use of each service was described overall and by individual components of secondary care (e.g. outpatient appointments) and ‘other’ services (e.g. nursing contacts). Usage patterns were identified using k-means cluster analysis using all distinct contacts for the whole study period and visualised by a heatmap. Results: There were 39 301 patients with a prevalent diagnosis of HF between 1 January 2015 and 31 December 2018. 90% used health services during the study period, most commonly outpatient services, GP consultations, unplanned A&E visits and community services. Use of cardiology-specific services ranged from around 3% (cardiology-related community care) to around 20% (outpatient cardiology visits). GP consultations decreased by 11% over our study period. Five clusters of patients were identified, each with significantly different care usage patterns and patient characteristics.Conclusions: HF patients make heavy but heterogeneous use of services. Relatively low and falling use of GP consultations, and apparently low uptake of community rehabilitation services by patients with HF, is concerning and suggests challenges in primary care access and integration of care.
Arhi CS, Burns EM, Bottle A, et al., 2020, Delays in referral from primary care worsen survival for patients with colorectal cancer: a retrospective cohort study, British Journal of General Practice, Vol: 70, Pages: E463-E471, ISSN: 0960-1643
Background Delays in referral for patients with colorectal cancer may occur if the presenting symptom is falsely attributed to a benign condition.Aim To investigate whether delays in referral from primary care are associated with a later stage of cancer at diagnosis and worse prognosis.Design and setting A national retrospective cohort study in England including adult patients with colorectal cancer identified from the cancer registry with linkage to Clinical Practice Research Datalink, who had been referred following presentation to their GP with a ‘red flag’ or ‘non-specific’ symptom.Method The hazard ratios (HR) of death were calculated for delays in referral of between 2 weeks and 3 months, and >3 months, compared with referrals within 2 weeks.Results A total of 4527 (63.5%) patients with colon cancer and 2603 (36.5%) patients with rectal cancer were included in the study. The percentage of patients presenting with red-flag symptoms who experienced a delay of >3 months before referral was 16.9% of those with colon cancer and 13.5% of those with rectal cancer, compared with 35.7% of patients with colon cancer and 42.9% of patients with rectal cancer who presented with non-specific symptoms. Patients referred after 3 months with red-flag symptoms demonstrated a significantly worse prognosis than patients who were referred within 2 weeks (colon cancer: HR 1.53; 95% confidence interval [CI] = 1.29 to 1.81; rectal cancer: HR 1.30; 95% CI = 1.06 to 1.60). This association was not seen for patients presenting with non-specific symptoms. Delays in referral were associated with a significantly higher proportion of late-stage cancers.Conclusion The first presentation to the GP provides a referral opportunity to identify the underlying cancer, which, if missed, is associated with a later stage in diagnosis and worse survival.
McCabe R, Schmit N, Christen P, et al., 2020, Report 27 Adapting hospital capacity to meet changing demands during the COVID-19 pandemic
To meet the growing demand for hospital care due to the COVID-19 pandemic, England implemented a range of hospital provision interventions including the procurement of equipment, the establishment of additional hospital facilities and the redeployment of staff and other resources. Additionally, to further release capacity across England’s National Health Service (NHS), elective surgery was cancelled in March 2020, leading to a backlog of patients requiring care. This created a pressure on the NHS to reintroduce elective procedures, which urgently needs to be addressed. Population-level measures implemented in March and April 2020 reduced transmission of SARS-CoV-2, prompting a gradual decline in the demand for hospital care by COVID-19 patients after the peak in mid-April. Planning capacity to bring back routine procedures for non-COVID-19 patients whilst maintaining the ability to respond to any potential future increases in demand for COVID-19 care is the challenge currently faced by healthcare planners.In this report, we aim to calculate hospital capacity for emergency treatment of COVID-19 and other patients during the pandemic surge in April and May 2020; to evaluate the increase in capacity achieved via five interventions (cancellation of elective surgery, field hospitals, use of private hospitals, and deployment of former and newly qualified medical staff); and to determine how to re-introduce elective surgery considering continued demand from COVID-19 patients. We do this by modelling the supply of acute NHS hospital care, considering different capacity scenarios, namely capacity before the pandemic (baseline scenario) and after the implementation of capacity expansion interventions that impact available general and acute (G&A) and critical care (CC) beds, staff and ventilators. Demand for hospital care is accounted for in terms of non-COVID-19 and COVID-19 patients. Our results suggest that NHS England would not have had sufficient daily capacity
Ruzangi J, Blair M, Cecil E, et al., 2020, Trends in healthcare use in children aged less than 15 years; a population-based cohort study in England from 2007 to 2017, BMJ Open, Vol: 10, ISSN: 2044-6055
Objective To describe changing use of primary care in relation to use of urgent care and planned hospital services by children aged less than 15 years in England in the decade following major primary care reforms from 2007 to 2017Design Population-based retrospective cohort study.Methods We used linked data from the Clinical Practice Research Datalink to study children’s primary care consultations and use of hospital care including emergency department (ED) visits, emergency and elective admissions to hospital and outpatient visits to specialists.Results Between 1 April 2007 and 31 March 2017, there were 7 604 024 general practitioner (GP) consultations, 981 684 ED visits, 287 719 emergency hospital admissions, 2 253 533 outpatient visits and 194 034 elective admissions among 1 484 455 children aged less than 15 years. Age-standardised GP consultation rates fell (−1.0%/year) to 1864 per 1000 child-years in 2017 in all age bands except infants rising by 1%/year to 6722 per 1000/child-years in 2017. ED visit rates increased by 1.6%/year to 369 per 1000 child-years in 2017, with steeper rises of 3.9%/year in infants (780 per 1000 child-years in 2017). Emergency hospital admission rates rose steadily by 3%/year to 86 per 1000 child-years and outpatient visit rates rose to 724 per 1000 child-years in 2017.Conclusions Over the past decade since National Health Service primary care reforms, GP consultation rates have fallen for all children, except for infants. Children’s use of hospital urgent and outpatient care has risen in all ages, especially infants. These changes signify the need for better access and provision of specialist and community-based support for families with young children.
Askari A, Guillen LS, Millan M, et al., 2020, Colorectal tumour characteristics and oncological outcome in patients with inflammatory bowel disease, SURGICAL PRACTICE, Vol: 24, Pages: 60-68, ISSN: 1744-1625
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Bottle R, Cohen C, Lucas A, et al., 2020, How an electronic health record became a real-world research resource: comparison between London’s Whole Systems Integrated Care database and the Clinical Practice Research Datalink, BMC Medical Informatics and Decision Making, Vol: 20, ISSN: 1472-6947
BackgroundIn the UK, several initiatives have resulted in the creation of local data warehouses of electronic patient records. Originally developed for commissioning and direct patient care, they are potentially useful for research, but little is known about them outside their home area. We describe one such local warehouse, the Whole Systems Integrated Care (WSIC) database in NW London, and its potential for research as the “Discover” platform. We compare Discover with the Clinical Practice Research Datalink (CPRD), a popular UK research database also based on linked primary care records.MethodsWe describe the key features of the Discover database, including scope, architecture and governance; descriptive analyses compare the population demographics and chronic disease prevalences with those in CPRD.ResultsAs of June 2019, Discover held records for a total of 2.3 million currently registered patients, or 95% of the NW London population; CPRD held records for over 11 million. The Discover population matches the overall age-sex distribution of the UK and CPRD but is more ethnically diverse. Most Discover chronic disease prevalences were comparable to the national rates. Unlike CPRD, Discover has identifiable care organisations and postcodes, allowing mapping and linkage to healthcare provider variables such as staffing, and includes contacts with social, community and mental health care. Discover also includes a consent-to-contact register of over 3000 volunteers to date for prospective studies.ConclusionsLike CPRD, Discover has been a number of years in the making, is a valuable research tool, and can serve as a model for other areas developing similar data warehouses.
Christen P, D'Aeth J, Lochen A, et al., 2020, Report 15: Strengthening hospital capacity for the COVID-19 pandemic
Planning for extreme surges in demand for hospital care of patients requiring urgent life-saving treatment for COVID-19, and other conditions, is one of the most challenging tasks facing healthcare commissioners and care providers during the pandemic. Due to uncertainty in expected patient numbers requiring care, as well as evolving needs day by day, planning hospital capacity is challenging. Health systems that are well prepared for the pandemic can better cope with large and sudden changes in demand by implementing strategies to ensure adequate access to care. Thereby the burden of the pandemic can be mitigated, and many lives saved. This report presents the J-IDEA pandemic planner, a hospital planning tool to calculate how much capacity in terms of beds, staff and ventilators is obtained by implementing healthcare provision interventions affecting the management of patient care in hospitals. We show how to assess baseline capacity, and then calculate how much capacity is gained by various healthcare interventions using impact estimates that are generated as part of this study. Interventions are informed by a rapid review of policy decisions implemented or being considered in 12 European countries over the past few months , an evaluation of the impact of the interventions on capacity using a variety of research methods, and by a review of key parameters in the care of COVID-19 patients.The J-IDEA planner is publicly available, interactive and adaptable to different and changing circumstances and newly emerging evidence. The planner estimates the additional number of beds, medical staff and crucial medical equipment obtained under various healthcare interventions using flexible inputs on assumptions of existing capacities, the number of hospitalisations, beds-to-staff ratios, and staff absences due to COVID-19. A detailed user guide accompanies the planner. The planner was developed rapidly and has limitations which we will address in future iterations. It support
Axson E, Sundaram V, Bloom C, et al., 2020, Temporal trends in the incidence of heart failure among patients with COPD and its association with mortality, Annals of the American Thoracic Society, Vol: 17, Pages: 939-948, ISSN: 1546-3222
Rationale: Heart failure (HF) is a common comorbidity in the chronic obstructive pulmonary disease (COPD) population, but previous research has shown under recognition. Objectives: To determine the incidence of HF in a prevalent COPD cohort. To determine the association of incident HF with short- and long-term mortality of patients with COPD. Methods: Crude incidence of HF in the HF-naïve primary care COPD population was calculated for each year from 2006-2016 using UK data from the Clinical Practice Research Datalink (CPRD). Patients with COPD were identified using a validated code list and were required to be over 35 years old at COPD diagnosis, have a history of smoking, and have documented airflow obstruction. Office of National Statistics provided mortality data for England. Adjusted mortality rate ratios (aMRR) from Poisson regression were calculated for patients with COPD and incident HF (COPD-iHF) in 2006, 2011, and 2015 and compared temporally with patients with COPD and without incident HF (COPD-no HF) in those years. Regression was adjusted for age, sex, BMI, severity of airflow limitation, smoking status, history of cardiovascular disease, and diabetes. Results: We identified 95,987 HF-naïve patients with COPD. Crude incidence of HF was steady from 2006-2016 (1.18 per 100 person-years (95%CI: 1.09, 1.27)). Patients with COPD-iHF experienced greater than threefold increase in one-year mortality and twofold increase in five-year and 10-year mortality compared with patients with COPD-no HF, with no change based on year of HF diagnosis. Mortality of patients with COPD-iHF did not improve over time, comparing incident HF in 2011 (1-year aMRR 1.26, 95%CI: 0.83, 1.90; 5-year aMRR 1.26, 95%CI: 0.98, 1.61) and 2015 (1-year aMRR 1.63, 95%CI: 0.98, 2.70) with incident HF in 2006. Conclusions: The incidence of HF in the UK COPD population was stable in the last decade. Survival of patients with COPD and incident HF has not improved over time in England. Be
Knox AMAF, Bottle A, 2020, HIP REPLACEMENT OUTCOMES Understanding patient flow is necessary to determine hospital level outcomes, BMJ-BRITISH MEDICAL JOURNAL, Vol: 368, ISSN: 0959-535X
Oke SM, Rye B, Malietzis G, et al., 2020, Survival and CT defined sarcopenia in patients with intestinal failure on home parenteral support, CLINICAL NUTRITION, Vol: 39, Pages: 829-836, ISSN: 0261-5614
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Axson E, Ragutheeswaran K, Sundaram V, et al., 2020, Hospitalisation and mortality in patients with comorbid COPD and heart failure: a systematic review and meta-analysis, Respiratory Research, Vol: 21, Pages: 1-13, ISSN: 1465-9921
BackgroundDiscrepancy exists amongst studies investigating the effect of comorbid heart failure (HF) on the morbidity and mortality of chronic obstructive pulmonary disease (COPD) patients.MethodsMEDLINE and Embase were searched using a pre-specified search strategy for studies comparing hospitalisation, rehospitalisation, and mortality of COPD patients with and without HF. Studies must have reported crude and/or adjusted rate ratios, risk ratios, odds ratios (OR), or hazard ratios (HR).ResultsTwenty-eight publications, reporting 55 effect estimates, were identified that compared COPD patients with HF with those without HF. One study reported on all-cause hospitalisation (1 rate ratio). Two studies reported on COPD-related hospitalisation (1 rate ratio, 2 OR). One study reported on COPD- or cardiovascular-related hospitalisation (4 HR). One study reported on 90-day all-cause rehospitalisation (1 risk ratio). One study reported on 3-year all-cause rehospitalisation (2 HR). Four studies reported on 30-day COPD-related rehospitalisation (1 risk ratio; 5 OR). Two studies reported on 1-year COPD-related rehospitalisation (1 risk ratio; 1 HR). One study reported on 3-year COPD-related rehospitalisation (2 HR). Eighteen studies reported on all-cause mortality (1 risk ratio; 4 OR; 24 HR). Five studies reported on all-cause inpatient mortality (1 risk ratio; 4 OR). Meta-analyses of hospitalisation and rehospitalisation were not possible due to insufficient data for all individual effect measures. Meta-analysis of studies requiring spirometry for the diagnosis of COPD found that risk of all-cause mortality was 1.61 (pooled HR; 95%CI: 1.38, 1.83) higher in patients with HF than in those without HF.ConclusionsIn this systematic review, we investigated the effect of HF comorbidity on hospitalisation and mortality of COPD patients. There is substantial evidence that HF comorbidity increases COPD-related rehospitalisation and all-cause mortality of COPD patients. The effect of HF
Mula V, Parikh S, Suresh S, et al., 2020, Venous thromboembolism rates after hip and knee arthroplasty and hip fractures, BMC Musculoskeletal Disorders, Vol: 21, ISSN: 1471-2474
BackgroundThe ideal thromboprophylaxis regime following lower limb arthroplasty and proximal femur fractures remains controversial. Guidelines disagree on the type of chemical prophylaxis, its dose or duration. This article describes a method of monitoring venous thromboembolism (VTE) rates following Total Hip (THA), Total Knee Arthroplasty (TKA) and surgery for hip fractures (NOF#).MethodsOver 3 years, all patients investigated for VTE were analysed using Picture Archiving Communications System (PACS). All positive scans were then cross-referenced using PACS and local registry data to see if they had undergone THA, TKA or NOF# in the preceding 90 days. Mortality data were obtained from the national administrative database, Hospital Episode Statistics.ResultsFive thousand seven hundred eighty-eight patients underwent investigation for VTE and there were 29 diagnoses of PE and 24 of DVT. There was a 0.77% rate of symptomatic DVT after THA, 0.05% after TKA and 0.55% after NOF #. The rate of confirmed symptomatic PE for THA was 0.46, 0.27% for TKA and 0.96% for NOF #. Mortality at one-year post-THA was 0.6, 0.6% for TKA and 25.9% after NOF#. All patients contacted either remained within the catchment area for the minimum 90 postoperative days or died within the catchment area.ConclusionsThe 90 day post-operative prevalence of symptomatic VTE of 1.2, 0.3 and 1.5% in THA, TKA and NOF # respectively are similar to other studies using symptomatic and imaging positive VTE as their endpoint. The study uses a method of collecting data which can be utilised in centres where PACS is available.
Bottle A, Cowie MR, 2020, Letter in reference to "Defining a 'frequent admitter' phenotype among patients with repeat heart failure admissions", European Journal of Heart Failure, Vol: 22, Pages: 384-385, ISSN: 1388-9842
Giuliani S, Honeyford K, Chang C-Y, et al., 2020, Outcomes of Primary versus Multiple-Staged Repair in Hirschsprung's Disease in England, EUROPEAN JOURNAL OF PEDIATRIC SURGERY, Vol: 30, Pages: 104-110, ISSN: 0939-7248
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- Citations: 2
Cecil E, Bottle R, Vincent C, et al., 2020, What is the relationship between mortality alerts and other indicators of quality of care? A national cross-sectional study, Journal of Health Services Research and Policy, Vol: 25, Pages: 13-21, ISSN: 1355-8196
Objective: To assess whether mortality alerts, triggered by sustained higher than expected hospital mortality, are associated with other potential indicators of hospital quality relating to factors of hospital structure, clinical process and patient outcomes.Study Design: Cross sectional study of National Health Service hospital trusts in England (2011-2013).Data collection/extraction methods: Publicly available hospital measures chosen a-prior to reflect 1) Organisational structure (mean acute bed occupancy, nurse/bed ratios, training satisfaction and proportion of trusts with low NHS Litigation Authority risk assessment or in financial deficit), 2) Process (mean % of eligible patients who receive percutaneous coronary intervention within 90 minutes) and 3) Outcome (mean patient satisfaction scores, summary measures of hospital mortality (SHMI and HSMR) and % of patient harmed). Mortality alerts were based on hospital administrative data.Principal Findings: Mortality alerts were associated with structural indicators and outcome indicators of quality. There was insufficient data to detect an association between mortality alerts and our process indicator.Conclusion:Mortality alerts appear to reflect aspects of quality within an English hospital setting, suggesting that there may be value in a mortality alerting system in highlighting poor hospital quality.
Blackwell J, Saxena S, Jayasooriya N, et al., 2020, Prevalence and duration of gastrointestinal symptoms in the 10 years before diagnosis of inflammatory bowel disease: A national cohort study, Publisher: OXFORD UNIV PRESS, Pages: S610-S610, ISSN: 1873-9946
Axson EL, Sundaram V, Bloom CI, et al., 2020, The Effect of Unrecognised and Confirmed Heart Failure on Acute Exacerbations of Chronic Obstructive Pulmonary Disease, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Spinazze P, Rykov Y, Bottle R, et al., 2019, Digital phenotyping for assessment and prediction of mental health outcomes: A scoping review protocol, BMJ Open, Vol: 9, ISSN: 2044-6055
Introduction: Rapid advancements in technology and the ubiquity of personal mobile digital devices have brought forth innovative methods of acquiring healthcare data. Smartphones can capture vast amounts of data both passively through inbuilt sensors or connected devices and actively via user engagement. This scoping review aims to evaluate evidence to date on the use of passive digital sensing/phenotyping in assessment and prediction of mental health.Methods and analysis: The methodological framework proposed by Arksey and O’Malley will be used to conduct the review following the five-step process. A three-step search strategy will be used: 1. Initial limited search of online databases namely, MEDLINE for literature on digital phenotyping or sensing for key terms; 2. Comprehensive literature search using all identified keywords, across all relevant electronic databases: IEEE Xplore, MEDLINE, the Cochrane Database of Systematic Reviews, PubMed, the ACM Digital Library and Web of Science Core Collection (Science Citation Index Expanded and Social Sciences Citation Index), Scopus; and 3. Snowballing approach using the reference and citing lists of all identified key conceptual papers and primary studies. Data will be charted and sorted using a thematic analysis approach.Ethics and Dissemination: The findings from this systematic scoping review will be reported at scientific meetings and published in a peer-reviewed journal.
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