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Grigoroglou C, Walshe K, Kontopantelis E, Ferguson J, Stringer G, Ashcroft DM, Allen T. Comparing the clinical practice and prescribing safety of locum and permanent doctors: observational study of primary care consultations in England. BMC Med 2024; 22:126. [PMID: 38532468 DOI: 10.1186/s12916-024-03332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/29/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Temporary doctors, known as locums, are a key component of the medical workforce in the NHS but evidence on differences in quality and safety between locum and permanent doctors is limited. We aimed to examine differences in the clinical practice, and prescribing safety for locum and permanent doctors working in primary care in England. METHODS We accessed electronic health care records (EHRs) for 3.5 million patients from the CPRD GOLD database with linkage to Hospital Episode Statistics from 1st April 2010 to 31st March 2022. We used multi-level mixed effects logistic regression to compare consultations with locum and permanent GPs for several patient outcomes including general practice revisits; prescribing of antibiotics; strong opioids; hypnotics; A&E visits; emergency hospital admissions; admissions for ambulatory care sensitive conditions; test ordering; referrals; and prescribing safety indicators while controlling for patient and practice characteristics. RESULTS Consultations with locum GPs were 22% more likely to involve a prescription for an antibiotic (OR = 1.22 (1.21 to 1.22)), 8% more likely to involve a prescription for a strong opioid (OR = 1.08 (1.06 to 1.09)), 4% more likely to be followed by an A&E visit on the same day (OR = 1.04 (1.01 to 1.08)) and 5% more likely to be followed by an A&E visit within 1 to 7 days (OR = 1.05 (1.02 to 1.08)). Consultations with a locum were 12% less likely to lead to a practice revisit within 7 days (OR = 0.88 (0.87 to 0.88)), 4% less likely to involve a prescription for a hypnotic (OR = 0.96 (0.94 to 0.98)), 15% less likely to involve a referral (OR = 0.85 (0.84 to 0.86)) and 19% less likely to involve a test (OR = 0.81 (0.80 to 0.82)). We found no evidence that emergency admissions, ACSC admissions and eight out of the eleven prescribing safety indicators were different if patients were seen by a locum or a permanent GP. CONCLUSIONS Despite existing concerns, the clinical practice and performance of locum GPs did not appear to be systematically different from that of permanent GPs. The practice and performance of both locum and permanent GPs is likely shaped by the organisational setting and systems within which they work.
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Affiliation(s)
- Christos Grigoroglou
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK.
| | - Kieran Walshe
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Jane Ferguson
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Gemma Stringer
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
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Moore D, Nyakutsikwa B, Allen T, Lam E, Birch S, Tickle M, Pretty IA, Walsh T. How effective and cost-effective is water fluoridation for adults and adolescents? The LOTUS 10-year retrospective cohort study. Community Dent Oral Epidemiol 2024. [PMID: 38191778 DOI: 10.1111/cdoe.12930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/10/2023] [Accepted: 11/19/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To pragmatically assess the clinical and cost-effectiveness of water fluoridation for preventing dental treatment and improving oral health in a contemporary population of adults and adolescents, using a natural experiment design. METHODS A 10-year retrospective cohort study (2010-2020) using routinely collected NHS dental treatment claims data. Participants were patients aged 12 years and over, attending NHS primary dental care services in England (17.8 million patients). Using recorded residential locations, individuals exposed to drinking water with an optimal fluoride concentration (≥0.7 mg F/L) were matched to non-exposed individuals using propensity scores. Number of NHS invasive dental treatments, DMFT and missing teeth were compared between groups using negative binomial regression. Total NHS dental treatment costs and cost per invasive dental treatment avoided were calculated. RESULTS Matching resulted in an analytical sample of 6.4 million patients. Predicted mean number of invasive NHS dental treatments (restorations 'fillings'/extractions) was 3% lower in the optimally fluoridated group (5.4) than the non-optimally fluoridated group (5.6) (IRR 0.969, 95% CI 0.967, 0.971). Predicted mean DMFT was 2% lower in the optimally fluoridated group (IRR 0.984, 95% CI 0.983, 0.985). There was no difference in the predicted mean number of missing teeth per person (IRR 1.001, 95% CI 0.999, 1.003) and no compelling evidence that water fluoridation reduced social inequalities in dental health. Optimal water fluoridation in England 2010-2020 was estimated to cost £10.30 per person (excludes initial set-up costs). NHS dental treatment costs for optimally fluoridated patients 2010-2020 were 5.5% lower, by £22.26 per person (95% CI -£21.43, -£23.09). CONCLUSIONS Receipt of optimal water fluoridation 2010-2020 resulted in very small positive health effects which may not be meaningful for individuals. Existing fluoridation programmes in England produced a positive return on investment between 2010 and 2020 due to slightly lower NHS dental care utilization. This return should be evaluated against the projected costs and lifespan of any proposed capital investment in water fluoridation, including new programmes.
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Affiliation(s)
- Deborah Moore
- Faculty of Biology, Medicine and Health, Division of Dentistry, The University of Manchester, Manchester, UK
| | - Blessing Nyakutsikwa
- Faculty of Biology, Medicine and Health, Division of Dentistry, The University of Manchester, Manchester, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | | | - Stephen Birch
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Martin Tickle
- Faculty of Biology, Medicine and Health, Division of Dentistry, The University of Manchester, Manchester, UK
| | - Iain A Pretty
- Faculty of Biology, Medicine and Health, Division of Dentistry, The University of Manchester, Manchester, UK
| | - Tanya Walsh
- Faculty of Biology, Medicine and Health, Division of Dentistry, The University of Manchester, Manchester, UK
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Stringer G, Ferguson J, Walshe K, Grigoroglou C, Allen T, Kontopantelis E, Ashcroft DM. Locum doctors in English general practices: evidence from a national survey. Br J Gen Pract 2023; 73:e667-e676. [PMID: 37604697 PMCID: PMC10471140 DOI: 10.3399/bjgp.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/16/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Locum doctors give practices flexibility to deliver patient services but there are concerns about the impact of locum working on continuity of care, patient safety, team function, and cost. AIM To explore locum working in English general practices, and understand why and where locum doctors were needed and how they were engaged, supported, perceived, and managed. DESIGN AND SETTING An online survey was sent to 3745 practices. METHOD Quantitative responses were analysed using frequency tables, t-tests, and correlations. Free-text responses were analysed using thematic analysis. RESULTS In total, 605 (16.2%) responses were returned between June and December 2021. Practices made frequent use of locums, preferring regular locums familiar with processes and patients. Disadvantages of agency locums included cost, lack of patient familiarity, and impact on continuity of care. Care provided by locums was generally viewed as the same but sometimes worse compared with permanent GPs. Some practices reported that locums did not always perform the full range of duties, resulting in increased workload for other staff. Practices were largely unfamiliar with national guidance for organisations engaging locums, and, although processes such as verifying documentation were conducted, far fewer responders reported providing feedback, support for revalidation, or professional development. CONCLUSION Locum working is an essential part of English general practice, but this research raises some concerns about the robustness of arrangements for locum working and the impact on quality and safety of care. Further research is needed about the clinical practice and performance of locums, and to explore how locum working can be organised in ways that assure safe and high-quality care.
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Affiliation(s)
- Gemma Stringer
- Alliance Manchester Business School, Institute for Health Policy and Organisation, University of Manchester, Manchester, UK
| | - Jane Ferguson
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Kieran Walshe
- Alliance Manchester Business School, Institute for Health Policy and Organisation, University of Manchester, Manchester, UK
| | - Christos Grigoroglou
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK; Danish Centre for Health Economics, University of Southern Denmark, Denmark
| | - Evangelos Kontopantelis
- National Institute for Health and Care Research School for Primary Care Research, Centre for Primary Care and Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
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Stringer G, Ferguson J, Walshe K, Grigoroglou C, Allen T, Kontopantelis E, Ashcroft DM. The use of locum doctors in the NHS - results of a national survey of NHS Trusts in England. BMC Health Serv Res 2023; 23:889. [PMID: 37612669 PMCID: PMC10464080 DOI: 10.1186/s12913-023-09830-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 07/18/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Locum working in healthcare organisations has benefits for individual doctors and organisations but there are concerns about the impact of locum working on continuity of care, patient safety, team function and cost. We conducted a national survey of NHS Trusts in England to explore locum work, and better understand why and where locum doctors were needed; how locum doctors were engaged, supported, perceived and managed; and any changes being made in the way locums are used. METHODS An online survey was sent to 191 NHS Trusts and 98 were returned (51%) including 66 (67%) acute hospitals, 26 (27%) mental health and six (6%) community health providers. Data was analysed using frequency tables, t-tests and correlations. Free-text responses were analysed using thematic analysis. RESULTS Most NHS Trusts use locums frequently and for varying lengths of time. Trusts prefer to use locums from internal locum banks but frequently rely on locum agencies. The benefits of using locums included maintaining workforce capacity and flexibility. Importantly, care provided by locums was generally viewed as the same or somewhat worse when compared to care provided by permanent doctors. The main disadvantages of using locum agencies included cost, lack of familiarity and impact on organisational development. Some respondents felt that locums could be unreliable and less likely to be invested in quality improvement. NHS Trusts were broadly unfamiliar with the national guidance from NHS England for supporting locums and there was a focus on processes like compliance checks and induction, with less focus on providing feedback and support for appraisal. CONCLUSIONS Locum doctors provide a necessary service within NHS Trusts to maintain workforce capacity and provide patient care. There are potential issues related to the way that locums are perceived, utilised, and supported which might impact the quality of the care that they provide. Future research should consider the arrangements for locum working and the performance of locums and permanent doctors, investigating the organisation of locums in order to achieve safe and high-quality care for patients.
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Affiliation(s)
- Gemma Stringer
- Alliance Manchester Business School, Institute for Health Policy and Organisation, The University of Manchester, Booth Street West, Manchester, M15 6PB UK
| | - Jane Ferguson
- Alliance Manchester Business School, Institute for Health Policy and Organisation, The University of Manchester, Booth Street West, Manchester, M15 6PB UK
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Kieran Walshe
- Alliance Manchester Business School, Institute for Health Policy and Organisation, The University of Manchester, Booth Street West, Manchester, M15 6PB UK
| | - Christos Grigoroglou
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UK
| | - Darren M. Ashcroft
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Wolbers K, Dostal H, Graham S, Branum-Martin L, Allen T, Holcomb L, Saulsburry R. Writing knowledge, practices, efficacy, interests, attitudes, and beliefs of deaf education teachers: a randomized controlled trial. Front Psychol 2023; 14:1214246. [PMID: 37484108 PMCID: PMC10361062 DOI: 10.3389/fpsyg.2023.1214246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/29/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Writing teachers play an extraordinarily important role in their students' writing development. Teachers' motivational beliefs, such as attitudes toward writing, perceptions of their efficacy to teach writing, or preparation to use evidence-based instructional practices, impact their writing instruction, which directly affects the advancement of students' writing skills. Deaf writers are a subpopulation of writers who may face discriminatory beliefs toward their writing development stemming from ableism, audism, or linguicism. Deaf education teachers may doubt their abilities to teach bilingual/multilingual students or teach deaf students experiencing language deprivation. The current study investigates whether deaf education teachers' beliefs can be fostered through an intensive one-year professional development (PD) program designed specifically for deaf education teachers. In this randomized controlled trial, we examine the extent to which the participation of deaf education teachers in specialized PD and subsequent writing instruction implementation (n = 26) impacts their pedagogical content knowledge, use of evidence-based practices for teaching writing, interest, attitudes, efficacy in teaching writing, and epistemological beliefs about writing compared to teachers in a business as usual condition (n = 24). Pre-post regression analyses indicate statistically significant group differences (with the treatment group scoring higher) on all variables except attitude and some epistemological beliefs. We speculate that specialized, sustained PD paired with supported implementation of writing instruction and ongoing teacher reflection are contributing factors to changes in teachers' motivational beliefs.
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Affiliation(s)
| | - Hannah Dostal
- University of Connecticut, Storrs, CT, United States
| | - Steve Graham
- Arizona State University, Tempe, AZ, United States
| | | | - Thomas Allen
- Gallaudet University, Washington, DC, United States
| | - Leala Holcomb
- The University of Tennessee, Knoxville, TN, United States
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Grigoroglou C, Walshe K, Kontopantelis E, Ferguson J, Stringer G, Ashcroft D, Allen T. Use of locum doctors in NHS trusts in England: analysis of routinely collected workforce data 2019-2021. BMJ Open 2023; 13:e065803. [PMID: 37230514 DOI: 10.1136/bmjopen-2022-065803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES Temporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is known about the extent of locum use in NHS trusts. This study aimed to quantify and describe locum use for all NHS trusts in England in 2019-2021. SETTING Descriptive analyses of data on locum shifts from all NHS trusts in England in 2019-2021. Weekly data were available for the number of shifts filled by agency and bank staff and the number of shifts requested by each trust. Negative binomial models were used to investigate the association between the proportion of medical staffing provided by locums and NHS trust characteristics. RESULTS In 2019, on average 4.4% of total medical staffing was provided by locums, but this varied substantially across trusts (25th-75th centile=2.2%-6.2%). Over time, on average two-thirds of locum shifts were filled by locum agencies and a third by trusts' staff banks. On average, 11.3% of shifts requested were left unfilled. In 2019-2021, the mean number of weekly shifts per trust increased by 19% (175.2-208.6) and the mean number of weekly unfilled shifts per trust increased by 54% (32.7 to 50.4). Trusts rated by the Care Quality Commission (CQC) as inadequate or requiring improvement (incidence rate ratio=1.495; 95% CI 1.191 to 1.877), and smaller trusts had a higher use of locums. Large variability was observed across regions for use of locums, proportion of shifts filled by locum agencies and unfilled shifts. CONCLUSIONS There were large variations in the demand for and use of locum doctors in NHS trusts. Trusts with poor CQC ratings and smaller trusts appear to use locum doctors more intensively compared with other trust types. Unfilled shifts were at a 3-year high at the end of 2021 suggesting increased demand which may result from growing workforce shortages in NHS trusts.
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Affiliation(s)
- Christos Grigoroglou
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Kieran Walshe
- Alliance Manchester Business School, Institute for Health Policy and Organisation, The University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research, The University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Jane Ferguson
- Alliance Manchester Business School, Institute for Health Policy and Organisation, The University of Manchester, Manchester, UK
| | - Gemma Stringer
- Alliance Manchester Business School, Institute for Health Policy and Organisation, The University of Manchester, Manchester, UK
| | - Darren Ashcroft
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
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Robinson H, Eleuteri A, Sacco JJ, Hussain R, Heimann H, Taktak AFG, Damato B, Thompson AJ, Allen T, Kalirai H, Coupland SE. Sensitivity and Specificity of Different Prognostic Systems in Guiding Surveillance for Metastases in Uveal Melanoma. Cancers (Basel) 2023; 15:cancers15092610. [PMID: 37174076 PMCID: PMC10177440 DOI: 10.3390/cancers15092610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/19/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Uveal melanoma (UM) metastasises in ~50% of patients, most frequently to the liver. Surveillance imaging can provide early detection of hepatic metastases; however, guidance regarding UM patient risk stratification for surveillance is unclear. This study compared sensitivity and specificity of four current prognostic systems, when used for risk stratification for surveillance, on patients treated at the Liverpool Ocular Oncology Centre (LOOC) between 2007-2016 (n = 1047). It found that the Liverpool Uveal Melanoma Prognosticator Online III (LUMPOIII) or Liverpool Parsimonious Model (LPM) offered greater specificity at equal levels of sensitivity than the American Joint Committee on Cancer (AJCC) system or monosomy 3 alone, and suggests guidance to achieve 95% sensitivity and 51% specificity (i.e., how to detect the same number of patients with metastases, while reducing the number of negative scans). For example, 180 scans could be safely avoided over 5 years in 200 patients using the most specific approach. LUMPOIII also offered high sensitivity and improved specificity over the AJCC in the absence of genetic information, making the result relevant to centres that do not perform genetic testing, or where such testing is inappropriate or fails. This study provides valuable information for clinical guidelines for risk stratification for surveillance in UM.
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Affiliation(s)
- Helena Robinson
- Department of Clinical Engineering, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8YE, UK
| | - Antonio Eleuteri
- NHS Digital, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8YE, UK
| | - Joseph J Sacco
- Liverpool Ocular Oncology Research Group, Department of Molecular and Cancer Medicine, University of Liverpool, Liverpool L7 8TX, UK
| | - Rumana Hussain
- Liverpool Ocular Oncology Research Group, Department of Molecular and Cancer Medicine, University of Liverpool, Liverpool L7 8TX, UK
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8TX, UK
| | - Heinrich Heimann
- Liverpool Ocular Oncology Research Group, Department of Molecular and Cancer Medicine, University of Liverpool, Liverpool L7 8TX, UK
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8TX, UK
| | - Azzam F G Taktak
- Department of Clinical Engineering, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS2 8HW, UK
| | - Bertil Damato
- Consultant Ocular Oncologist, St Erik's Eye Hospital & Karolinska Institutet, 171 64 Stockholm, Sweden
| | - Alexander J Thompson
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester M13 9PL, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester M13 9PL, UK
| | - Helen Kalirai
- Liverpool Ocular Oncology Research Group, Department of Molecular and Cancer Medicine, University of Liverpool, Liverpool L7 8TX, UK
| | - Sarah E Coupland
- Liverpool Ocular Oncology Research Group, Department of Molecular and Cancer Medicine, University of Liverpool, Liverpool L7 8TX, UK
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Rajagopal S, Allen T, Berendt M, Lin D, Alam SU, Richardson DJ, Cox BT. The effect of source backing materials and excitation pulse durations on laser-generated ultrasound waveforms. J Acoust Soc Am 2023; 153:2649. [PMID: 37129678 DOI: 10.1121/10.0019306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
In this article, it is shown experimentally that a planar laser-generated ultrasound source with a hard reflective backing will generate higher acoustic pressures than a comparable source with an acoustically matched backing when the stress confinement condition is not met. Furthermore, while the source with an acoustically matched backing will have a broader bandwidth when the laser pulse is short enough to ensure stress confinement, the bandwidths of both source types will converge as the laser pulse duration increases beyond stress confinement. The explanation of the results is supported by numerical simulations.
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Affiliation(s)
- Srinath Rajagopal
- Ultrasound and Underwater Acoustics, National Physical Laboratory, Hampton Road, Teddington, TW11 0LW, United Kingdom
| | - Thomas Allen
- Department of Medical Physics and Biomedical Engineering, University College London, Malet Place Engineering Building, Gower Street, London, WC1E 6BT, United Kingdom
| | - Martin Berendt
- Optoelectronics Research Centre, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Di Lin
- Optoelectronics Research Centre, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Shaif-Ul Alam
- Optoelectronics Research Centre, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - David J Richardson
- Optoelectronics Research Centre, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Ben T Cox
- Department of Medical Physics and Biomedical Engineering, University College London, Malet Place Engineering Building, Gower Street, London, WC1E 6BT, United Kingdom
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Penner LS, Armitage CJ, Thornley T, Whelan P, Chuter A, Allen T, Elliott RA. What affected UK adults' adherence to medicines during the COVID-19 pandemic? Cross-sectional survey in a representative sample of people with long-term conditions. Z Gesundh Wiss 2023; 32:1-14. [PMID: 36691578 PMCID: PMC9849112 DOI: 10.1007/s10389-022-01813-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/19/2022] [Indexed: 01/20/2023]
Abstract
Aim Medicines non-adherence is associated with poorer outcomes and higher costs. COVID-19 affected access to healthcare, with increased reliance on remote methods, including medicines supply. This study aimed to identify what affected people's adherence to medicines for long-term conditions (LTCs) during the pandemic. Subject and methods Cross-sectional online survey of UK adults prescribed medicines for LTCs assessing self-reported medicines adherence, reasons for non-adherence (using the capability, opportunity and motivation model of behaviour [COM-B]), medicines access and COVID-19-related behaviours. Results The 1746 respondents reported a mean (SD) of 2.5 (1.9) LTCs, for which they were taking 2.4 (1.9) prescribed medicines, 525 (30.1%) reported using digital tools to support ordering or taking medicines and 22.6% reported medicines non-adherence. No access to at least one medicine was reported by 182 (10.4%) respondents; 1048 (60.0%) reported taking at least one non-prescription medicine as a substitute; 409 (23.4%) requested emergency supply from pharmacy for at least one medicine. Problems accessing medicines, being younger, male, in the highest socioeconomic group and working were linked to poorer adherence. Access problems were mostly directly or indirectly related to the COVID-19 pandemic. Respondents were generally lacking in capabilities and opportunities, but disruptions to habits (automatic motivation) was the major reason for non-adherence. Conclusion Navigating changes in how medicines were accessed, and disruption of habits during the COVID-19 pandemic, was associated with suboptimal adherence. People were resourceful in overcoming barriers to access. Solutions to support medicines-taking need to take account of the multiple ways that medicines are prescribed and supplied remotely. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-022-01813-0.
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Affiliation(s)
- L. S. Penner
- Janssen-Cilag GmbH, Johnson & Johnson Platz 1, 41470 Neuss, Germany
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 4th Floor, Jean McFarlane Building, Manchester, M13 9PL UK
| | - C. J. Armitage
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Coupland Building 1, Manchester, M13 9PL; Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, M13 9PT; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Coupland Building 1, Manchester, M13 9PL UK
| | - T. Thornley
- School of Pharmacy, University of Nottingham, University Park, Nottingham, NG7 2RD UK
| | - P. Whelan
- Digital Health Technical Lead, Centre for Health Informatics, Division of Informatics, Imaging and Data Science| School of Health Sciences | Faculty of Biology, Medicine and Health, University of Manchester, Vaughan House, Manchester, M13 9PL UK
| | - A. Chuter
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 4th Floor, Jean McFarlane Building, Manchester, M13 9PL UK
| | - T. Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 4th Floor, Jean McFarlane Building, Manchester, M13 9PL UK
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - R. A. Elliott
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 4th Floor, Jean McFarlane Building, Manchester, M13 9PL UK
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Claiborne D, Detwiler Z, Okawa K, Bateson T, Chen T, Scadden D, Boutwell C, Allen T. OP 6.4 – 00096 High-efficiency CRISPR/Cas9-mediated disruption of ccr5 in human hematopoietic stem progenitor cells generates HIV-refractory immune systems. J Virus Erad 2022. [DOI: 10.1016/j.jve.2022.100249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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11
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Fitzgerald M, Allen T, Bai S, Mitra B, Chiu W, Helsloot D, Groombridge C, Mathew J, Kim Y. Pleural decompression procedural safety for traumatic pneumothorax and haemothorax: Kelly clamps versus fine artery forceps. Emerg Med Australas 2022; 34:954-958. [PMID: 35618677 PMCID: PMC9796613 DOI: 10.1111/1742-6723.14019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 04/27/2022] [Accepted: 05/06/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The present study aimed to determine the difference in force required to puncture simulated pleura comparing Kelly clamps to fine artery forceps. The treatment of symptomatic traumatic pneumothorax and haemothorax involves puncture of the parietal pleura to allow decompression. This is usually performed using Kelly clamps or fine artery forceps. Over-puncture pulmonary injury risk increases with the force used. METHODS An experienced single operator performed puncturing of simulated parietal pleura on a thoracic mannequin while wearing a force sensor under gloves. The force imparted at the device tip onto the parietal pleura was estimated by subtracting the force required to hold the device from the total force. Outcome variables were the total maximum force and force imparted by the device. RESULTS There were 11 simulated procedures completed, seven using Kelly clamps and four using fine artery forceps. After subtracting the force required to hold the chosen forceps, the median value of pleural puncture force using Kelly clamps was 52.91 N (IQR 36.68-63.56) and 10.70 N (IQR 7.64-26.56) using fine artery forceps (P = 0.006). CONCLUSION A significantly increased force was required to puncture simulated parietal pleura using Kelly clamps compared to fine artery forceps. This higher puncture force will be associated with increased instrument acceleration at the time of pleural puncture, which may result in an increased risk of injury to the underlying lung. Based on these data, clinicians may reduce the risk of pulmonary injury by using fine artery forceps rather than Kelly clamps when performing pleural decompression.
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Affiliation(s)
- Mark Fitzgerald
- National Trauma Research InstituteMonash UniversityMelbourneVictoriaAustralia,Trauma ServiceAlfred HealthMelbourneVictoriaAustralia
| | - Thomas Allen
- National Trauma Research InstituteMonash UniversityMelbourneVictoriaAustralia
| | - Shifeng Bai
- Department of Mechanical and Aerospace EngineeringMonash UniversityMelbourneVictoriaAustralia
| | - Biswadev Mitra
- National Trauma Research InstituteMonash UniversityMelbourneVictoriaAustralia,Emergency and Trauma CentreAlfred HealthMelbourneVictoriaAustralia
| | - Wing Chiu
- Department of Mechanical and Aerospace EngineeringMonash UniversityMelbourneVictoriaAustralia
| | | | - Chris Groombridge
- National Trauma Research InstituteMonash UniversityMelbourneVictoriaAustralia,Trauma ServiceAlfred HealthMelbourneVictoriaAustralia,Emergency and Trauma CentreAlfred HealthMelbourneVictoriaAustralia
| | - Joseph Mathew
- National Trauma Research InstituteMonash UniversityMelbourneVictoriaAustralia,Trauma ServiceAlfred HealthMelbourneVictoriaAustralia,Emergency and Trauma CentreAlfred HealthMelbourneVictoriaAustralia
| | - Yesul Kim
- National Trauma Research InstituteMonash UniversityMelbourneVictoriaAustralia
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12
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Nyakutsikwa B, Allen T, Walsh T, Pretty I, Birch S, Tickle M, Moore D. Who are the 10%? Characteristics of the populations and communities receiving fluoridated water in England. Community Dent Health 2022; 39:247-253. [PMID: 35946922 DOI: 10.1922/cdh_00092nyakutsikwa07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES In England, around 10% of the population receive optimally fluoridated water. This coverage has evolved through a combination of historical local decision-making and natural geography, rather than being strategically targeted at the national level. It is important to understand if the current distribution is equitable according to indicators of oral health need and to identify any population-level differences in socio-demographic characteristics that could introduce bias to studies evaluating the effectiveness of water fluoridation. BASIC RESEARCH DESIGN Descriptive analysis comparing the census characteristics of populations that received optimally fluoridated (=/⟩ 0.7 mg F/L) and non-fluoridated water (⟨0.7 mg F/L) between 2009 and 2020. RESULTS Populations receiving fluoridated water between 2009-2020 were on average slightly younger, more urban, more deprived, with lower education levels, higher unemployment and lower car and home ownership than the populations who received non-fluoridated water. They are more ethnically diverse, with a higher proportion of Asian ethnicity and a lower proportion of White ethnicity, compared to the non-fluoridated population. DISCUSSION This descriptive analysis provides evidence that water fluoridation coverage within England is targeted reasonably equitably in relation to population-level indicators of need. It also confirms the need to consider the impact of underlying differences in age, deprivation, rurality, and ethnicity when evaluating the impact of water fluoridation on health outcomes in England.
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Affiliation(s)
- B Nyakutsikwa
- Division of Dentistry, The University of Manchester, UK
| | - T Allen
- Manchester Centre for Health Economics, Manchester, UK
| | - T Walsh
- Division of Dentistry, The University of Manchester, UK
| | - I Pretty
- Division of Dentistry, The University of Manchester, UK
| | - S Birch
- Manchester Centre for Health Economics, Manchester, UK
| | - M Tickle
- Division of Dentistry, The University of Manchester, UK
| | - D Moore
- Division of Dentistry, The University of Manchester, UK
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13
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Kim J, Boehmer L, Plotkin E, Allen T, Gutman P, Shiller M, Brown S, Pan V. Enhancing Coordination Around Cancer Biomarker and Hereditary Genetic Testing Among Members of the Multidisciplinary Care Team. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Advances in precision medicine necessitate a closer integration across pathologists, genetic counselors, and other members of the multidisciplinary cancer care team (MDT). Recognizing that physical distancing and fragmented communication may hinder care delivery, the Association of Community Cancer Centers (ACCC) ran a multi-year initiative to explore ways to improve MDT care coordination.
Methods/Case Report
ACCC held a multistakeholder leadership summit to identify and discuss critical issues regarding biomarker and hereditary genetic testing and the ways in which pathology and genetic counseling professionals interface with the cancer MDT. Through a consensus-driven process, participants identified key opportunities for achieving optimal integration. ACCC also conducted a national survey to explore barriers around biomarker and hereditary genetic testing. Building off these insights, ACCC conducted virtual workshops at three community cancer programs to improve processes around biomarker testing and targeted treatment planning.
Results (if a Case Study enter NA)
The pathology leadership summit identified the following priorities: 1) streamline and standardize the biomarker test ordering process; 2) improve tissue handling to optimize timely biomarker testing; 3) strengthen communication between pathologists and genetic counselors; 4) empower pathologists with leadership opportunities. In the ACCC survey (n=659), 57% indicated that some or most of their pathologists were generalists. 21% only held one general tumor board. 6% indicated that pathologists often do not attend tumor boards or cancer committee meetings. 64% indicated that pathologists can directly access some or all medical oncology patient records. 67% sent some or most biopsy samples out for biomarker testing. In the ACCC workshops, cancer programs in KS, NC, and NV identified ways to improve the timeliness of genetic counseling referrals and coordinate biomarker testing. Following the workshops, 64% indicated they planned to make moderate or significant changes in their processes.
Conclusion
Improving collaboration across pathologists, genetic counselors, and the rest of the cancer MDT may lead to more timely and comprehensive biomarker and hereditary genetic testing. These findings may help cancer programs refine processes of care.
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Affiliation(s)
- J Kim
- Quality, Q Synthesis LLC , Newtown, Pennsylvania , United States
| | - L Boehmer
- Association of Community Cancer Centers , Rockville, Maryland , United States
| | - E Plotkin
- Association of Community Cancer Centers , Rockville, Maryland , United States
| | - T Allen
- University of Mississippi , Jackson, Mississippi , United States
| | - P Gutman
- Holy Cross Hospital , Silver Spring, Maryland , United States
| | - M Shiller
- Baylor Scott & White Health , Dallas, Texas , United States
| | - S Brown
- Providence St. Joseph Hospital Orange , Orange, California , United States
| | - V Pan
- Cook County Health , Chicago, Illinois , United States
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14
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Rodgers S, Taylor AC, Roberts SA, Allen T, Ashcroft DM, Barrett J, Boyd MJ, Elliott RA, Khunti K, Sheikh A, Laparidou D, Siriwardena AN, Avery AJ. Scaling-up a pharmacist-led information technology intervention (PINCER) to reduce hazardous prescribing in general practices: Multiple interrupted time series study. PLoS Med 2022; 19:e1004133. [PMID: 36383560 PMCID: PMC9718399 DOI: 10.1371/journal.pmed.1004133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 12/02/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We previously reported on a randomised trial demonstrating the effectiveness and cost-effectiveness of a pharmacist-led information technology intervention (PINCER). We sought to investigate whether PINCER was effective in reducing hazardous prescribing when rolled out at scale in UK general practices. METHODS AND FINDINGS We used a multiple interrupted time series design whereby successive groups of general practices received the PINCER intervention between September 2015 and April 2017. We used 11 prescribing safety indicators to identify potentially hazardous prescribing and collected data over a maximum of 16 quarterly time periods. The primary outcome was a composite of all the indicators; a composite for indicators associated with gastrointestinal (GI) bleeding was also reported, along with 11 individual indicators of hazardous prescribing. Data were analysed using logistic mixed models for the quarterly event numbers with the appropriate denominator, and calendar time included as a covariate. PINCER was implemented in 370 (94.1%) of 393 general practices covering a population of almost 3 million patients in the East Midlands region of England; data were successfully extracted from 343 (92.7%) of these practices. For the primary composite outcome, the PINCER intervention was associated with a decrease in the rate of hazardous prescribing of 16.7% (adjusted odds ratio (aOR) 0.83, 95% confidence interval (CI) 0.80 to 0.86) at 6 months and 15.3% (aOR 0.85, 95% CI 0.80 to 0.90) at 12 months postintervention. The unadjusted rate of hazardous prescribing reduced from 26.4% (22,503 patients in the numerator/853,631 patients in the denominator) to 20.1% (11,901 patients in the numerator/591,364 patients in the denominator) at 6 months and 19.1% (3,868 patients in the numerator/201,992 patients in the denominator). The greatest reduction in hazardous prescribing associated with the intervention was observed for the indicators associated with GI bleeding; for the GI composite indicator, there was a decrease of 23.9% at both 6 months (aOR 0.76, 95% CI 0.73 to 0.80) and 12 months (aOR 0.76, 95% CI 0.70 to 0.82) postintervention. The unadjusted rate of hazardous prescribing reduced from 31.4 (16,185 patients in the numerator/515,879 patients in the denominator) to 21.2% (7,607 patients in the numerator/358,349 patients in the denominator) at 6 months and 19.5% (2,369 patients in the numerator/121,534 patients in the denominator). We adjusted for calendar time and practice, but since this was an observational study, the findings may have been influenced by unknown confounding factors or behavioural changes unrelated to the PINCER intervention. Data were also not collected for all practices at 6 months and 12 months postintervention. CONCLUSIONS The PINCER intervention, when rolled out at scale in routine clinical practice, was associated with a reduction in hazardous prescribing by 17% and 15% at 6 and 12 months postintervention. The greatest reductions in hazardous prescribing were for indicators associated with risk of GI bleeding. These findings support the wider national rollout of PINCER in England.
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Affiliation(s)
- Sarah Rodgers
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
- PRIMIS, University of Nottingham, Nottingham, United Kingdom
| | - Amelia C Taylor
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Stephen A Roberts
- Centre for Biostatistics, University of Manchester, Manchester, United Kingdom
| | - Thomas Allen
- Manchester Centre for Health Economics, University of Manchester, Manchester, United Kingdom
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, United Kingdom
| | - James Barrett
- PRIMIS, University of Nottingham, Nottingham, United Kingdom
| | - Matthew J Boyd
- School of Pharmacy, University of Nottingham, Nottingham, United Kingdom
| | - Rachel A Elliott
- Manchester Centre for Health Economics, University of Manchester, Manchester, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Despina Laparidou
- Community and Health Research Unit, University of Lincoln, Lincoln, United Kingdom
| | | | - Anthony J Avery
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, United Kingdom
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15
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Goldthorpe J, Allen T, Brooks J, Kontopantelis E, Holland F, Moss C, Wake DJ, Brodie D, Cunningham SG, Kanumilli N, Bishop H, Jones E, Milne N, Ball S, Jenkins M, Nicinska B, Ratto M, Morgan-Curran M, Johnson G, Rutter MK. Digital Interventions Supporting Self-care in People With Type 2 Diabetes Across Greater Manchester (Greater Manchester Diabetes My Way): Protocol for a Mixed Methods Evaluation. JMIR Res Protoc 2022; 11:e26237. [PMID: 35976184 PMCID: PMC9434385 DOI: 10.2196/26237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/17/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Type 2 Diabetes (T2D) is common, with a prevalence of approximately 7% of the population in the United Kingdom. The quality of T2D care is inconsistent across the United Kingdom, and Greater Manchester (GM) does not currently achieve the National Institute for Health and Care Excellence treatment targets. Barriers to delivery of care include low attendance and poor engagement with local T2D interventions, which tend to consist of programs of education delivered in traditional, face-to-face clinical settings. Thus, a flexible approach to T2D management that is accessible to people from different backgrounds and communities is needed. Diabetes My Way (DMW) is a digital platform that offers a comprehensive self-management and educational program that should be accessible to a wide range of people through mobile apps and websites. Building on evidence generated by a Scotland-wide pilot study, DMW is being rolled out and tested across GM. OBJECTIVE The overarching objectives are to assess whether DMW improves outcomes for patients with T2D in the GM area, to explore the acceptability of the DMW intervention to stakeholders, and to assess the cost-effectiveness of the intervention. METHODS A mixed methods approach will be used. We will take a census approach to recruitment in that all eligible participants in GM will be invited to participate. The primary outcomes will be intervention-related changes compared with changes observed in a matched group of controls, and the secondary outcomes will be within-person intervention-related changes. The cost-effectiveness analysis will focus on obtaining reliable estimates of how each intervention affects risk factors such as HbA1c and costs across population groups. Qualitative data will be collected via semistructured interviews and focus groups and organized using template analysis. RESULTS As of May 10, 2021, a total of 316 participants have been recruited for the quantitative study and have successfully enrolled. A total of 278 participants attempted to register but did not have appropriate permissions set by the general practitioners to gain access to their data. In total, 10 participants have been recruited for the qualitative study (7 practitioners and 3 patients). An extension to recruitment has been granted for the quantitative element of the research, and analysis should be complete by December 2022. Recruitment and analysis for the qualitative study should be complete by December 2021. CONCLUSIONS The findings from this study can be used both to develop the DMW system and improve accessibility and usability in more deprived populations generally, thus improving equity in access to support for T2D self-management. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/26237.
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Affiliation(s)
- Joanna Goldthorpe
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Thomas Allen
- Manchester Centre for Health Economics, University of Manchester, Manchester, United Kingdom
| | - Joanna Brooks
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Fiona Holland
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Charlie Moss
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Deborah J Wake
- My Way Digital Health, Dundee, United Kingdom.,Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Scott G Cunningham
- My Way Digital Health, Dundee, United Kingdom.,Population Health & Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Naresh Kanumilli
- Northenden Group Practice, Manchester, United Kingdom.,Diabetes, Endocrinology & Metabolism Centre, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Hannah Bishop
- Greater Manchester & Eastern Cheshire Strategic Clinical Networks, Greater Manchester Health & Social Care Partnership, Manchester, United Kingdom
| | - Ewan Jones
- Greater Manchester & Eastern Cheshire Strategic Clinical Networks, Greater Manchester Health & Social Care Partnership, Manchester, United Kingdom
| | - Nicola Milne
- Diabetes, Endocrinology & Metabolism Centre, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Steve Ball
- Diabetes, Endocrinology & Metabolism Centre, Manchester Royal Infirmary, Manchester, United Kingdom
| | | | | | - Martina Ratto
- Beingwell Group, English Institute of Sport, Sheffield, United Kingdom
| | | | - Gemma Johnson
- Changing Health Limited, Newcastle upon Tyne, United Kingdom
| | - Martin K Rutter
- Diabetes, Endocrinology & Metabolism Centre, Manchester Royal Infirmary, Manchester, United Kingdom.,Division of Diabetes, Endocrinology & Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
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Ratnappan R, Whitaker J, Allen T, Rock J, Howell M. 853 A novel expression based, non-invasive method to differentiate atopic dermatitis and psoriasis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.867] [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: 10/17/2022]
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17
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Kaur K, Allen T, Hill K, Howell M, Jansen B, Rock J, Clarke L, Ibarra C. 629 Performance monitoring of a streamlined and scalable non-invasive gene expression assay for pigmented lesions. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.640] [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: 10/17/2022]
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18
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Shelley A, Winwood K, Allen T, Horner K. Effectiveness of hard inserts in sports mouthguards: a systematic review. Br Dent J 2022:10.1038/s41415-022-4089-x. [PMID: 35379927 DOI: 10.1038/s41415-022-4089-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/20/2021] [Indexed: 11/09/2022]
Abstract
Objectives To improve the protective capacity of conventional ethylene-vinyl acetate mouthguards, some authors have suggested reinforcement with a hard material to distribute impact energy more widely. The research question for this systematic review was: 'does the inclusion of a hard insert in mouthguards improve the protection of anterior teeth from a direct blow?'Data sources Three bibliographic databases (PubMed/Medline, Ovid/Embase and the Cochrane CENTRAL databases) were searched up to 20 February 2021. Additional searches included hand searching of key articles and journals.Data selection A systematic search of the literature included studies where the intervention was the incorporation of hard material into sports mouthguards and where the comparator was conventional mouthguard material. Eligibility required the use of anatomical specimens or anatomical analogues which included or represented anterior maxillary teeth. Twelve eligible publications were identified.Data extraction Data extraction was first carried out independently by two reviewers. Discrepancies were resolved by discussion.Data synthesis Results of individual studies were conflicting and methodological diversity created difficulty in making a synthesis of results. All studies employed low-energy impacts that did not represent the potentially high-energy impacts encountered in sport.Conclusion The efficacy of hard inserts in sports mouthguards has not been demonstrated.
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Affiliation(s)
- Andrew Shelley
- Dental Practitioner, Shelley and Pope Dental Practice, 117 Stockport Road, Denton, Manchester, M34 6DH, UK; Honorary Research Fellow, University of Manchester, Manchester, UK; Team Dentist, Manchester Storm Ice Hockey Club, Manchester, UK.
| | - Keith Winwood
- Musculoskeletal Science and Sports Medicine, Department of Life Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Thomas Allen
- Department of Engineering, Manchester Metropolitan University, Faculty of Science and Engineering, Manchester, UK
| | - Keith Horner
- Emeritus Professor of Oral and Maxillofacial Imaging, Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester, UK
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Moore D, Allen T, Boyers D, McKenzie K, Thompson W, Nyakutsikwa B, Pretty I, Tickle M. Unlocking the potential of NHS primary care dental datasets. Br Dent J 2022; 232:241-250. [PMID: 35217745 DOI: 10.1038/s41415-022-3987-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/25/2021] [Indexed: 11/09/2022]
Abstract
Introduction Maximising the use of routinely collected health data for research is a key part of the UK Government's Industrial Strategy. Rich data are generated by NHS primary care dental services, but the extent of their use in research is unknown.Aims To profile the utility of the post-2006 NHS dental datasets for research, map how they have been used to date and develop recommendations to maximise their utility.Methods The content of and access to the four UK NHS dental datasets was collated using publicly available information and a free-text questionnaire, completed by the relevant data controllers. A scoping review was carried out to identify and map literature that has utilised NHS dental activity data.Results The contents of the UK NHS dental activity datasets are described, alongside how they may be accessed for research. Strengths and weaknesses of these datasets for research are highlighted. The scoping review identified 33 studies which had utilised NHS dental activity data since 2006. We classified 15 as public health practice, 11 as service evaluation and 7 as research.Conclusion In comparision to other NHS activity datasets, it appears that the UK dental datasets have been underutilised for research. We make 11 recommendations on how their utility for research may be increased.
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Affiliation(s)
- Deborah Moore
- Research Associate, Dental Public Health, The University of Manchester, Division of Dentistry, Dental Health Unit, Lloyd Street North, Manchester Science Park, M15 6SE, UK.
| | - Thomas Allen
- Research Fellow, Health Economics, Danish Centre for Health Economics, University of Southern Denmark, Denmark; The University of Manchester, Manchester Centre for Health Economics, Room 4.305 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Dwayne Boyers
- Research Fellow, Health Economics Research Unit, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Kate McKenzie
- Research Assistant, Dental Public Health, The University of Manchester, Division of Dentistry, Dental Health Unit, Lloyd Street North, Manchester Science Park, M15 6SE, UK
| | - Wendy Thompson
- NIHR Clinical Lecturer, The University of Manchester, Division of Dentistry, Coupland 3, M13 9PL, UK
| | - Blessing Nyakutsikwa
- Research Associate, Dental Public Health, The University of Manchester, Division of Dentistry, Dental Health Unit, Lloyd Street North, Manchester Science Park, M15 6SE, UK
| | - Iain Pretty
- Professor of Public Health Dentistry, The University of Manchester, Division of Dentistry, Dental Health Unit, Lloyd Street North, Manchester Science Park, M15 6SE, UK
| | - Martin Tickle
- Professor of Dental Public Health and Primary Care, The University of Manchester, Division of Dentistry, Coupland 3, M13 9PL, UK
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Allen T, Gyrd-Hansen D, Kristensen SR, Oxholm AS, Pedersen LB, Pezzino M. Physicians under Pressure: Evidence from Antibiotics Prescribing in England. Med Decis Making 2022; 42:303-312. [PMID: 35021900 PMCID: PMC8918864 DOI: 10.1177/0272989x211069931] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many physicians are experiencing increasing demands from both their patients and society. Evidence is scarce on the consequences of the pressure on physicians' decision making. We present a theoretical framework and predict that increasing pressure may make physicians disregard societal welfare when treating patients. SETTING We test our prediction on general practitioners' antibiotic-prescribing choices. Because prescribing broad-spectrum antibiotics does not require microbiological testing, it can be performed more quickly than prescribing for narrow-spectrum antibiotics and is therefore often preferred by the patient. In contrast, from a societal perspective, inappropriate prescribing of broad-spectrum antibiotics should be minimized as it may contribute to antimicrobial resistance in the general population. METHODS We combine longitudinal survey data and administrative data from 2010 to 2017 to create a balanced panel of up to 1072 English general practitioners (GPs). Using a series of linear models with GP fixed effects, we estimate the importance of different sources of pressure for GPs' prescribing. RESULTS We find that the percentage of broad-spectrum antibiotics prescribed increases by 6.4% as pressure increases on English GPs. The link between pressure and prescribing holds for different sources of pressure. CONCLUSIONS Our findings suggest that there may be societal costs of physicians working under pressure. Policy makers need to take these costs into account when evaluating existing policies as well as when introducing new policies affecting physicians' work pressure. An important avenue for further research is also to determine the underlying mechanisms related to the different sources of pressure.JEL-code: I11, J28, J45. HIGHLIGHTS Many physicians are working under increasing pressure.We test the importance of pressure on physicians' prescribing of antibiotics.The prescribed rate of broad-spectrum antibiotics increases with pressure.Policy makers should be aware of the societal costs of pressured physicians.[Formula: see text].
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Affiliation(s)
- Thomas Allen
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK.,Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark
| | - Dorte Gyrd-Hansen
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark
| | - Søren Rud Kristensen
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark.,Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Anne Sophie Oxholm
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark
| | - Line Bjørnskov Pedersen
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark.,Research Unit for General Practice, University of Southern Denmark, J..B, Odense C, Denmark
| | - Mario Pezzino
- School of Social Sciences, University of Manchester, Manchester, UK
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21
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O’Malley L, Macey R, Allen T, Brocklehurst P, Thomson F, Rigby J, Lalloo R, Tomblin Murphy G, Birch S, Tickle M. Workforce Planning Models for Oral Health Care: A Scoping Review. JDR Clin Trans Res 2022; 7:16-24. [PMID: 33323035 PMCID: PMC8674798 DOI: 10.1177/2380084420979585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND For health care services to address the health care needs of populations and respond to changes in needs over time, workforces must be planned. This requires quantitative models to estimate future workforce requirements that take account of population size, oral health needs, evidence-based approaches to addressing needs, and methods of service provision that maximize productivity. The aim of this scoping review was to assess whether and how these 4 elements contribute to existing models of oral health workforce planning. METHODS A scoping review was conducted. MEDLINE, Embase, HMIC, and EconLit were searched, all via OVID. Additionally, gray literature databases were searched and key bodies and policy makers contacted. Workforce planning models were included if they projected workforce numbers and were specific to oral health. No limits were placed on country. A single reviewer completed initial screening of abstracts; 2 independent reviewers completed secondary screening and data extraction. A narrative synthesis was conducted. RESULTS A total of 4,009 records were screened, resulting in 42 included articles detailing 47 models. The workforce planning models varied significantly in their use of data on oral health needs, evidence-based services, and provider productivity, with most models relying on observed levels of service utilization and demand. CONCLUSIONS This review has identified quantitative workforce planning models that aim to estimate future workforce requirements. Approaches to planning the oral health workforce are not always based on deriving workforce requirements from population oral health needs. In many cases, requirements are not linked to population needs, while in models where needs are included, they are constrained by the existence and availability of the required data. It is critical that information systems be developed to effectively capture data necessary to plan future oral health care workforces in ways that relate directly to the needs of the populations being served. KNOWLEDGE TRANSFER STATEMENT Policy makers can use the results of this study when making decisions about the planning of oral health care workforces and about the data to routinely collect within health services. Collection of suitable data will allow for the continual improvement of workforce planning, leading to a responsive health service and likely future cost savings.
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Affiliation(s)
- L. O’Malley
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - R. Macey
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - T. Allen
- Centre for Health Economics, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - P. Brocklehurst
- NWORTH Clinical Trials Unit, University of Bangor, Bangor, UK
| | - F. Thomson
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - J. Rigby
- WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Canada
- Research, Innovation and Discovery, Nova Scotia Health Authority, Halifax, Canada
| | - R. Lalloo
- School of Dentistry, The University of Queensland, Brisbane, Australia
| | - G. Tomblin Murphy
- WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Canada
- Research, Innovation and Discovery, Nova Scotia Health Authority, Halifax, Canada
| | - S. Birch
- Centre for the Business and Economics of Health, Faculty of Business Economics and Law, The University of Queensland, Brisbane, Australia
| | - M. Tickle
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
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22
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Gatt I, Allen T, Wheat J. Quantifying wrist angular excursion on impact for Jab and Hook lead arm shots in boxing. Sports Biomech 2021:1-13. [PMID: 34872457 DOI: 10.1080/14763141.2021.2006296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
The hand region is reported as the most common injury site in boxing, with more observed time loss than any other area in this sport. The amount of wrist motion, specifically flexion, has been described as contributing to these injuries, yet no literature is available to quantify wrist kinematics in boxing. This is the first paper describing wrist motion on impact in boxing. Utilising an electromagnetic tracking system, two types of shots were assessed, Jab (straight arm) and Hook (bent arm), during in-vivo testing procedures with 29 elite boxers. For both shots, flexion and ulnar deviation occurred concurrent on impact, with an M and SD of 9.3 ± 1.9° and 4.7 ± 1.2° respectively for Jab shots, and 5.5 ± 1.1° and 3.3 ± 1.1° respectively for Hook shots, supporting dart throwing motion at the wrist. For both Jab & Hook, wrist motion on impact occurred within >30% and >20% respectively of total available active range of motion, with wrist angles greater in both flexion (t = 9.0, p < 0.001, d = 1.7) and ulnar deviation (t = 8.4, p < 0.001, d = 1.6) for Jab compared to Hook shots. The study provides novel and quantifiable information regarding wrist kinematics during the impact phase of punching and potentially an improved understanding of injury mechanisms in boxing.
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Affiliation(s)
- Ian Gatt
- Physiotherapy Department, English Institute of Sport, Manchester, United Kingdom of Great Britain and Northern Ireland
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Thomas Allen
- School of Engineering, Manchester Metropolitan University, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Jonathan Wheat
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, United Kingdom of Great Britain and Northern Ireland
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Baumann E, Pohle U, Zhang E, Allen T, Villringer C, Pulwer S, Gerhardt H, Laufer J. A backward-mode optical-resolution photoacoustic microscope for 3D imaging using a planar Fabry-Pérot sensor. Photoacoustics 2021; 24:100293. [PMID: 34466380 PMCID: PMC8385441 DOI: 10.1016/j.pacs.2021.100293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/23/2021] [Accepted: 08/08/2021] [Indexed: 06/13/2023]
Abstract
Optical-resolution photoacoustic microscopy (OR-PAM) combines high spatial resolution and strong absorption-based contrast in tissue, which has enabled structural and spectroscopic imaging of endogenous chromophores, primarily hemoglobin. Conventional piezoelectric ultrasound transducers are typically placed far away from the photoacoustic source due to their opacity, which reduces acoustic sensitivity. Optical ultrasound sensors are an alternative as their transparency allows them to be positioned close to the sample with minimal source-detector distances. In this work, a backward-mode OR-PAM system based on a planar Fabry-Pérot ultrasound sensor and coaxially aligned excitation and interrogation beams was developed. Two 3D imaging modes, using raster-scanning for enhanced image quality and continuous-scanning for fast imaging, were implemented and tested on a leaf skeleton phantom. In fast imaging mode, a scan-rate of 100,000 A-lines/s was achieved. 3D images of a zebrafish embryo were acquired in vivo in raster-scanning mode. The transparency of the FP sensor in the visible and near-infrared wavelength region makes it suitable for combined functional and molecular imaging applications using OR-PAM and multi-photon fluorescence microscopy.
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Affiliation(s)
- Elisabeth Baumann
- Integrative Vascular Biology Laboratory, Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Robert-Rössle-Strasse 10, 13125, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ulrike Pohle
- Institut für Physik, Martin-Luther-Universität Halle-Wittenberg, Von-danckelmann-platz 3, 06120, Halle (Saale), Germany
| | - Edward Zhang
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, WC1E 6BT, UK
| | - Thomas Allen
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, WC1E 6BT, UK
| | - Claus Villringer
- Institut für Physik, Martin-Luther-Universität Halle-Wittenberg, Von-danckelmann-platz 3, 06120, Halle (Saale), Germany
- University of Applied Sciences Wildau, Hochschulring 1, 15745, Wildau, Germany
| | - Silvio Pulwer
- University of Applied Sciences Wildau, Hochschulring 1, 15745, Wildau, Germany
| | - Holger Gerhardt
- Integrative Vascular Biology Laboratory, Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Robert-Rössle-Strasse 10, 13125, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner site, Potsdamer Str. 58, 10785, Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straβe 2, 10178, Berlin, Germany
| | - Jan Laufer
- Institut für Physik, Martin-Luther-Universität Halle-Wittenberg, Von-danckelmann-platz 3, 06120, Halle (Saale), Germany
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Taberner M, Allen T, O'keefe J, Cohen DD. Contextual considerations using the 'control-chaos continuum' for return to sport in elite football - Part 1: Load planning. Phys Ther Sport 2021; 53:67-74. [PMID: 34839202 DOI: 10.1016/j.ptsp.2021.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/28/2021] [Accepted: 10/31/2021] [Indexed: 12/26/2022]
Abstract
The 'control-chaos continnum' is an adaptable framework developed to guide the on-pitch rehabilitation process in elite football. One of the key objectives of the continuum is to progressively return players to their preinjury chronic running load, while incorporating the qualitative aspects of movement and cognitive stresses integral to competitive match-play. Whilst injury and player-specific considerations are key to an individualised rehabilitation approach, a host of contextual factors also play an important role in return to sport (RTS) planning. In this article, we highlight some key intrinsic and extrinsic contextual factors for the practitioner to consider in the RTS planning process to help mitigate reinjury risk upon a return to team training. While a return to chronic running load is generally a critical component of the framework, we highlight circumstances in elite football where it is a less relevant factor in RTS decision-making.
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Affiliation(s)
- M Taberner
- Performance and Medical Department, Orlando Magic Basketball Club, Orlando, USA; School of Sport and Exercise Sciences, Liverpool John Moore's University, Liverpool, UK.
| | - T Allen
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK; Institute of Coaching and Performance, University of Central Lancashire, Preston, UK. https://twitter.com/tallen_5
| | - J O'keefe
- Academy Sports Science Department, Everton Football Club, Liverpool, UK. https://twitter.com/JasonOkeefe10
| | - D D Cohen
- Masira Research Institute, University of Santander (UDES), Bucaramanga, Colombia; Sports Science Center (CCD), Colombian Ministry of Sport (Mindeporte), Colombia. https://twitter.com/danielcohen1971
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Moss C, Sutton M, Cheraghi-Sohi S, Sanders C, Allen T. Comparative 4-year risk and type of hospital admission among homeless and housed emergency department attendees: longitudinal study of hospital records in England 2013-2018. BMJ Open 2021; 11:e049811. [PMID: 34312208 PMCID: PMC8314693 DOI: 10.1136/bmjopen-2021-049811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES People experiencing homelessness are frequent users of secondary care. Currently, there is no study of potentially preventable admissions for homeless patients in England. We aim to estimate the number of potentially preventable hospital admissions for homeless patients and compare to housed patients with similar characteristics. DESIGN Retrospective matched cohort study. SETTING Hospitals in England. PARTICIPANTS 16 161 homeless patients and 74 780 housed patients aged 16-75 years who attended an emergency department (ED) in England in 2013/2014, matched on the basis of age, sex, ED attended and primary diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES Annual counts of admissions, emergency admissions, ambulatory care-sensitive (ACS) emergency admissions, acute ACS emergency admissions and chronic ACS emergency admissions over the following 4 years (2014/2015-2017/2018). We additionally compare the prevalence of specific ACS conditions for homeless and housed patients. RESULTS Mean admissions per 1000 patients per year were 470 for homeless patients and 230 for housed patients. Adjusted for confounders, annual admissions were 1.79 times higher (incident rate ratio (IRR)=1.79; 95% CI 1.69 to 1.90), emergency admissions 2.08 times higher (IRR=2.08; 95% CI 1.95 to 2.21) and ACS admissions 1.65 times higher (IRR=1.65; 95% CI 1.51 to 1.80), compared with housed patients. The effect was greater for acute (IRR=1.78; 95% CI 1.64 to 1.93) than chronic (IRR=1.45; 95% CI 1.27 to 1.66) ACS conditions. ACS conditions that were relatively more common for homeless patients were cellulitis, convulsions/epilepsy and chronic angina. CONCLUSIONS Homeless patients use hospital services at higher rates than housed patients, particularly emergency admissions. ACS admissions of homeless patients are higher which suggests some admissions may be potentially preventable with improved access to primary care. However, these admissions comprise a small share of total admissions.
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Affiliation(s)
- Charlie Moss
- Health Organisation, Policy and Economics, Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics, Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK
- Melbourne Institute: Applied Economic and Social Research, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sudeh Cheraghi-Sohi
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Caroline Sanders
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, School of Health Sciences, The University of Manchester, Manchester, UK
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark
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26
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Pendharkar SR, Minty E, Shukalek CB, Kerr B, MacMullan P, Lail P, Cheema K, Alimohamed N, Allen T, Vlasschaert MEO, Kachra R, Ma IWY, Johannson KA, Gibson PS, Elliott MJ, Papini A, Smith S, Lemaire J, Ruzycki SM, Hunter A, Desjardins-Kallar W, Schaefer JP, Zarnke KB, Bharwani A, Fabreau GE. Description of a Multi-faceted COVID-19 Pandemic Physician Workforce Plan at a Multi-site Academic Health System. J Gen Intern Med 2021; 36:1310-1318. [PMID: 33564947 PMCID: PMC7872510 DOI: 10.1007/s11606-020-06543-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The evolving COVID-19 pandemic has and continues to present a threat to health system capacity. Rapidly expanding an existing acute care physician workforce is critical to pandemic response planning in large urban academic health systems. INTERVENTION The Medical Emergency-Pandemic Operations Command (MEOC)-a multi-specialty team of physicians, operational leaders, and support staff within an academic Department of Medicine in Calgary, Canada-partnered with its provincial health system to rapidly develop a comprehensive, scalable pandemic physician workforce plan for non-ventilated inpatients with COVID-19 across multiple hospitals. The MEOC Pandemic Plan comprised seven components, each with unique structure and processes. METHODS In this manuscript, we describe MEOC's Pandemic Plan that was designed and implemented from March to May 2020 and re-escalated in October 2020. We report on the plan's structure and process, early implementation outcomes, and unforeseen challenges. Data sources included MEOC documents, health system, public health, and physician engagement implementation data. KEY RESULTS From March 5 to October 26, 2020, 427 patients were admitted to COVID-19 units in Calgary hospitals. In the initial implementation period (March-May 2020), MEOC communications reached over 2500 physicians, leading to 1446 physicians volunteering to provide care on COVID-19 units. Of these, 234 physicians signed up for hospital shifts, and 227 physicians received in-person personal protective equipment simulation training. Ninety-three physicians were deployed on COVID-19 units at four large acute care hospitals. The resurgence of cases in September 2020 has prompted re-escalation including re-activation of COVID-19 units. CONCLUSIONS MEOC leveraged an academic health system partnership to rapidly design, implement, and refine a comprehensive, scalable COVID-19 acute care physician workforce plan whose components are readily applicable across jurisdictions or healthcare crises. This description may guide other institutions responding to COVID-19 and future health emergencies.
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Affiliation(s)
- Sachin R Pendharkar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Evan Minty
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Caley B Shukalek
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brendan Kerr
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Paul MacMullan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Parabhdeep Lail
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Kim Cheema
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Nimira Alimohamed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Thomas Allen
- Cumming School of Medicine, University of Calgary, Health Sciences Centre, Calgary, AB, Canada
| | - Meghan E O Vlasschaert
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Rahim Kachra
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Health Sciences Centre, Calgary, AB, Canada
| | - Irene W Y Ma
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kerri A Johannson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul S Gibson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Meghan J Elliott
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adam Papini
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Stephanie Smith
- Cumming School of Medicine, University of Calgary, Health Sciences Centre, Calgary, AB, Canada
| | - Jane Lemaire
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Shannon M Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Angela Hunter
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Wendy Desjardins-Kallar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Jeffrey P Schaefer
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Kelly B Zarnke
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Aleem Bharwani
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gabriel E Fabreau
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Allen T, Wilson S, Cohen DD, Taberner M. Drill design using the 'control-chaos continuum': Blending science and art during return to sport following knee injury in elite football. Phys Ther Sport 2021; 50:22-35. [PMID: 33862346 DOI: 10.1016/j.ptsp.2021.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/25/2020] [Revised: 01/31/2021] [Accepted: 02/16/2021] [Indexed: 11/15/2022]
Abstract
Establishing the level of risk, planning and adapting the return to sport (RTS) process following a complex knee injury involves drawing on a combination of relevant high-quality evidence and practitioner experience. On-pitch rehabilitation is a critical element of this process, providing an effective transition from rehabilitation to team training. The 'control-chaos continuum' (CCC) is an adaptable framework for on-pitch rehabilitation moving from high control to high chaos, progressively increasing running load demands and incorporating greater perceptual and neurocognitive challenges within sport-specific drills. Drills are a key element of the CCC, and are designed to ensure specificity, ecological validity and maintaining player interest. We showcase drill progression through the phases of the CCC, highlighting the use of constraints to create drills that incorporate the physical, technical, tactical and injury-specific needs of the player. We also provide recommendations to help practitioners create training session content using the CCC to help replicate the demands of team training within their own environment.
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Affiliation(s)
- T Allen
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK; Institute of Coaching and Performance, University of Central Lancashire, Preston, UK.
| | - S Wilson
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK
| | - D D Cohen
- Masira Research Institute, University of Santander (UDES), Bucaramanga, Colombia; Sports Science Center (CCD), Colombian Ministry of Sport (Mindeporte), Colombia
| | - M Taberner
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
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Moore D, Allen T, Birch S, Tickle M, Walsh T, Pretty IA. How effective and cost-effective is water fluoridation for adults? Protocol for a 10-year retrospective cohort study. BDJ Open 2021; 7:3. [PMID: 33479223 PMCID: PMC7820470 DOI: 10.1038/s41405-021-00062-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Tooth decay can cause pain, sleepless nights and loss of productive workdays. Fluoridation of drinking water was identified in the 1940s as a cost-effective method of prevention. In the mid-1970s, fluoride toothpastes became widely available. Since then, in high-income countries the prevalence of tooth decay in children has reduced whilst natural tooth retention in older age groups has increased. Most water fluoridation research was carried out before these dramatic changes in fluoride availability and oral health. Furthermore, there is a paucity of evidence in adults. The aim of this study is to assess the clinical and cost-effectiveness of water fluoridation in preventing invasive dental treatment in adults and adolescents aged over 12. METHODS/DESIGN Retrospective cohort study using 10 years of routinely available dental treatment data. Individuals exposed to water fluoridation will be identified by sampled water fluoride concentration linked to place of residence. Outcomes will be based on the number of invasive dental treatments received per participant (fillings, extractions, root canal treatments). A generalised linear model with clustering by local authority area will be used for analysis. The model will include area level propensity scores and individual-level covariates. The economic evaluation will focus on (1) cost-effectiveness as assessed by the water fluoridation mean cost per invasive treatment avoided and (2) a return on investment from the public sector perspective, capturing the change in cost of dental service utilisation resulting from investment in water fluoridation. DISCUSSIONS There is a well-recognised need for contemporary evidence regarding the effectiveness and cost-effectiveness of water fluoridation, particularly for adults. The absence of such evidence for all age groups may lead to an underestimation of the potential benefits of a population-wide, rather than targeted, fluoride delivery programme. This study will utilise a pragmatic design to address the information needs of policy makers in a timely manner.
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Affiliation(s)
- Deborah Moore
- grid.5379.80000000121662407Dental Public Health, Division of Dentistry, Dental Health Unit, The University of Manchester, Lloyd Street North Manchester Science Park, Manchester, M15 6SE UK
| | - Thomas Allen
- Director, Centre for the Business and Economics of Health, University of Queensland, St Lucia, Queensland, 4072 UK
| | - Stephen Birch
- Director, Centre for the Business and Economics of Health, University of Queensland, St Lucia, Queensland, 4072 UK ,grid.5379.80000000121662407Health Economics, Manchester Centre for Health Economics, The University of Manchester, Jean McFarlane Building Oxford Road, Manchester, M13 9PL UK
| | - Martin Tickle
- grid.5379.80000000121662407Dental Public Health & Primary Care, Division of Dentistry, The University of Manchester, Coupland 3, Manchester, M13 9PL UK
| | - Tanya Walsh
- grid.5379.80000000121662407Healthcare Evaluation, Division of Dentistry, The University of Manchester, Coupland 3, Manchester, M139PL UK
| | - Iain A. Pretty
- grid.5379.80000000121662407Public Health Dentistry, Division of Dentistry, Dental Health Unit, The University of Manchester, Lloyd Street North Manchester Science Park, Manchester, M15 6SE UK
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Allen T, Awais M, Bailenson JN, Bhattacharjee M, Biswas U, Bouzid Z, Bullock K, Celik Y, Clark CC, Clark RA, Coulby G, Dahiya R, Dodd LE, Drehlich M, Duncan O, Gage WH, Ganti RK, Godfrey A, Goh CH, Gower S, Greenleaf W, Harte R, Heywood S, Hickey A, Hosseini ES, Hough EJ, Javed E, Johnston W, Kahn M, Kettley S, Khalid M, Khalifa Y, Kim J, King L, Lim E, Lovell NH, Mancin M, Manjakkal L, Mao S, Marchiori E, Marshall SJ, Martini DN, Mohammadian Rad N, Moore J, Morris R, Nouredanesh M, Ó Laighin G, Ooi SY, Ooteghem KV, Paranthaman VV, Parrington L, Pettigrew N, Powell D, Pua Y, Quinlan L, Raza M, Redmond SJ, Ridgers ND, Scanlan K, Sejdic E, Shepherd J, Shu K, Singh N, Srivatsa M, Stuart S, Suri A, Tan HH, Thilarajah S, Torun H, Trojaniello D, Tung J, Tyler D, Weiss TL, Wilhelm J, Williams G, Wood D, Wood J, Young F, Zhang Z. List of contributors. Digit Health 2021. [DOI: 10.1016/b978-0-12-818914-6.00027-2] [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: 11/28/2022] Open
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Bernicker E, Xiao Y, Abraham A, Redpath S, Engstrom-Melnyk J, Croix D, Yang B, Shah R, Allen T. OFP01.07 Delayed ALK Testing Results in the US - Analysis with a Large Real World Oncology Database. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.039] [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: 10/22/2022]
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Allen T, Walshe K, Proudlove N, Sutton M. Do performance indicators predict regulator ratings of healthcare providers? Cross-sectional study of acute hospitals in England. Int J Qual Health Care 2020; 32:113-119. [PMID: 31725874 PMCID: PMC7184898 DOI: 10.1093/intqhc/mzz101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/29/2019] [Accepted: 09/12/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To determine whether a large set of care performance indicators ('Intelligent Monitoring (IM)') can be used to predict the Care Quality Commission's (CQC) acute hospital trust provider ratings. DESIGN The IM dataset and first-inspection ratings were used to build linear and ordered logistic regression models for the whole dataset (all trusts). This was repeated for subsets of the trusts, with these models then applied to predict the inspection ratings of the remaining trusts. SETTING The United Kingdom Department of Health and Social Care's Care Quality Commission is the regulator for all health and social care services in England. We consider their first-inspection cycle of acute hospital trusts (2013-2016). PARTICIPANTS All 156 English NHS acute hospital trusts. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Percentage of correct predictions and weighted kappa. RESULTS Only 24% of the predicted overall ratings for the test sample were correct and the weighted kappa of 0.01 indicates very poor agreement between predicted and actual ratings. This lack of predictive power is also found for each of the rating domains. CONCLUSION While hospital inspections draw on a much wider set of information, the poor power of performance indicators to predict subsequent inspection ratings may call into question the validity of indicators, ratings or both. We conclude that a number of changes to the way performance indicators are collected and used could improve their predictive value, and suggest that assessing predictive power should be undertaken prospectively when the sets of indicators are being designed and selected by regulators.
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Affiliation(s)
- Thomas Allen
- Manchester Centre for Health Economics, University of Manchester, 4.305 Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK
| | - Kieran Walshe
- Alliance Manchester Business School, University of Manchester, Booth Street West, Manchester M15 6PB, UK
| | - Nathan Proudlove
- Alliance Manchester Business School, University of Manchester, Booth Street West, Manchester M15 6PB, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics, Division of Population Health, Health Services Research & Primary Care, Williamson Building, Oxford Road, University of Manchester, Manchester M13 9QQ, UK
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Tomalty HE, Kukal O, Allen T, Walker VK, Davies PL. Supercooling to preserve a renal proximal tubule cell line. Cryobiology 2020. [DOI: 10.1016/j.cryobiol.2020.10.032] [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: 11/28/2022]
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Fergus CA, Allen T, Parker M, Pearson G, Storer L, Dawson K. Localising evidence for decision-making: participatory approach to inform schistosomiasis control. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The linear theories of change which ground many interventions do not account for the complex processes and systems in which they are implemented. This reductionist approach prioritises statistical methods which do not accommodate the stochastic, non-linear, dynamic interactions between humans and their environment. The inclusion of practitioners in the process of evidence development and utilisation of complex systems methods mitigates these issues and results in locally relevant, timely evidence for decision-making.
Methods
The aim of this work was to develop localised evidence for decision-making for schistosomiasis control in Uganda, Malawi, and Tanzania. Workshops were conducted with practitioners from the Ministries of Health at various levels and partner organisations to identify evidence needs for their decision-making processes and perceptions of disease transmission and control activities. Participatory systems mapping was used to identify factors directly and indirectly related to transmission. The maps were synthesised to a master complex systems map, which served as the blueprint for a generalised spatial agent-based model and specific ABMs tailored to the evidence needs of decision-makers.
Results
There was a gap in available evidence for practitioners to advocate for resources within the MoH and government budgets, as well as intervention efficacy and resource allocation. The adaptable and data-inclusive characteristics of the AMBs made them well-suited to produce localised outputs. Converted to NetLogo with a tailored user interface, these models were appropriate and responsive to the needs of decision-makers from village to national levels and across country contexts.
Conclusions
Used together, participatory and agent-based modelling resulted in the development of responsive and relevant evidence for practitioner decision-making. This process is generalisable and transferable to other diseases and locations outside of those in this study.
Key messages
The use of participatory systems mapping to develop agent-based models resulted in relevant and timely evidence for practitioner decision-making. The approach used here is transferable and generalisable outside schistosomiasis control and the contexts in this study.
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Affiliation(s)
- C A Fergus
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
- Department of International Development, London School of Economics and Political Science, London, UK
| | - T Allen
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
- Department of International Development, London School of Economics and Political Science, London, UK
| | - M Parker
- Department of Global Health and Development, LSHTM, London, UK
| | - G Pearson
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
| | - L Storer
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
| | - K Dawson
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
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Pearson G, Parker M, Storer E, Allen T, Fergus C. Participatory systems mapping for localised evidence and decision-making: helminth control, SSA. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evidence-informed decision-making to assist public health practitioners in local-level programme implementation requires adaptive approaches to research, policy and practice. To address these needs there is focus on using participatory methods. Adopting such methods, this research asks: what are the evidence needs of local public health practitioners? How do evidence and decision-making processes interact? We reflect on the process of using Participatory Systems Mapping (PSM) and implications for localising evidence-informed decision-making.
Methods
We conducted workshops with district and national-level MoH personnel in Uganda and Malawi using PSM to elicit insights into local modes of schistosomiasis transmission and control, and group discussions on evidence needs and use in implementing control programmes. PSM maps are analysed, triangulated with thematic analysis of group discussion transcripts.
Results
Analysing PSM outputs alongside discussions on evidence provides critical methodological and policy insights with implications for localised evidence and decision-making. Further insights into the local dynamics of public health decision-making are gained by triangulating PSM with discussions on the meanings and importance of 'factors' identified. Information which is accessible and useful for local practitioner's decision-making in implementing disease control measures does not always align with academic production and dissemination of evidence, nor across levels where policy is produced or implemented.
Conclusions
An array of factors influence local decision-making with implications for global health policies and practices such as for schistosomiasis control. Processes of decision-making and evidence needs of local practitioners need to be better understood within broader context. Evidence and knowledge production on health interventions rarely feedback or respond to local implementation needs, decision-making practices and public health practitioners.
Key messages
Processes of decision-making and evidence needs of local practitioners need to be better understood within broader context. Evidence and knowledge production on health interventions rarely feedback or respond to local implementation needs, decision-making practices and public health practitioners.
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Affiliation(s)
- G Pearson
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
| | - M Parker
- Department of Global Health and Development, LSHTM, London, UK
| | - E Storer
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
| | - T Allen
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
| | - C Fergus
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
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Nichols L, Knighton A, Brunisholz K, Elbel R, Smith G, Choberka A, Belnap T, Allen T, Moore M, Srivastava R. Adapting a Complex, Integrated Health and Social Services Intervention in Two Communities. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- L. Nichols
- Intermountain Healthcare Salt Lake City UT United States
| | - A. Knighton
- Intermountain Healthcare Murray UT United States
| | | | - R. Elbel
- SelectHealth Murray UT United States
| | - G. Smith
- Intermountain Healthcare Salt Lake City UT United States
| | - A. Choberka
- Intermountain Healthcare Ogden UT United States
| | - T. Belnap
- Intermountain Healthcare Murray UT United States
| | - T. Allen
- Intermountain Healthcare Salt Lake City UT United States
| | - M. Moore
- Intermountain Healthcare Salt Lake City UT United States
| | - R. Srivastava
- Intermountain Healthcare Salt Lake City UT United States
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Ascenso G, Yap MH, Allen T, Choppin SS, Payton C. A review of silhouette extraction algorithms for use within visual hull pipelines. Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization 2020. [DOI: 10.1080/21681163.2020.1790040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Guido Ascenso
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Moi Hoon Yap
- Department of Computing and Mathematics, Manchester Metropolitan University, Manchester, UK
| | - Thomas Allen
- Department of Engineering, Manchester Metropolitan University, Manchester, UK
| | - Simon S. Choppin
- Centre for Sports Engineering Research, Sheffield Hallam University, Sheffield, UK
| | - Carl Payton
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
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Pedersen LB, Allen T, Waldorff FB, Andersen MKK. Does accreditation affect the job satisfaction of general practitioners? A combined panel data survey and cluster randomised field experiment. Health Policy 2020; 124:849-855. [PMID: 32540210 DOI: 10.1016/j.healthpol.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/02/2019] [Revised: 01/24/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
A critical question for policy makers in health care is whether external interventions have unintended consequences such as lowering professionals' job satisfaction. We investigate whether a non-monetary incentive, in the form of mandatory accreditation, affects the job satisfaction of Danish GPs. Accreditation of general practice in Denmark was introduced as a cluster randomised stepwise implementation from 2016 to 2018. We measure job satisfaction at three time points: before the randomisation took place, one year into the accreditation process and two years into the accreditation process. We use a balanced panel of GPs who have completed all three waves of the survey (n = 846) and estimate a series of random and mixed effects ordered logit models. Despite many GPs having negative attitudes towards accreditation, we find no evidence of accreditation affecting GP job satisfaction. However, there are negative associations between job satisfaction and perceiving accreditation as a tool for external control. Policy makers are therefore encouraged to carefully inform about new interventions and identify barriers to diminish pre-existing negative perceptions about the incentive.
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Affiliation(s)
- Line Bjørnskov Pedersen
- DaCHE - Danish Centre for Health Economics, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9B, 5000 Odense C, Denmark; Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9A, 5000 Odense C, Denmark.
| | - Thomas Allen
- Manchester Centre for Health Economics, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Frans Boch Waldorff
- Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9A, 5000 Odense C, Denmark
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Wille B, Allen T, Van Lierde K, Van Herreweghe M. Using the Adapted Flemish Sign Language Visual Communication and Sign Language Checklist. J Deaf Stud Deaf Educ 2020; 25:188-198. [PMID: 31711160 DOI: 10.1093/deafed/enz039] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 09/03/2019] [Accepted: 09/08/2019] [Indexed: 06/10/2023]
Abstract
This study addresses the topic of visual communication and early sign language acquisition in deaf children with a Flemish Sign Language (Vlaamse Gebarentaal or VGT) input. Results are obtained through a checklist focusing on sign-exposed deaf children's visual communication and early sign language acquisition: the adapted VGT Visual Communication and Sign Language checklist. The purpose is to obtain the first detailed picture of these children's visual and early VGT acquisition and to determine the optimal support for the checklist's ongoing standardization process. At the time of testing, all children were 24-months old and had been diagnosed with a severe or profound hearing loss before the age of 6 months. Half of the children were being raised in deaf families with native VGT exposure, while the other half were from hearing families with no prior VGT knowledge. All parents declared VGT accessibility to the child and that they used VGT in the home. Resulting from this study is the identification of five early visual communication items as being potentially good indicators of later (sign) language development. Further, concerns were put forward on the lack of ongoing visual, communication, and language support for deaf children and their parents in Flanders.
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Vaughan B, Mulcahy J, Allen T, Coupe E, Gobbo D, Nasser L, Pain K, Fitzgerald K. Life satisfaction and musculoskeletal complaints in a population seeking osteopathy care: consecutive sample of 611 patients. Chiropr Man Therap 2020; 28:14. [PMID: 32156310 PMCID: PMC7065312 DOI: 10.1186/s12998-020-00303-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 02/19/2020] [Indexed: 01/07/2023] Open
Abstract
Background Life satisfaction is a component of the subjective well-being construct. Research consistently suggests that life satisfaction is associated with enhanced social benefits and improved health outcomes. However, its relationship to musculoskeletal health outcomes is underexplored. This study evaluates the life satisfaction of a patient population presenting with musculoskeletal complaints, and the relationship of life satisfaction with other health demographics and behaviours. Method The study used a consecutive sampling design. Patients attending the Victoria University Osteopathy Clinic (Melbourne, Australia) were invited to complete the PROMIS® General Life Satisfaction scale (GLSS) along with questions related to health demographics and behaviours. Results The GLSS T-score was not significantly different for gender, being born outside of Australia, speaking English at home, or complaint chronicity. Conclusions Life satisfaction did not appear to be related to a range of health and demographic variables in the current musculoskeletal pain cohort. The PROMIS® General Life Satisfaction scale could prove useful to explore the relationship between life satisfaction and treatment outcomes for musculoskeletal complaints.
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Affiliation(s)
- Brett Vaughan
- Department of Medical Education, University of Melbourne, Melbourne, Australia.
| | - Jane Mulcahy
- College of Health & Biomedicine, Victoria University, Melbourne, Australia
| | - Thomas Allen
- College of Health & Biomedicine, Victoria University, Melbourne, Australia
| | - Emi Coupe
- College of Health & Biomedicine, Victoria University, Melbourne, Australia
| | - David Gobbo
- College of Health & Biomedicine, Victoria University, Melbourne, Australia
| | - Leila Nasser
- College of Health & Biomedicine, Victoria University, Melbourne, Australia
| | - Karen Pain
- College of Health & Biomedicine, Victoria University, Melbourne, Australia
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Allen T, Walshe K, Proudlove N, Sutton M. Measurement and improvement of emergency department performance through inspection and rating: an observational study of emergency departments in acute hospitals in England. Emerg Med J 2019; 36:326-332. [PMID: 30944115 PMCID: PMC6582714 DOI: 10.1136/emermed-2018-207941] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 11/25/2022]
Abstract
Introduction Hospital inspection and the publication of inspection ratings are widely used regulatory interventions that may improve hospital performance by providing feedback, creating incentives to change and promoting choice. However, evidence that these interventions assess performance accurately and lead to improved performance is scarce. Methods We calculated six standard indicators of emergency department (ED) performance for 118 hospitals in England whose EDs were inspected by the Care Quality Commission, the national regulator in England, between 2013 and 2016. We linked these to inspection dates and subsequent rating scores. We used multilevel linear regression models to estimate the relationship between prior performance and subsequent rating score and the relationship between rating score and post-inspection performance. Results We found no relationship between performance on any of the six indicators prior to inspection and the subsequent rating score. There was no change in performance on any of the six indicators following inspection for any rating score. In each model, CIs were wide indicating no statistically significant relationships. Discussion We found no association between established performance indicators and rating scores. This might be because the inspection and rating process adds little to the external performance management that EDs receive. It could also indicate the limited ability of hospitals to improve ED performance because of extrinsic factors that are beyond their control.
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Affiliation(s)
- Thomas Allen
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Kieran Walshe
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Nathan Proudlove
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Matt Sutton
- School of Health Sciences, University of Manchester, Manchester, UK
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Cogswell R, Teigen L, Allen T, Estep J, Araujo R, Schultz J, John R, Martin C, Trachtenberg B. Measurement of Pectoralis Muscle Quantity and Attenuation by Computed Tomography Using Routinely Available Software is Feasible and Predicts Mortality after LVAD Implantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1134] [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: 11/29/2022] Open
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Ji W, Zhao Y, Fahad HM, Bullock J, Allen T, Lien DH, De Wolf S, Javey A. Dip Coating Passivation of Crystalline Silicon by Lewis Acids. ACS Nano 2019; 13:3723-3729. [PMID: 30830749 DOI: 10.1021/acsnano.9b01038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The reduction of carrier recombination processes by surface passivation is vital for highly efficient crystalline silicon (c-Si) solar cells and bulk wafer metrological characterization. Herein, we report a dip coating passivation of silicon surfaces in ambient air and temperature with Nafion, achieving a champion effective carrier lifetime of 12 ms on high resistivity n-type c-Si, which is comparable to state-of-the-art passivation methods. Nafion is a nonreactive polymer with strong Lewis acidity, thus leading to the formation of a large density of fixed charges at silicon surface, 1-2 orders of magnitude higher than what is achievable with conventional thin-film passivation layers. Notably, Nafion passivates the c-Si surface only by the fixed charges without chemical modification of dangling bonds, which is fundamentally different from the common practice of combining chemical with field-effect passivation. This dip coating process is simple and robust, without the need for complex equipment or parameter optimization as there is no chemical reaction involved.
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Affiliation(s)
- Wenbo Ji
- Electrical Engineering and Computer Sciences , University of California , Berkeley , California 94720 , United States
- Materials Sciences Division , Lawrence Berkeley National Laboratory , Berkeley , California 94720 , United States
- Materials Science and Engineering , University of California , Berkeley , California 94720 , United States
| | - Yingbo Zhao
- Electrical Engineering and Computer Sciences , University of California , Berkeley , California 94720 , United States
- Materials Sciences Division , Lawrence Berkeley National Laboratory , Berkeley , California 94720 , United States
| | - Hossain M Fahad
- Electrical Engineering and Computer Sciences , University of California , Berkeley , California 94720 , United States
- Materials Sciences Division , Lawrence Berkeley National Laboratory , Berkeley , California 94720 , United States
| | - James Bullock
- Electrical Engineering and Computer Sciences , University of California , Berkeley , California 94720 , United States
- Materials Sciences Division , Lawrence Berkeley National Laboratory , Berkeley , California 94720 , United States
| | - Thomas Allen
- KAUST Solar Center (KSC) , King Abdullah University of Science and Technology (KAUST) , Thuwal 23955-6900 , Saudi Arabia
| | - Der-Hsien Lien
- Electrical Engineering and Computer Sciences , University of California , Berkeley , California 94720 , United States
- Materials Sciences Division , Lawrence Berkeley National Laboratory , Berkeley , California 94720 , United States
| | - Stefaan De Wolf
- KAUST Solar Center (KSC) , King Abdullah University of Science and Technology (KAUST) , Thuwal 23955-6900 , Saudi Arabia
| | - Ali Javey
- Electrical Engineering and Computer Sciences , University of California , Berkeley , California 94720 , United States
- Materials Sciences Division , Lawrence Berkeley National Laboratory , Berkeley , California 94720 , United States
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Lugo-Palacios DG, Hammond J, Allen T, Darley S, McDonald R, Blakeman T, Bower P. The impact of a combinatorial digital and organisational intervention on the management of long-term conditions in UK primary care: a non-randomised evaluation. BMC Health Serv Res 2019; 19:159. [PMID: 30866917 PMCID: PMC6416963 DOI: 10.1186/s12913-019-3984-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/01/2019] [Indexed: 02/01/2023] Open
Abstract
Background Better management of long-term conditions remains a policy priority, with a focus on improving outcomes and reducing use of expensive hospital services. A number of interventions have been tested, but many have failed to show benefit in rigorous comparative research. In 2016, the NHS Test Beds scheme was launched to implement and test interventions combining digital technologies and pathway redesign in routine health care settings, with each intervention comprising multiple innovations to better realise benefit from their ‘combinatorial’ effect. We present the evaluation of one of the NHS Test Beds, which combined risk stratification algorithms, practice-based quality improvement and health monitoring and coaching to improve management of long-term conditions in a single health economy in the north-west of England. Methods The NHS Test Bed was implemented in one clinical commissioning group in the north-west of England (patient population 235,800 served by 36 general practices). Routine administrative data on hospital use (the primary outcome) and a selection of secondary outcomes (data from both hospital and primary care) were collected in the intervention site, and from a comparator area in the same region. We used difference-in-differences analysis to compare outcomes in the NHS Test Bed area and the comparator after initiation of the combinatorial intervention. Results Tests confirmed the existence of parallel trends in the intervention and comparator sites for hospital outcomes for the period April 2016 to March 2017, and for some of the planned primary care outcomes. Based on 10 months of post-intervention secondary care data and 13 months post-intervention primary care data, we found no significant impact on primary outcomes between the intervention and comparator site, and a significant impact on only one secondary outcome. Conclusion A combinatorial digital and organisational intervention to improve the management of long-term conditions was implemented across a whole health economy, but we found no evidence of a positive impact on health care utilisation outcomes in hospital and primary care. Electronic supplementary material The online version of this article (10.1186/s12913-019-3984-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David G Lugo-Palacios
- Manchester Centre for Health Economics, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Jonathan Hammond
- Centre for Primary Care and Health Services Research, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Sarah Darley
- Centre for Primary Care and Health Services Research, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Ruth McDonald
- Centre for Primary Care and Health Services Research and Alliance Manchester Business School, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Thomas Blakeman
- NIHR Collaboration for Leadership in Applied Health Research and Care, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, M13 9PL, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Williamson Building, Oxford Road, Manchester, M13 9PL, UK
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Maw S, Allen T. Sports engineering education. Sports Eng 2018. [DOI: 10.1007/s12283-018-0287-9] [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: 11/28/2022]
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Allen T, Whittaker W, Kontopantelis E, Sutton M. Influence of financial and reputational incentives on primary care performance: a longitudinal study. Br J Gen Pract 2018; 68:e811-e818. [PMID: 30397016 PMCID: PMC6255225 DOI: 10.3399/bjgp18x699797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/25/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The Quality and Outcomes Framework has generated reputational as well as financial rewards for general practices because the number of quality points a practice receives is publicly reported. These rewards vary across diseases and practices, and over time. AIM To determine the relative effects on performance of the financial and reputational rewards resulting from a pay-for-performance programme. DESIGN AND SETTING Observational study of the published performance on 42 indicators of 8929 practices in England between 2004 and 2013. METHOD The authors calculated the revenue offered (financial reward, measured in £100s) and the points offered (reputational reward) per additional patient treated for each indicator for each practice in each year. Fixed-effects multivariable regression models were used to estimate whether the percentage of eligible patients treated responded to changes in these financial and reputational rewards. RESULTS Both the offered financial rewards and reputational rewards had small but statistically significant associations with practice performance. The effect of the financial reward on performance decreased from 0.797 percentage points per £100 (95% confidence interval [CI] = 0.614 to 0.979) in 2004, to 0.092 (95% CI = 0.045 to 0.138) in 2013. The effect of the reputational reward increased from -0.121 percentage points per quality point (95% CI = -0.220 to -0.022) in 2004, to 0.209 (95% CI = 0.147 to 0.271) in 2013. CONCLUSION In the short term, general practices were more sensitive to revenue than reputational rewards. In the long term, general practices appeared to divert their focus towards the reputational reward, once benchmarks of performance became established.
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Affiliation(s)
| | | | | | - Matt Sutton
- School of Health Sciences, University of Manchester, Manchester
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Huff AG, Allen T, Whiting K, Williams F, Hunter L, Gold Z, Madoff LC, Karesh WB. Biosurveillance: a systematic review of global infectious disease surveillance systems from 1900 to 2016. REV SCI TECH OIE 2018; 36:513-524. [PMID: 30152467 DOI: 10.20506/rst.36.2.2670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Biosurveillance is crucial to detect, identify and minimise the negative consequences of infectious disease. Its value to society and importance to global public health and global health security are growing. Despite the long history and global importance of biosurveillance, a systematic review of all existing biosurveillance systems across the 'One Health' spectrum has not yet been published. This study conducted a systematic review to identify all extant and defunct biosurveillance systems from 1900 to 2016. Of the 815 systems examined, the majority surveyed human, animal or plant data discretely. Some 105 collected human and animal data, whereas only 31 collected data on all three categories. The authors found a large increase in the number of global biosurveillance systems between 1900 and 2008, but a reduction in the number of biosurveillance systems from 2008 to the present. The number of syndromic systems created, versus laboratory-based biosurveillance systems, increased rapidly after 1980 across the globe.
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Lewis MM, Sterling NW, Du G, Lee EY, Shyu G, Goldenberg M, Allen T, Stetter C, Kong L, Snipes SA, Jones BC, Chen H, Mailman RB, Huang X. Lateralized Basal Ganglia Vulnerability to Pesticide Exposure in Asymptomatic Agricultural Workers. Toxicol Sci 2018. [PMID: 28633499 DOI: 10.1093/toxsci/kfx126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Pesticide exposure is linked to Parkinson's disease, a neurodegenerative disorder marked by dopamine cell loss in the substantia nigra of the basal ganglia (BG) that often presents asymmetrically. We previously reported that pesticide-exposed agricultural workers (AW) have nigral diffusion tensor imaging (DTI) changes. The current study sought to confirm this finding, and explore its hemisphere and regional specificity within BG structures using an independent sample population. Pesticide exposure history, standard neurological exam, high-resolution magnetic resonance imaging (T1/T2-weighted and DTI), and [123I]ioflupane SPECT images (to quantify striatal dopamine transporters) were obtained from 20 AW with chronic pesticide exposure and 11 controls. Based on median cumulative days of pesticide exposure, AW were subdivided into high (AWHi, n = 10) and low (AWLo, n = 10) exposure groups. BG (nigra, putamen, caudate, and globus pallidus [GP]) fractional anisotropy (FA), mean diffusivity (MD), and striatal [123I]ioflupane binding in each hemisphere were quantified, and compared across exposure groups using analysis of variance. Left, but not right, nigral and GP FA were significantly lower in AW compared with controls (p's < .029). None of the striatal (putamen and caudate) DTI or [123I]ioflupane binding measurements differed between AW and controls. Subgroup analyses indicated that significant left nigral and GP DTI changes were present only in the AWHi (p ≤ .037) but not the AWLo subgroup. AW, especially those with higher pesticide exposure history, demonstrate lateralized microstructural changes in the nigra and GP, whereas striatal areas appear relatively unaffected. Future studies should elucidate how environmental toxicants cause differential lateralized- and regionally specific brain vulnerability.
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Affiliation(s)
| | | | | | | | | | | | - Thomas Allen
- Department of Radiology, and Department of Public Health Sciences, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033
| | - Christy Stetter
- Department of Radiology, and Department of Public Health Sciences, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033
| | - Lan Kong
- Department of Radiology, and Department of Public Health Sciences, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033
| | - Shedra Amy Snipes
- Department of Biobehavioral Health, Pennsylvania State University University Park, Pennsylvania 16802
| | - Byron C Jones
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center, Memphis, Tennessee 38163
| | - Honglei Chen
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan 48824
| | | | - Xuemei Huang
- Department of Neurology.,Department of Pharmacology.,Department of Radiology, and Department of Public Health Sciences, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033
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Abstract
The disparity in maternal mortality for African American women remains one of the greatest public health inequities in the United States (US). To better understand approaches toward amelioration of these differences, we examine settings with similar disparities in maternal mortality and "near misses" based on race/ethnicity. This global analysis of disparities in maternal mortality/morbidity will focus on middle- and high-income countries (based on World Bank definitions) with multiethnic populations. Many countries with similar histories of slavery and forced migration demonstrate disparities in health outcomes based on social determinants such as race/ethnicity. We highlight comparisons in the Americas between the US and Brazil-two countries with the largest populations of African descent brought to the Americas primarily through the transatlantic slave trade. We also address the need to capture race/ethnicity/country of origin in a meaningful way in order to facilitate transnational comparisons and potential translatable solutions. Race, class, and gender-based inequities are pervasive, global themes. This approach is human rights-based and consistent with the UN Millennium Development Goals (MDG) and post 2015-sustainable development goals' aim to place women's health the context of health equity/women's rights. Solutions to these issues of inequity in maternal mortality are nation-specific and global.
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Affiliation(s)
- M Small
- Duke University School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Durham, NC
| | - T Allen
- Duke University School of Medicine, Department of Anesthesiology, Division of Women’s Anesthesia, Durham, NC
| | - HL Brown
- Duke University School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Durham, NC
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Yamamoto Y, Nagaoka K, Kamite Y, Watanabe G, Allen T, Stansfield F, Taya K. Different origins of two corpora lutea recovered from a pregnant African elephant (Loxodonta africana
). Reprod Domest Anim 2017; 52:1138-1141. [DOI: 10.1111/rda.13010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 05/23/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Y Yamamoto
- Department of Veterinary Medicine; Tokyo University of Agriculture and Technology; Tokyo Japan
| | - K Nagaoka
- Department of Veterinary Medicine; Tokyo University of Agriculture and Technology; Tokyo Japan
| | - Y Kamite
- Department of Veterinary Medicine; Tokyo University of Agriculture and Technology; Tokyo Japan
| | - G Watanabe
- Department of Veterinary Medicine; Tokyo University of Agriculture and Technology; Tokyo Japan
| | - T Allen
- The Elephant Research Unit; Save Valley Conservancy Zimbabwe
- The Paul Mellon Laboratory; Suffolk UK
| | - F Stansfield
- The Elephant Research Unit; Save Valley Conservancy Zimbabwe
- Department of Production Animal Studies; Faculty of Veterinary Science; University of Pretoria; Onderstepoort South Africa
| | - K Taya
- Department of Veterinary Medicine; Tokyo University of Agriculture and Technology; Tokyo Japan
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