Publications
171 results found
Saganowski S, Misiaszek A, Bródka P, et al., 2016, TRANSFoRm eHealth solution for quality of life monitoring., AMIA Joint Summits on Translational Science proceedings AMIA Summit on Translational Science, Vol: 2016, Pages: 231-239, ISSN: 2153-4063
Patient Recorded Outcome Measures (PROMs) are an essential part of quality of life monitoring, clinical trials, improvement studies and other medical tasks. Recently, web and mobile technologies have been explored as means of improving the response rates and quality of data collected. Despite the potential benefit of this approach, there are currently no widely accepted standards for developing or implementing PROMs in CER (Comparative Effectiveness Research). Within the European Union project Transform (Translational Research and Patient Safety in Europe) an eHealth solution for quality of life monitoring has been developed and validated. This paper presents the overall architecture of the system as well as a detailed description of the mobile and web applications.
Chhaya V, Saxena S, Cecil E, et al., 2016, Steroid dependency and trends in prescribing for inflammatory bowel disease - a 20-year national population-based study., Alimentary Pharmacology and Therapeutics, Vol: 44, Pages: 482-494, ISSN: 0269-2813
BACKGROUND: It is unclear whether adherence to prescribing standards has been achieved in inflammatory bowel disease (IBD). AIM: To determine how prescribing of 5-aminosalicylates (5-ASAs), steroids and thiopurines has changed in response to emerging evidence. METHODS: We examined trends in oral and topical therapies in 23 509 incident IBD cases (6997 with Crohn's disease and 16 512 with ulcerative colitis) using a nationally representative sample between 1990 and 2010. We created five eras according to the year of diagnosis: era 1 (1990-1993), era 2 (1994-1997), era 3 (1998-2001), era 4 (2002-2005) and era 5 (2006-2010). We calculated the proportion of patients treated with prolonged 5-ASAs (>12 months) and steroid dependency, defined as prolonged steroids (>3 months) or recurrent (restarting within 3 months) steroid exposure. We calculated the cumulative probability of receiving each medication using survival analysis. RESULTS: Half of the Crohn's disease patients were prescribed prolonged oral 5-ASAs during the study, although this decreased between era 3 and 5 from 61.8% to 56.4% (P = 0.002). Thiopurine use increased from 14.0% to 47.1% (P < 0.001) between era 1 and 5. This coincided with a decrease in steroid dependency from 36.5% to 26.8% (P < 0.001) between era 1 and 2 and era 4 and 5 respectively. In ulcerative colitis, 49% of patients were maintained on prolonged oral 5-ASAs. Despite increasing thiopurine use, repeated steroid exposure increased from 15.3% to 17.8% (P = 0.02) between era 1 and 2 and era 4 and 5 respectively. CONCLUSIONS: Prescribing in clinical practice insufficiently mirrors the evidence base. Physicians should direct management towards reducing steroid dependency and optimising 5-ASA use in patients with IBD.
Liang SF, Porat T, Tapuria A, et al., 2016, MeTMapS-Medical terminology mapping system, AMIA Joint Summits in Translational Science, ISSN: 1613-0073
Motivation: Medical terminology mapping is a long-standing challenge for projects requiring retrieval, querying and integration of heterogeneous patient data. Current tools fail to fully utilise the richness of the underlying coding systems, and can be difficult to install and maintain. For example, National Library of Medicine's UMLS provides a rich collection of terminology mapping, however, its search results are displayed in a simplistic general purpose interface that cannot easily be navigated and results filtered according to user's preferences. Specifically, returned results cannot be visualised in a tree to show positions and relationships. BioPortal offers a large number of terminologies and ontologies, each of which can be viewed in a tree structure, however it does not allow for multiple ontologies to be viewed and compared on a single page. Our work aims to address these issues and provide a simple and easy to use terminology mapping software. Results: MeTMapS was evaluated with academic and clinical research users. The users have tested the mapping between ICD10, Read CTV2, V3 in Hypertension. It was also tested on a list of clinical terms from the inclusion and exclusion criteria of the INFORM clinical trial protocol. Our initial evaluation produced positive results. Availability: We are currently in the process of updating the design based on some improvements suggested by the participants. MeTMapS is developed under Apache V2 license and is currently hosted at KCL for internal use and will shortly be opened to the public once the internal security concerns are resolved. In the meantime, the tool is available from the author upon request.
Mastellos N, Bliźniuk G, Czopnik D, et al., 2015, Feasibility and acceptability of TRANSFoRm to improve clinical trial recruitment in primary care, Family Practice, ISSN: 1460-2229
Background: Recruitment of study participants is a challenging process for health professionals and patients. The TRANSFoRm clinical trial tools enable automated identification, recruitment and follow-up in clinical trials, potentially saving time, effort and costs for all parties involved. Objective(s): This study evaluates the acceptability and feasibility of TRANSFoRm to improve clinical trial recruitment in primary care. Methods: A feasibility study was conducted in three general practices in Poland. Participants were physicians and patients with Gastro-Oesophageal Reflux Disease. Semi-structured interviews were held to obtain feedback about the usefulness, ease of use and overall experience with the TRANSFoRm tools and to identify potential usability issues. Data were analysed thematically.Results: A total of five physicians and ten patients participated in the study. Physicians were satisfied with the usefulness of the system, as it enabled easier and faster identification, recruitment and follow-up of patients compared with existing methods. Patients found the TRANSFoRm apps easy to use to report patient outcomes. However, they also felt that the apps may not be useful for patients with limited exposure to smartphone and web technologies. Two main usability issues were identified: physicians could not access the result of the randomisation at the end of each visit, and participants could not locate the follow-up reminder email.Conclusions: This study provides new evidence on the acceptability and feasibility of TRANSFoRm to enable automated identification, recruitment and follow-up of study participants in primary care trials. It also helps to better understand and address users’ requirements in eHealth-supported clinical research.
Chhaya V, Pollok RCG, Cecil E, et al., 2015, Impact of early thiopurines on surgery in 2770 children and young people diagnosed with inflammatory bowel disease: a national population-based study, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 42, Pages: 990-999, ISSN: 0269-2813
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- Citations: 28
Danger R, Curcin V, Missier P, et al., 2015, Access control and view generation for provenance graphs, FUTURE GENERATION COMPUTER SYSTEMS-THE INTERNATIONAL JOURNAL OF ESCIENCE, Vol: 49, Pages: 8-27, ISSN: 0167-739X
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- Citations: 7
Delaney BC, Curcin V, Andreasson A, et al., 2015, Translational Medicine and Patient Safety in Europe: TRANSFoRm-Architecture for the Learning Health System in Europe., Biomed Research International, Vol: 2015, ISSN: 2314-6133
The Learning Health System (LHS) describes linking routine healthcare systems directly with both research translation and knowledge translation as an extension of the evidence-based medicine paradigm, taking advantage of the ubiquitous use of electronic health record (EHR) systems. TRANSFoRm is an EU FP7 project that seeks to develop an infrastructure for the LHS in European primary care. Methods. The project is based on three clinical use cases, a genotype-phenotype study in diabetes, a randomised controlled trial with gastroesophageal reflux disease, and a diagnostic decision support system for chest pain, abdominal pain, and shortness of breath. Results. Four models were developed (clinical research, clinical data, provenance, and diagnosis) that form the basis of the projects approach to interoperability. These models are maintained as ontologies with binding of terms to define precise data elements. CDISC ODM and SDM standards are extended using an archetype approach to enable a two-level model of individual data elements, representing both research content and clinical content. Separate configurations of the TRANSFoRm tools serve each use case. Conclusions. The project has been successful in using ontologies and archetypes to develop a highly flexible solution to the problem of heterogeneity of data sources presented by the LHS.
Chhaya V, Saxena S, Cecil E, et al., 2015, PTH-085 The use of 5-asa in inflammatory bowel disease: national population based study, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ Publishing Group, Pages: A444-A444, ISSN: 0017-5749
Chhaya V, Saxena S, Cecil E, et al., 2015, PTH-086 Surgery for perianal crohn’s disease: uk national population based cohort study, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ Publishing Group, Pages: A444-A445, ISSN: 0017-5749
Chhaya V, Saxena S, Cecil E, et al., 2015, Steroid Dependency in Inflammatory Bowel Disease: National Population Based Study, 46th Annual Digestive Disease Week (DDW), Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S830-S830, ISSN: 0016-5085
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- Citations: 1
Mastellos N, Andreasson A, Huckvale K, et al., 2015, A cluster randomised controlled trial evaluating the effectiveness of eHealth-supported patient recruitment in primary care research: the TRANSFoRm study protocol, Implementation Science, Vol: 10, ISSN: 1748-5908
Background Opportunistic recruitment is a highly laborious and time-consuming process that is currently performed manually, increasing the workload of already busy practitioners and resulting in many studies failing to achieve their recruitment targets. The Translational Medicine and Patient Safety in Europe (TRANSFoRm) platform enables automated recruitment, data collection and follow-up of patients, potentially improving the efficiency, time and costs of clinical research. This study aims to assess the effectiveness of TRANSFoRm in improving patient recruitment and follow-up in primary care trials.Methods/design This multi-centre, parallel-arm cluster randomised controlled trial will compare TRANSFoRm-supported with standard opportunistic recruitment. Participants will be general practitioners and patients with gastro-oesophageal reflux disease from 40 primary care centres in five European countries. Randomisation will take place at the care centre level. The intervention arm will use the TRANSFoRm tools for recruitment, baseline data collection and follow-up. The control arm will use web-based case report forms and paper self-completed questionnaires. The primary outcome will be the proportion of eligible patients successfully recruited at the end of the 16-week recruitment period. Secondary outcomes will include the proportion of recruited patients with complete baseline and follow-up data and the proportion of participants withdrawn or lost to follow-up. The study will also include an economic evaluation and measures of technology acceptance and user experience.Discussion The study should shed light on the use of eHealth to improve the effectiveness of recruitment and follow-up in primary care research and provide an evidence base for future eHealth-supported recruitment initiatives. Reporting of results is expected in October 2015.Trial registration EudraCT: 2014-001314-25
Koshy E, Watt H, Curcin V, et al., 2015, Tonsillectomy among children with low baseline acute throat infection consultation rates in UK general practices: a cohort study, BMJ Open, Vol: 5, ISSN: 2044-6055
Objective: To investigate the effectiveness oftonsillectomy in reducing acute throat infection (ATI)consultation rates over 6 years’ follow-up amongchildren with low baseline ATI consultation rates.Design: Retrospective cohort study.Setting: UK general practices from the ClinicalPractice Research Datalink.Participants: Children aged 4–15 years with ≤3 ATIconsultations during the 3 years prior to 2001(baseline). 450 children who underwent tonsillectomy(tonsillectomy group) and 13 442 other children withan ATI consultation (comparison group) in 2001.Main outcome measures: Mean differences in ATIconsultation rates over the first 3 years’ andsubsequent 3 years’ follow-up compared with 3 yearsprior to 2001 (baseline); odds of ≥3 ATI consultationsat the same time points.Results: Among children in the tonsillectomy group,the 3-year mean ATI consultation rate decreased from1.31 to 0.66 over the first 3 years’ follow-up andfurther declined to 0.60 over the subsequent 3 years’follow-up period. Compared with children who had nooperation, those who underwent tonsillectomyexperienced a reduction in 3-year mean ATIconsultations per child of 2.5 (95% CI 2.3 to 2.6,p<0.001) over the first 3 years’ follow-up, but only 1.2(95% CI 1.0 to 1.4, p<0.001) over the subsequent3 years’ follow-up compared with baseline,respectively. This equates to a mean reduction of 3.7ATI consultations over a 6-year period andapproximates to a mean annual reduction of 0.6 ATIconsultations per child, per year, over 6 years’ followup.Children who underwent tonsillectomy were alsomuch less likely to experience ≥3 ATI consultationsduring the first 3 years’ follow-up (adjusted OR=0.12,95% CI 0.08 to 0.17) and the subsequent 3 years’follow-up (adjusted OR=0.24, 95% CI 0.14 to 0.41).Conclusions: Among children with low baseline ATIrates, there was a statistically significant reduction inATI consultation rates over 6 years’ foll
Chhaya V, Saxena S, Cecil E, et al., 2015, Impact of Timing and Duration of Thiopurine Treatment on First Perianal Surgery in Crohn's Disease: UK Population-based Study (1995-2009), INFLAMMATORY BOWEL DISEASES, Vol: 21, Pages: 385-391, ISSN: 1078-0998
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- Citations: 12
Chhaya V, Saxena S, Cecil E, et al., 2015, Prolonged and repeated steroid exposure in inflammatory bowel disease: National population based study, JOURNAL OF CROHNS & COLITIS, Vol: 9, Pages: S269-S269, ISSN: 1873-9946
Chhaya V, Pollok R, Cecil E, et al., 2015, Early thiopurine use is associated with a reduced risk of surgery in children and young people with Crohn's disease but not in ulcerative colitis, JOURNAL OF CROHNS & COLITIS, Vol: 9, Pages: S52-S53, ISSN: 1873-9946
Chhaya V, Saxena S, Cecil E, et al., 2015, The impact of timing and duration of thiopurine treatment on colectomy in ulcerative colitis: a national population-based study of incident cases between 1989-2009, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 41, Pages: 87-98, ISSN: 0269-2813
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- Citations: 34
Keung SNLC, Zhao L, Arvanitis TN, et al., 2015, TRANSFoRm: Implementing a Learning Healthcare System in Europe through Embedding Clinical Research into Clinical Practice, 48th Annual Hawaii International Conference on System Sciences (HICSS), Publisher: IEEE COMPUTER SOC, Pages: 3176-3185, ISSN: 1060-3425
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- Citations: 3
Missier P, Bryans J, Gamble C, et al., 2015, <i>ProvAbs</i>: Model, Policy, and Tooling for Abstracting PROV Graphs, 5th International Provenance and Annotation Workshop (IPAW), Publisher: SPRINGER-VERLAG BERLIN, Pages: 3-15, ISSN: 0302-9743
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- Citations: 4
Danger R, Corrigan D, Soler JK, et al., 2015, A methodology for mining clinical data: experiences from TRANSFoRm project, DIGITAL HEALTHCARE EMPOWERING EUROPEANS, Vol: 210, Pages: 85-89, ISSN: 0926-9630
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- Citations: 1
Ethier J-F, Curcin V, Barton A, et al., 2015, Clinical Data Integration Model Core Interoperability Ontology for Research Using Primary Care Data, METHODS OF INFORMATION IN MEDICINE, Vol: 54, Pages: 16-23, ISSN: 0026-1270
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- Citations: 24
Chhaya V, Saxena S, Cecil E, et al., 2014, HAVE PERIANAL SURGERY RATES DECREASED WITH THE RISE IN THIOPURINE USE IN CROHN'S DISEASE?, GUT, Vol: 63, Pages: A176-A176, ISSN: 0017-5749
Chhaya V, Saxena S, Cecil E, et al., 2014, PREDICTORS OF COLECTOMY AND THE IMPACT OF THIOPURINES ON THE RISK OF COLECTOMY IN ULCERATIVE COLITIS - A NATIONAL UK BASED OBSERVATIONAL STUDY, GUT, Vol: 63, Pages: A176-A177, ISSN: 0017-5749
Curcin V, Woodcock T, Poots A, et al., 2014, Model-driven approach to data collection and reporting for quality improvement, Journal of Biomedical Informatics, Vol: 52, Pages: 151-162, ISSN: 1532-0480
Continuous data collection and analysis have been shown essential to achieving improvement in healthcare. However, the data required for local improvement initiatives are often not readily available from hospital Electronic Health Record (EHR) systems or not routinely collected. Furthermore, improvement teams are often restricted in time and funding thus requiring inexpensive and rapid tools to support their work. Hence, the informatics challenge in healthcare local improvement initiatives consists of providing a mechanism for rapid modelling of the local domain by non-informatics experts, including performance metric definitions, and grounded in established improvement techniques. We investigate the feasibility of a model-driven software approach to address this challenge, whereby an improvement data model designed by a team is used to automatically generate required electronic data collection instruments and reporting tools. To that goal, we have designed a generic Improvement Data Model (IDM) to capture the data items and quality measures relevant to the project, and constructed Web Improvement Support in Healthcare (WISH), a prototype tool that takes user-generated IDM models and creates a data schema, data collection web interfaces, and a set of live reports, based on Statistical Process Control (SPC) for use by improvement teams. The software has been successfully used in over 50 improvement projects, with more than 700 users. We present in detail the experiences of one of those initiatives, Chronic Obstructive Pulmonary Disease project in Northwest London hospitals. The specific challenges of improvement in healthcare are analysed and the benefits and limitations of the approach are discussed.
Curcin V, Miles S, Danger R, et al., 2014, Implementing interoperable provenance in biomedical research, FUTURE GENERATION COMPUTER SYSTEMS-THE INTERNATIONAL JOURNAL OF ESCIENCE, Vol: 34, Pages: 1-16, ISSN: 0167-739X
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- Citations: 21
Lim Choi Keung SN, Zhao L, Rossiter J, et al., 2014, Detailed clinical modelling approach to data extraction from heterogeneous data sources for clinical research., AMIA Joint Summits on Translational Science proceedings AMIA Summit on Translational Science, Vol: 2014, Pages: 55-59, ISSN: 2153-4063
The reuse of routinely collected clinical data for clinical research is being explored as part of the drive to reduce duplicate data entry and to start making full use of the big data potential in the healthcare domain. Clinical researchers often need to extract data from patient registries and other patient record datasets for data analysis as part of clinical studies. In the TRANSFoRm project, researchers define their study requirements via a Query Formulation Workbench. We use a standardised approach to data extraction to retrieve relevant information from heterogeneous data sources, using semantic interoperability enabled via detailed clinical modelling. This approach is used for data extraction from data sources for analysis and for pre-population of electronic Case Report Forms from electronic health records in primary care clinical systems.
Thomas G, Khunti K, Curcin V, et al., 2014, Obesity paradox in people newly diagnosed with type 2 diabetes with and without prior cardiovascular disease, DIABETES OBESITY & METABOLISM, Vol: 16, Pages: 317-325, ISSN: 1462-8902
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- Citations: 39
Vamos EP, Pape UJ, Curcin V, et al., 2014, Influenza vaccine effectiveness against hospitalisation and death in people with Type 2 diabetes, Publisher: WILEY-BLACKWELL, Pages: 74-75, ISSN: 0742-3071
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- Citations: 1
Chatu S, Saxena S, Subramanian V, et al., 2014, The Impact of Timing and Duration of Thiopurine Treatment on First Intestinal Resection in Crohn's Disease: National UK Population-Based Study 1989-2010, AMERICAN JOURNAL OF GASTROENTEROLOGY, Vol: 109, Pages: 409-416, ISSN: 0002-9270
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- Citations: 54
Koshy E, Curcin V, Bottle A, et al., 2013, Re: Sore throat consultations in general practice prior to tonsillectomy among eight hundred and sixty-three children in England: is this in accordance with the SIGN guidelines? Response, CLINICAL OTOLARYNGOLOGY, Vol: 38, Pages: 560-560, ISSN: 1749-4478
Koshy E, Curcin V, Bottle A, et al., 2013, Sore throat consultations in general practice prior to tonsillectomy among eight hundred and sixty-three children in England: is this in accordance with the SIGN guidelines?, CLINICAL OTOLARYNGOLOGY, Vol: 38, Pages: 266-270, ISSN: 1749-4478
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- Citations: 4
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