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1دورية أكاديمية
المؤلفون: Graham Cooke, Shashank Patil, Runa Lazzarino, Amen-Patrick Nwosu, Kate Honeyford, Céire E Costelloe, Anne Kinderlerer, Andrew J Brent, John Welch, Peter Ghazal
المصدر: BMJ Health & Care Informatics, Vol 30, Iss 1 (2023)
مصطلحات موضوعية: Computer applications to medicine. Medical informatics, R858-859.7
الوصف: Objectives Describe digital sepsis alerts (DSAs) in use in English National Health Service (NHS) acute hospitals.Methods A Freedom of Information request surveyed acute NHS Trusts on their adoption of electronic patient records (EPRs) and DSAs.Results Of the 99 Trusts that responded, 84 had an EPR. Over 20 different EPR system providers were identified as operational in England. The most common providers were Cerner (21%). System C, Dedalus and Allscripts Sunrise were also relatively common (13%, 10% and 7%, respectively). 70% of NHS Trusts with an EPR responded that they had a DSA; most of these use the National Early Warning Score (NEWS2). There was evidence that the EPR provider was related to the DSA algorithm. We found no evidence that Trusts were using EPRs to introduce data driven algorithms or DSAs able to include, for example, pre-existing conditions that may be known to increase risk.Not all Trusts were willing or able to provide details of their EPR or the underlying algorithm.Discussion The majority of NHS Trusts use an EPR of some kind; many use a NEWS2-based DSA in keeping with national guidelines.Conclusion Many English NHS Trusts use DSAs; even those using similar triggers vary and many recreate paper systems. Despite the proliferation of machine learning algorithms being developed to support early detection of sepsis, there is little evidence that these are being used to improve personalised sepsis detection.
وصف الملف: electronic resource
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2دورية أكاديمية
المؤلفون: Marcela Maus, Caron Jacobson, Frederick L Locke, Oliver Dorigo, David Maloney, Jennifer Specht, Saurabh Dahiya, Edward Garon, Diane M Simeone, John Welch, Kedar Kirtane, Marwan Fakih, Julian Molina, Ariane Lozac’hmeur, J Randolph Hecht, Jong Chul Park, Caleb Smith, Theodore Welling, M Pia Morelli, Patrick M Grierson, Tomislav Dragovich, William Y Go, Eric W Ng, Peter Vu, Jessica Tebbets, Gayanie Ong
المصدر: Journal for ImmunoTherapy of Cancer, Vol 11, Iss Suppl 1 (2023)
مصطلحات موضوعية: Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
وصف الملف: electronic resource
Relation: https://doaj.org/toc/2051-1426
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3دورية أكاديمية
المؤلفون: Sarah Nikiforow, Yi Lin, Marcela Maus, Armen Mardiros, Frederick L Locke, Scott Kopetz, Matthew Frigault, David Maloney, Jeffrey Ward, Jennifer Specht, Edward Garon, Diane M Simeone, John Welch, Kedar Kirtane, Marwan Fakih, Julian Molina, Kirstin Liechty, Ariane Lozac’hmeur, J Randolph Hecht, Caleb Smith, Salman R Punekar, Theodore Welling, M Pia Morelli, Patrick M Grierson, Sandip P Patel, Wen-Kai Weng, Tomislav Dragovich, Judy Vong, William Y Go, Eric W Ng
المصدر: Journal for ImmunoTherapy of Cancer, Vol 11, Iss Suppl 1 (2023)
مصطلحات موضوعية: Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
وصف الملف: electronic resource
Relation: https://doaj.org/toc/2051-1426
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4دورية أكاديمية
المؤلفون: Dyfrig A Hughes, Emily A Holmes, Christian Subbe, Cor Kalkman, John Welch, Sally Lewis, Ralph So, Sumeshni Tranka
المصدر: BMJ Open, Vol 13, Iss 4 (2023)
مصطلحات موضوعية: Medicine
الوصف: Objectives Failure to rescue deteriorating patients in hospital is a well-researched topic. We aimed to explore the impact of safer care on health economic considerations for clinicians, providers and policymakers.Design We undertook a rapid review of the available literature and convened a round table of international specialists in the field including experts on health economics and value-based healthcare to better understand health economics of clinical deterioration and impact of systems to reduce failure to rescue.Results Only a limited number of publications have examined the health economic impact of failure to rescue. Literature examining this topic lacked detail and we identified no publications on long-term cost outside the hospital following a deterioration event. The recent pandemic has added limited literature on prevention of deterioration in the patients’ home.Cost-effectiveness and cost-efficiency are dependent on broader system effects of adverse events. We suggest including the care needs beyond the hospital and loss of income of patients and/or their informal carers as well as sickness of healthcare staff exposed to serious adverse events in the analysis of adverse events. They are likely to have a larger health economic impact than the direct attributable cost of the hospital admission of the patient suffering the adverse event. Premorbid status of a patient is a major confounder for health economic considerations.Conclusion In order to optimise health at the population level, we must limit long-term effects of adverse events through improvement of our ability to rapidly recognise and respond to acute illness and worsening chronic illness both in the home and the hospital.
وصف الملف: electronic resource
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5دورية أكاديمية
المؤلفون: Helen Hogan, Andrew Hutchings, Jerome Wulff, Catherine Carver, Elizabeth Holdsworth, Jerry Nolan, John Welch, David Harrison, Nick Black
المصدر: BMC Health Services Research, Vol 20, Iss 1, Pp 1-9 (2020)
مصطلحات موضوعية: Track and Trigger system, National Early Warning Score, Electronic Track and Trigger system, In-hospital cardiac arrest, Deterioration, Public aspects of medicine, RA1-1270
الوصف: Abstract Background Failure to recognise and respond to patient deterioration on hospital wards is a common cause of healthcare-related harm. If patients are not rescued and suffer a cardiac arrest as a result then only around 15% will survive. Track and Trigger systems have been introduced into the NHS to improve both identification and response to such patients. This study examines the association between the type of Track & Trigger System (TTS) (National Early Warning Score (NEWS) versus non-NEWS) and the mode of TTS (paper TTS versus electronic TTS) and incidence of in-hospital ward-based cardiac arrests (IHCA) attended by a resuscitation team. Methods TTS type and mode was retrospectively collected at hospital level from 106 NHS acute hospitals in England between 2009 to 2015 via an organisational survey. Poisson regression and logistic regression models, adjusted for case-mix, temporal trends and seasonality were used to determine the association between TTS and hospital-level ward-based IHCA and survival rates. Results The NEWS was introduced in England in 2012 and by 2015, three-fifths of hospitals had adopted it. One fifth of hospitals had instituted an electronic TTS by 2015. Between 2009 and 2015 the incidence of IHCA fell. Introduction or use of NEWS in a hospital was associated with a reduction of 9.4% in the rate of ward-based IHCA compared to non-NEWS systems (incidence rate ratio 0.906, p
وصف الملف: electronic resource
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6دورية أكاديمية
المؤلفون: Jeremy Opie, Maura Bellio, Rachel Williams, Maya Sussman, Petra Voegele, John Welch, Ann Blandford
المصدر: Frontiers in Big Data, Vol 4 (2021)
مصطلحات موضوعية: pain management, dashboards, critical care unit, electronic health record, quality improvement team, Information technology, T58.5-58.64
الوصف: Pain management is often considered lower priority than many other aspects of health management in hospitals. However, there is potential for Quality Improvement (QI) teams to improve pain management by visualising and exploring pain data sets. Although dashboards are already used by QI teams in hospitals, there is limited evidence of teams accessing visualisations to support their decision making. This study aims to identify the needs of the QI team in a UK Critical Care Unit (CCU) and develop dashboards that visualise longitudinal data on the efficacy of patient pain management to assist the team in making informed decisions to improve pain management within the CCU. This research is based on an analysis of transcripts of interviews with healthcare professionals with a variety of roles in the CCU and their evaluation of probes. We identified two key uses of pain data: direct patient care (focusing on individual patient data) and QI (aggregating data across the CCU and over time); in this paper, we focus on the QI role. We have identified how CCU staff currently interpret information and determine what supplementary information can better inform their decision making and support sensemaking. From these, a set of data visualisations has been proposed, for integration with the hospital electronic health record. These visualisations are being iteratively refined in collaboration with CCU staff and technical staff responsible for maintaining the electronic health record. The paper presents user requirements for QI in pain management and a set of visualisations, including the design rationale behind the various methods proposed for visualising and exploring pain data using dashboards.
وصف الملف: electronic resource
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7دورية أكاديمية
المؤلفون: Sohini Sengupta, Sam Q. Sun, Kuan-lin Huang, Clara Oh, Matthew H. Bailey, Rajees Varghese, Matthew A. Wyczalkowski, Jie Ning, Piyush Tripathi, Joshua F. McMichael, Kimberly J. Johnson, Cyriac Kandoth, John Welch, Cynthia Ma, Michael C. Wendl, Samuel H. Payne, David Fenyö, Reid R. Townsend, John F. Dipersio, Feng Chen, Li Ding
المصدر: Genome Medicine, Vol 10, Iss 1, Pp 1-20 (2018)
مصطلحات موضوعية: Cancer genomics, Multi-omics, Proteogenomics, Precision medicine, Cancer and druggability, Medicine, Genetics, QH426-470
الوصف: Abstract Background Although large-scale, next-generation sequencing (NGS) studies of cancers hold promise for enabling precision oncology, challenges remain in integrating NGS with clinically validated biomarkers. Methods To overcome such challenges, we utilized the Database of Evidence for Precision Oncology (DEPO) to link druggability to genomic, transcriptomic, and proteomic biomarkers. Using a pan-cancer cohort of 6570 tumors, we identified tumors with potentially druggable biomarkers consisting of drug-associated mutations, mRNA expression outliers, and protein/phosphoprotein expression outliers identified by DEPO. Results Within the pan-cancer cohort of 6570 tumors, we found that 3% are druggable based on FDA-approved drug-mutation interactions in specific cancer types. However, mRNA/phosphoprotein/protein expression outliers and drug repurposing across cancer types suggest potential druggability in up to 16% of tumors. The percentage of potential drug-associated tumors can increase to 48% if we consider preclinical evidence. Further, our analyses showed co-occurring potentially druggable multi-omics alterations in 32% of tumors, indicating a role for individualized combinational therapy, with evidence supporting mTOR/PI3K/ESR1 co-inhibition and BRAF/AKT co-inhibition in 1.6 and 0.8% of tumors, respectively. We experimentally validated a subset of putative druggable mutations in BRAF identified by a protein structure-based computational tool. Finally, analysis of a large-scale drug screening dataset lent further evidence supporting repurposing of drugs across cancer types and the use of expression outliers for inferring druggability. Conclusions Our results suggest that an integrated analysis platform can nominate multi-omics alterations as biomarkers of druggability and aid ongoing efforts to bring precision oncology to patients.
وصف الملف: electronic resource
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8دورية أكاديمية
المؤلفون: Paul R Mouncey, Dorothy Wade, Alvin Richards-Belle, Zia Sadique, Jerome Wulff, Richard Grieve, Lydia M Emerson, Chris R Brewin, Sheila Harvey, David Howell, Nicholas Hudson, Imran Khan, Monty Mythen, Deborah Smyth, John Weinman, John Welch, David A Harrison, Kathryn M Rowan
المصدر: Health Services and Delivery Research, Vol 7, Iss 30 (2019)
مصطلحات موضوعية: CRITICAL CARE, INTENSIVE CARE, ICU, MENTAL HEALTH, POST-TRAUMATIC STRESS DISORDER, PSYCHOLOGICAL INTERVENTION, Public aspects of medicine, RA1-1270, Medicine (General), R5-920
الوصف: Background: High numbers of patients experience severe acute stress in critical care units. Acute stress has been linked to post-critical care psychological morbidity, including post-traumatic stress disorder (PTSD). Previously, a preventive, complex psychological intervention [Psychological Outcomes following a nurse-led Preventative Psychological Intervention for critically ill patients (POPPI)] was developed by this research team, to be led by nurses, to reduce the development of PTSD symptom severity at 6 months. Objectives: The objectives were to (1) standardise and refine the POPPI intervention, and, if feasible, (2) evaluate it in a cluster randomised clinical trial (RCT). Design: Two designs were used – (1) two feasibility studies to test the delivery and acceptability (to patients and staff) of the intervention, education package and support tools, and to test the trial procedures (i.e. recruitment and retention), and (2) a multicentre, parallel-group, cluster RCT with a baseline period and staggered roll-out of the intervention. Setting: This study was set in NHS adult, general critical care units. Participants: The participants were adult patients who were > 48 hours in a critical care unit, receiving level 3 care and able to consent. Interventions: The intervention comprised three elements – (1) creating a therapeutic environment in critical care, (2) three stress support sessions for patients identified as acutely stressed and (3) a relaxation and recovery programme for patients identified as acutely stressed. Main outcome measures: Primary outcome – patient-reported symptom severity using the PTSD Symptom Scale – Self Report (PSS-SR) questionnaire (to measure clinical effectiveness) and incremental costs, quality-adjusted life-years (QALYs) and net monetary benefit at 6 months (to measure cost-effectiveness). Secondary outcomes – days alive and free from sedation to day 30; duration of critical care unit stay; PSS-SR score of > 18 points; depression, anxiety and health-related quality of life at 6 months; and lifetime cost-effectiveness. Results: (1) A total of 127 participants were recruited to the intervention feasibility study from two sites and 86 were recruited to the RCT procedures feasibility study from another two sites. The education package, support tools and intervention were refined. (2) A total of 24 sites were randomised to the intervention or control arms. A total of 1458 participants were recruited. Twelve sites delivered the intervention during the intervention period: > 80% of patients received two or more stress support sessions and all 12 sites achieved the target of > 80% of clinical staff completing the POPPI online training. There was, however, variation in delivery across sites. There was little difference between baseline and intervention periods in the development of PTSD symptom severity (measured by mean PSS-SR score) at 6 months for surviving patients in either the intervention or the control group: treatment effect estimate −0.03, 95% confidence interval (CI) −2.58 to 2.52; p = 0.98. On average, the intervention decreased costs and slightly improved QALYs, leading to a positive incremental net benefit at 6 months (£835, 95% CI −£4322 to £5992), but with considerable statistical uncertainty surrounding these results. There were no significant differences between the groups in any of the secondary outcomes or in the prespecified subgroup analyses. Limitations: There was a risk of bias because different consent processes were used and as a result of the lack of blinding, which was mitigated as far as possible within the study design. The intervention started later than anticipated. Patients were not routinely monitored for delirium. Conclusions: Among level 3 patients who stayed > 48 hours in critical care, the delivery of a preventive, complex psychological intervention, led by nurses, did not reduce the development of PTSD symptom severity at 6 months, when compared with usual care. Future work: Prior to development and evaluation of subsequent psychological interventions, there is much to learn from post hoc analyses of the cluster RCT rich quantitative and qualitative data. Trial registration: This trial is registered as ISRCTN61088114 and ISRCTN53448131. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 23, No. 30. See the NIHR Journals Library website for further project information.
وصف الملف: electronic resource
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9دورية أكاديمية
المؤلفون: Christian P. Subbe, John Kellett, Paul Barach, Catriona Chaloner, Hayley Cleaver, Tim Cooksley, Erik Korsten, Eilish Croke, Elinor Davis, Ashley JR De Bie, Lesley Durham, Chris Hancock, Jilian Hartin, Tracy Savijn, John Welch, on behalf of the Crisis Checklist Collaborative
المصدر: BMC Health Services Research, Vol 17, Iss 1, Pp 1-8 (2017)
مصطلحات موضوعية: Rapid response teams, Crisis, Reliability, Patient safety, Simulation, Learning Collaborative, Public aspects of medicine, RA1-1270
الوصف: Abstract Background ‘Failure to rescue’ of hospitalized patients with deteriorating physiology on general wards is caused by a complex array of organisational, technical and cultural failures including a lack of standardized team and individual expected responses and actions. The aim of this study using a learning collaborative method was to develop consensus recomendations on the utility and effectiveness of checklists as training and operational tools to assist in improving the skills of general ward staff on the effective rescue of patients with abnormal physiology. Methods A scoping study of the literature was followed by a multi-institutional and multi-disciplinary international learning collaborative. We sought to achieve a consensus on procedures and clinical simulation technology to determine the requirements, develop and test a safe using a checklist template that is rapidly accessible to assist in emergency management of common events for general ward use. Results Safety considerations about deteriorating patients were agreed upon and summarized. A consensus was achieved among an international group of experts on currently available checklist formats performing poorly in simulation testing as first responders in general ward clinical crises. The Crisis Checklist Collaborative ratified a consensus template for a general ward checklist that provides a list of issues for first responders to address (i.e. ‘Check In’), a list of prompts regarding common omissions (i.e. ‘Stop & Think’), and, a list of items required for the safe “handover” of patients that remain on the general ward (i.e. ‘Check Out’). Simulation usability assessment of the template demonstrated feasibility for clinical management of deteriorating patients. Conclusions Emergency checklists custom-designed for general ward patients have the potential to guide the treatment speed and reliability of responses for emergency management of patients with abnormal physiology while minimizing the risk of adverse events. Interventional trials are needed.
وصف الملف: electronic resource
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10دورية أكاديمية
المؤلفون: Helen Hogan, Andrew Hutchings, Jerome Wulff, Catherine Carver, Elizabeth Holdsworth, John Welch, David Harrison, Nick Black
المصدر: Health Services and Delivery Research, Vol 7, Iss 2 (2019)
مصطلحات موضوعية: Public aspects of medicine, RA1-1270, Medicine (General), R5-920
الوصف: Background: Unchecked patient deterioration can lead to in-hospital cardiac arrest (IHCA) and avoidable death. The National Cardiac Arrest Audit (NCAA) has found fourfold variation in IHCA rates and survival between English hospitals. Key to reducing IHCA is both the identification of patients at risk of deterioration and prompt response. A range of targeted interventions have been introduced but implementation varies between hospitals. These differences are likely to contribute to the observed variation between and within hospitals over time. Objective: To determine how interventions aimed at identification and management of deteriorating patients are associated with IHCA rates and outcomes. Design: A mixed-methods study involving a systematic literature review, semistructured interviews with 60 NHS staff, an organisational survey in 171 hospitals and interrupted time series and difference-in-difference analyses (106 hospitals). Setting: English hospitals participating in the NCAA audit. Participants: NHS staff (approximately 300) and patients (13 million). Interventions: Education, track-and-trigger systems (TTSs), standardised handover tools and outreach teams. Main outcome measures: IHCA rates, survival and hospital-wide mortality. Data sources: NCAA, Hospital Episode Statistics, Office for National Statistics Mortality Statistics. Methods: A literature review and qualitative interviews were used to design an organisational survey that determined how interventions have been implemented in practice and across time. Associations between variations in services and IHCA rates and survival were determined using cross-sectional, interrupted time series and difference-in-difference analyses over the index study period (2009/10 to 2014/15). Results: Across NCAA hospitals, IHCAs fell by 6.4% per year and survival increased by 5% per year, with hospital mortality decreasing by a similar amount. A national, standard TTS [the National Early Warning Score (NEWS)], introduced in 2012, was adopted by 70% of hospitals by 2015. By 2015, one-third of hospitals had converted from paper-based TTSs to electronic TTSs, and there had been an increase in the number of hospitals with an outreach team and an increase in the number with a team available at all times. The extent of variation in the uses of educational courses and structured handover tools was limited, with 90% of hospitals reporting use of standardised communication tools, such as situation, background, assessment and recommendation, in 2015. Introduction of the NEWS was associated with an additional 8.4% decrease in IHCA rates and, separately, a conversion from paper to electronic TTS use was associated with an additional 7.6% decrease. However, there was no associated change in IHCA survival or hospital mortality. Outreach teams were not associated with a change in IHCA rates, survival or hospital mortality. A sensitivity analysis restricted to ward-based IHCAs did not alter the findings but did identify an association between increased outreach team intensity in 2015 and IHCA survival. Limitations: The organisational survey was not able to explore all aspects of the interventions and the contextual factors that influenced them. Changes over time were dependent on respondents’ recall. Conclusions: Standardisation of TTSs and introduction of electronic TTSs are associated with a reduction in IHCAs. The apparent lack of impact of outreach teams may reflect their mode of introduction, that their effect is through providing support for implementation of TTS or that the organisation of the response to deterioration is not critical, as long as it is timely. Their role in end-of-life decision-making may account for the observed association with IHCA survival. Future work: To assess the potential impact of outreach teams at hospital level and patient level, and to establish which component of the TTS has the greatest effect on outcomes. Funding: The National Institute for Health Research Health Services and Delivery Research programme.
وصف الملف: electronic resource
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