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Thomson-Anderson A, Fawcett N, Naseer S, Kumar A, Onen B, Nolte H, Bone R, Bowen J, Gamble J. A tertiary care ambulatory heart failure pathway managing one-third of all admissions including older patients with similar quality to inpatient management. Clin Med (Lond) 2022; 22 Suppl 4:59-60. [PMID: 38614594 PMCID: PMC9600823 DOI: 10.7861/clinmed.22-4-s59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Onen B, Fawcett N, Daniel S, Samm E, Lasserson D, Bowen J, Singh S. Service evaluation of the impact of direct ambulance calls from paramedics to the ambulatory assessment unit in the John Radcliffe hospital, Oxford. Future Healthc J 2022; 9:14-15. [PMID: 36310957 PMCID: PMC9601023 DOI: 10.7861/fhj.9-2-s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Barbara Onen
- AOxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nicola Fawcett
- AOxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephen Daniel
- BSouth Central Ambulance Service NHS Foundation Trust, Bicester, UK
| | - Edward Samm
- AOxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Jordan Bowen
- AOxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sudhir Singh
- AOxford University Hospitals NHS Foundation Trust, Oxford, UK
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Pritchard E, Fawcett N, Quan TP, Crook D, Peto TE, Walker AS. Combining Charlson and Elixhauser scores with varying lookback predicated mortality better than using individual scores. J Clin Epidemiol 2020; 130:32-41. [PMID: 33002637 DOI: 10.1016/j.jclinepi.2020.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/02/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate variation in the presence of secondary diagnosis codes in Charlson and Elixhauser comorbidity scores and assess whether including a 1-year lookback period improved prognostic adjustment by these scores individually, and combined, for 30-day mortality. STUDY DESIGN AND SETTING We analyzed inpatient admissions from January 1, 2007 to May 18, 2018 in Oxfordshire, UK. Comorbidity scores were calculated using secondary diagnostic codes in the diagnostic-dominant episode, and primary and secondary codes from the year before. Associations between scores and 30-day mortality were investigated using Cox models with natural cubic splines for nonlinearity, assessing fit using Akaike Information Criteria. RESULTS The 1-year lookback improved model fit for Charlson and Elixhauser scores vs. using diagnostic-dominant methods. Including both, and allowing nonlinearity, improved model fit further. The diagnosis-dominant Charlson score and Elixhauser score using a 1-year lookback, and their interaction, provided the best comorbidity adjustment (reduction in AIC: 761 from best single score model). CONCLUSION The Charlson and Elixhauser score calculated using primary and secondary diagnostic codes from 1-year lookback with secondary diagnostic codes from the current episode improved individual predictive ability. Ideally, comorbidities should be adjusted for using both the Charlson (diagnostic-dominant) and Elixhauser (1-year lookback) scores, incorporating nonlinearity and interactions for optimal confounding control.
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Affiliation(s)
- Emma Pritchard
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Nicola Fawcett
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK; Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK
| | - T Phuong Quan
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK; National Institute for Health Research Biomedical Research Centre, Oxford, UK
| | - Derrick Crook
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK; National Institute for Health Research Biomedical Research Centre, Oxford, UK
| | - Tim Ea Peto
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK; National Institute for Health Research Biomedical Research Centre, Oxford, UK
| | - A Sarah Walker
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK; National Institute for Health Research Biomedical Research Centre, Oxford, UK
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Quan TP, Muller-Pebody B, Fawcett N, Young BC, Minaji M, Sandoe J, Hopkins S, Crook D, Peto T, Johnson AP, Walker AS. Investigation of the impact of the NICE guidelines regarding antibiotic prophylaxis during invasive dental procedures on the incidence of infective endocarditis in England: an electronic health records study. BMC Med 2020; 18:84. [PMID: 32238164 PMCID: PMC7114779 DOI: 10.1186/s12916-020-01531-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Infective endocarditis is an uncommon but serious infection, where evidence for giving antibiotic prophylaxis before invasive dental procedures is inconclusive. In England, antibiotic prophylaxis was offered routinely to patients at risk of infective endocarditis until March 2008, when new guidelines aimed at reducing unnecessary antibiotic use were issued. We investigated whether changes in infective endocarditis incidence could be detected using electronic health records, assessing the impact of inclusion criteria/statistical model choice on inferences about the timing/type of any change. METHODS Using national data from Hospital Episode Statistics covering 1998-2017, we modelled trends in infective endocarditis incidence using three different sets of inclusion criteria plus a range of regression models, identifying the most likely date for a change in trends if evidence for one existed. We also modelled trends in the proportions of different organism groups identified during infection episodes, using secondary diagnosis codes and data from national laboratory records. Lastly, we applied non-parametric local smoothing to visually inspect any changes in trend around the guideline change date. RESULTS Infective endocarditis incidence increased markedly over the study (22.2-41.3 per million population in 1998 to 42.0-67.7 in 2017 depending on inclusion criteria). The most likely dates for a change in incidence trends ranged from September 2001 (uncertainty interval August 2000-May 2003) to May 2015 (March 1999-January 2016), depending on inclusion criteria and statistical model used. For the proportion of infective endocarditis cases associated with streptococci, the most likely change points ranged from October 2008 (March 2006-April 2010) to August 2015 (September 2013-November 2015), with those associated with oral streptococci decreasing in proportion after the change point. Smoothed trends showed no notable changes in trend around the guideline date. CONCLUSIONS Infective endocarditis incidence has increased rapidly in England, though we did not detect any change in trends directly following the updated guidelines for antibiotic prophylaxis, either overall or in cases associated with oral streptococci. Estimates of when changes occurred were sensitive to inclusion criteria and statistical model choice, demonstrating the need for caution in interpreting single models when using large datasets. More research is needed to explore the factors behind this increase.
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Affiliation(s)
- T Phuong Quan
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Microbiology Level 7, Headley Way, Oxford, OX3 9DU, UK. .,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK. .,NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK.
| | | | - Nicola Fawcett
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Microbiology Level 7, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Bernadette C Young
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Mehdi Minaji
- National Infection Service, Public Health England, Colindale, London, UK
| | - Jonathan Sandoe
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, LS1 3EX, UK
| | - Susan Hopkins
- National Infection Service, Public Health England, Colindale, London, UK
| | - Derrick Crook
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Microbiology Level 7, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Timothy Peto
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Microbiology Level 7, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Alan P Johnson
- National Infection Service, Public Health England, Colindale, London, UK
| | - A Sarah Walker
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Microbiology Level 7, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK
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Mawer D, Byrne F, Drake S, Brown C, Prescott A, Warne B, Bousfield R, Skittrall JP, Ramsay I, Somasunderam D, Bevan M, Coslett J, Rao J, Stanley P, Kennedy A, Dobson R, Long S, Obisanya T, Esmailji T, Petridou C, Saeed K, Brechany K, Davis-Blue K, O'Horan H, Wake B, Martin J, Featherstone J, Hall C, Allen J, Johnson G, Hornigold C, Amir N, Henderson K, McClements C, Liew I, Deshpande A, Vink E, Trigg D, Guilfoyle J, Scarborough M, Scarborough C, Wong THN, Walker T, Fawcett N, Morris G, Tomlin K, Grix C, O'Cofaigh E, McCaffrey D, Cooper M, Corbett K, French K, Harper S, Hayward C, Reid M, Whatley V, Winfield J, Hoque S, Kelly L, King I, Bradley A, McCullagh B, Hibberd C, Merron M, McCabe C, Horridge S, Taylor J, Koo S, Elsanousi F, Saunders R, Lim F, Bond A, Stone S, Milligan ID, Mack DJF, Nagar A, West RM, Wilcox MH, Kirby A, Sandoe JAT. Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea. J Hosp Infect 2019; 103:200-209. [PMID: 31077777 DOI: 10.1016/j.jhin.2019.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 05/01/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking. AIM To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards. METHODS A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively. FINDINGS Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset. CONCLUSION HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.
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Affiliation(s)
- D Mawer
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK.
| | - F Byrne
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - S Drake
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - C Brown
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - A Prescott
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - B Warne
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - R Bousfield
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - J P Skittrall
- Royal Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK
| | - I Ramsay
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - D Somasunderam
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - M Bevan
- Department of Infection Prevention, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - J Coslett
- Department of Infection Prevention, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - J Rao
- Department of Microbiology, Barnsley Hospital NHS Foundation Trust, Barnsley, S75 2EP, UK
| | - P Stanley
- Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - A Kennedy
- Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - R Dobson
- Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - S Long
- Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
| | - T Obisanya
- Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
| | - T Esmailji
- Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
| | - C Petridou
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - K Saeed
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - K Brechany
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - K Davis-Blue
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - H O'Horan
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - B Wake
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - J Martin
- Department of Microbiology, Harrogate and District NHS Foundation Trust, Harrogate, HG2 7SX, UK
| | - J Featherstone
- Department of Microbiology, Harrogate and District NHS Foundation Trust, Harrogate, HG2 7SX, UK
| | - C Hall
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - J Allen
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - G Johnson
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - C Hornigold
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - N Amir
- Department of Microbiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4DG, UK
| | - K Henderson
- Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - C McClements
- Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - I Liew
- Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - A Deshpande
- Department of Microbiology, Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - E Vink
- Department of Microbiology, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - D Trigg
- Department of Infection Prevention & Control, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - J Guilfoyle
- Department of Infection Prevention & Control, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - M Scarborough
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - C Scarborough
- Nuffield Department of Medicine, University of Oxford, OX3 7FZ, UK
| | - T H N Wong
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - T Walker
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - N Fawcett
- Department of Medicine, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - G Morris
- Department of Microbiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - K Tomlin
- Department of Infection Prevention & Control, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - C Grix
- Department of Infection Prevention & Control, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - E O'Cofaigh
- Department of Medicine, Friarage Hospital, South Tees Hospital NHS Foundation Trust, Northallerton, DL6 1JG, UK
| | - D McCaffrey
- Department of Infection Prevention & Control, James Cook University Hospital, South Tees Hospital NHS Foundation Trust, Middlesborough, TS4 3BW, UK
| | - M Cooper
- Department of Microbiology, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - K Corbett
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - K French
- Department of Microbiology, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - S Harper
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - C Hayward
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - M Reid
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - V Whatley
- Corporate Support Services, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - J Winfield
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - S Hoque
- Department of Microbiology, Torbay and South Devon Healthcare NHS Foundation Trust, Torquay, TQ2 7AA, UK
| | - L Kelly
- Department of Infection Prevention & Control, Torbay and South Devon Healthcare NHS Foundation Trust, Torquay, TQ2 7AA, UK
| | - I King
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - A Bradley
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - B McCullagh
- Pharmacy Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - C Hibberd
- Pharmacy Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - M Merron
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - C McCabe
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - S Horridge
- Department of Microbiology, University Hospital Coventry, University Hospitals of Coventry and Warwickshire, Warwick, CV2 2DX, UK
| | - J Taylor
- Department of Virology and Molecular Pathology, University Hospital Coventry, University Hospitals of Coventry and Warwickshire, Warwick, CV2 2DX, UK
| | - S Koo
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - F Elsanousi
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - R Saunders
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - F Lim
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - A Bond
- Department of Microbiology, York Teaching Hospital NHS Foundation Trust, York, YO31 8HE, UK
| | - S Stone
- Royal Free Campus, University College Medical School, London, NW3 2QG, UK
| | - I D Milligan
- Department of Microbiology, Royal Free Hospital, University College London Hospitals NHS Foundation Trust, London, NW3 2QG, UK
| | - D J F Mack
- Department of Microbiology, Royal Free Hospital, University College London Hospitals NHS Foundation Trust, London, NW3 2QG, UK
| | - A Nagar
- Department of Microbiology, Antrim Area Hospital, Northern Health and Social Care Trust, Bush Road, Antrim, BT41 2RL, UK
| | - R M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - M H Wilcox
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - A Kirby
- Leeds Institute of Medical Research, University of Leeds, Leeds, LS2 9JT, UK
| | - J A T Sandoe
- Leeds Institute of Medical Research, University of Leeds, Leeds, LS2 9JT, UK
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6
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Fawcett N, Young B, Peto L, Quan TP, Gillott R, Wu J, Middlemass C, Weston S, Crook DW, Peto TEA, Muller-Pebody B, Johnson AP, Walker AS, Sandoe JAT. 'Caveat emptor': the cautionary tale of endocarditis and the potential pitfalls of clinical coding data-an electronic health records study. BMC Med 2019; 17:169. [PMID: 31481119 PMCID: PMC6724235 DOI: 10.1186/s12916-019-1390-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diagnostic codes from electronic health records are widely used to assess patterns of disease. Infective endocarditis is an uncommon but serious infection, with objective diagnostic criteria. Electronic health records have been used to explore the impact of changing guidance on antibiotic prophylaxis for dental procedures on incidence, but limited data on the accuracy of the diagnostic codes exists. Endocarditis was used as a clinically relevant case study to investigate the relationship between clinical cases and diagnostic codes, to understand discrepancies and to improve design of future studies. METHODS Electronic health record data from two UK tertiary care centres were linked with data from a prospectively collected clinical endocarditis service database (Leeds Teaching Hospital) or retrospective clinical audit and microbiology laboratory blood culture results (Oxford University Hospitals Trust). The relationship between diagnostic codes for endocarditis and confirmed clinical cases according to the objective Duke criteria was assessed, and impact on estimations of disease incidence and trends. RESULTS In Leeds 2006-2016, 738/1681(44%) admissions containing any endocarditis code represented a definite/possible case, whilst 263/1001(24%) definite/possible endocarditis cases had no endocarditis code assigned. In Oxford 2010-2016, 307/552(56%) reviewed endocarditis-coded admissions represented a clinical case. Diagnostic codes used by most endocarditis studies had good positive predictive value (PPV) but low sensitivity (e.g. I33-primary 82% and 43% respectively); one (I38-secondary) had PPV under 6%. Estimating endocarditis incidence using raw admission data overestimated incidence trends twofold. Removing records with non-specific codes, very short stays and readmissions improved predictive ability. Estimating incidence of streptococcal endocarditis using secondary codes also overestimated increases in incidence over time. Reasons for discrepancies included changes in coding behaviour over time, and coding guidance allowing assignment of a code mentioning 'endocarditis' where endocarditis was never mentioned in the clinical notes. CONCLUSIONS Commonly used diagnostic codes in studies of endocarditis had good predictive ability. Other apparently plausible codes were poorly predictive. Use of diagnostic codes without examining sensitivity and predictive ability can give inaccurate estimations of incidence and trends. Similar considerations may apply to other diseases. Health record studies require validation of diagnostic codes and careful data curation to minimise risk of serious errors.
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Affiliation(s)
- Nicola Fawcett
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK. .,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK. .,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK. .,Microbiology Level 7, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
| | - Bernadette Young
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Leon Peto
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - T Phuong Quan
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK
| | - Richard Gillott
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, LS1 3EX, UK
| | - Jianhua Wu
- School of Dentistry, University of Leeds, Leeds, LS2 9LU, UK
| | - Chris Middlemass
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Sheila Weston
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Derrick W Crook
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK
| | - Tim E A Peto
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK
| | | | - Alan P Johnson
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,National Infection Service, Public Health England, Colindale, London, UK
| | - A Sarah Walker
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK
| | - Jonathan A T Sandoe
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, LS1 3EX, UK
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Abstract
BACKGROUND Medical students are not sufficiently knowledgeable about the dangers of online social media, and education about how to use it responsibly may be beneficial. METHODS We conducted an online questionnaire to assess whether or not medical students in years 2-6 of study at the University of Oxford would intuitively know what doctors should and should not do on social media. We also assessed whether the study intervention of sending out guidance about appropriate use of social media published by the UK General Medical Council (GMC) would improve students' knowledge of how to use social media correctly. RESULTS We found that, although social media use was widespread among medical students, the majority were unaware of GMC guidance on this issue. Administration of GMC guidance significantly improved the proportion of GMC-correct responses in four of 16 questionnaire items. Medical students are not sufficiently knowledgeable about the dangers of online social media DISCUSSION It is possible that educating medical students about the dangers of online social media, and how to use it appropriately, could be worthwhile.
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Affiliation(s)
- James Kang
- Green Templeton College, University of Oxford, UK
| | | | - Prabir Patel
- Oxford University Hospitals, NHS Trust, Oxford, UK
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8
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Bain BJ, Fawcett N. A T-lineage neoplasm-Which one? Am J Hematol 2009; 84:678. [PMID: 19373891 DOI: 10.1002/ajh.21403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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9
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Abstract
Administered Zabin and Melamed's (1980) Child Development Questionnaire in their native languages to 20 Haitian, 20 Hispanic, 20 black American, and 20 white American mothers in a public hospital setting to inquire how they dealt with their children in various fearful situations. The white Americans were significantly more likely than black Americans or Haitians to report use of modeling and reassurance, whereas Haitians were less likely than the other groups to report use of these methods. Conversely, the Haitians were more likely than some of the other groups to report use of force in these situations. There were no significant differences in the groups' reported use of positive reinforcement or in reinforcement of dependency once two culturally inappropriate items were removed. The reported differences, especially those involving Haitians, were interpreted as reflecting historical and cultural trends.
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10
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Gonzalez JC, Routh DK, Saab PG, Armstrong FD, Shifman L, Guerra E, Fawcett N. Effects of parent presence on children's reactions to injections: behavioral, physiological, and subjective aspects. J Pediatr Psychol 1989; 14:449-62. [PMID: 2795401 DOI: 10.1093/jpepsy/14.3.449] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Observed 47 children ranging in age from 13 months to 7 years 9 months receiving injections as part of a regular visit to a pediatric clinic. Twenty-three children were randomly assigned to a condition with parent (mainly mothers) present and 24 to a condition with parent absent. During the medical procedure, the child's reactions were observed via videotape (for later behavioral coding) and physiological recording (to measure heart rates). Following the injection, data were collected on the child's preference of condition (either parent present or parent absent) for future injections. Older children (but not younger ones) showed significantly more behavioral distress when the parent was present. However, the oldest children's preference of condition for future injections was overwhelmingly that of parent present (86%).
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Shifman L, Scott CS, Fawcett N, Orr L. Utilizing a game for both needs assessment and learning in adolescent sexuality education. Soc Work Groups 1986; 9:41-56. [PMID: 12284188 DOI: 10.1300/j009v09n02_04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Roth W, Penneys NS, Fawcett N. Hereditary painful callosities. Arch Dermatol 1978; 114:591-2. [PMID: 646376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
An autosomal dominant genodermatosis that is characterized by painful callosities develops over pressure points. Histologically, these lesions are similar to epidermal nevi.
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13
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Nyhan WL, Fawcett N, Ando T, Rennert OM, Julius RL. Response to dietary therapy in B 12 unresponsive methylmalonic acidemia. Pediatrics 1973; 51:539-48. [PMID: 4707869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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14
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Goldberg DM, Sale JK, Fawcett N, Wormsley KG. Trypsin and chymotrypsin as aids in the diagnosis of pancreatic disease. Am J Dig Dis 1972; 17:780-92. [PMID: 5056859 DOI: 10.1007/bf02231147] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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15
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Bakay B, Nyhan WL, Fawcett N, Kogut MD. Isoenzymes of hypoxanthine-guanine-phosphoribosyl transferase in a family with partial deficiency of the enzyme. Biochem Genet 1972; 7:73-85. [PMID: 5041886 DOI: 10.1007/bf00487011] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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