Publications by authors named "Jacques Richard"

72 Publications

Patient compliance with NHS 111 advice: Analysis of adult call and ED attendance data 2013-2017.

PLoS One 2021 10;16(5):e0251362. Epub 2021 May 10.

School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom.

The NHS 111 telephone advice and triage service is a vital part of the management of urgent and emergency care (UEC) services in England. Demand for NHS 111 advice has increased since its introduction in 2013, and the service is of particular importance in light of the current pandemic and resulting increased demand for emergency care. Currently, little is known about the effectiveness of NHS 111 in terms of the appropriateness of the advice given, or about the compliance of patients with that advice. We aimed to address this issue by analysing a large linked routine dataset of all NHS 111 calls (n = 3,631,069) and subsequent emergency department (ED) attendances made in the Yorkshire & Humber region from March 2013-March 2017. We found that many patients do not comply with advice, with 11% (n = 289,748) of patients attending ED when they are advised to self-care or seek primary care. We also found that a considerable number of these patients are further classed as urgent (88%, n = 255,931) and a substantial minority (37%, 106,207) are subsequently admitted to hospital. Further, many patients who are sent an ambulance or told to attend ED are classed as non-urgent upon attending ED (9%, n = 42,372). This research suggests that the level at which NHS 111 is currently triaging results in many hundreds of thousands of mis-triaged cases annually. Additionally, patients frequently do not comply with the advice they receive. This has implications for understanding the accuracy and efficiency of triaging systems.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251362PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8109810PMC
May 2021

Effect of selenium supplementation on musculoskeletal health in older women: a randomised, double-blind, placebo-controlled trial.

Lancet Healthy Longev 2021 Apr;2(4):e212-e221

Mellanby Centre for Musculoskeletal Research, University of Sheffield, Northern General Hospital, Sheffield, UK.

Background: Observational and preclinical studies show associations between selenium status, bone health, and physical function. Most adults in Europe have serum selenium below the optimum range. We hypothesised that selenium supplementation could reduce pro-resorptive actions of reactive oxygen species on osteoclasts and improve physical function.

Methods: We completed a 6-month randomised, double-blind, placebo-controlled trial. We recruited postmenopausal women older than 55 years with osteopenia or osteoporosis at the Northern General Hospital, Sheffield, UK. Participants were randomly assigned 1:1:1 to receive selenite 200 μg, 50 μg, or placebo orally once per day. Medication was supplied to the site blinded and numbered by a block randomisation sequence with a block size of 18, and participants were allocated medication in numerical order. All participants and study team were masked to treatment allocation. The primary endpoint was urine N-terminal cross-linking telopeptide of type I collagen (NTx, expressed as ratio to creatinine) at 26 weeks. Analysis included all randomly assigned participants who completed follow-up. Groups were compared with analysis of covariance with Hochberg testing. Secondary endpoints were other biochemical markers of bone turnover, bone mineral density, short physical performance battery, and grip strength. Mechanistic endpoints were glutathione peroxidase, highly sensitive C-reactive protein, and interleukin-6. This trial is registered with EU clinical trials, EudraCT 2016-002964-15, and ClinicalTrials.gov, NCT02832648, and is complete.

Findings: 120 participants were recruited between Jan 23, 2017, and April 11, 2018, and randomly assigned to selenite 200 μg, 50 μg, or placebo (n=40 per group). 115 (96%) of 120 participants completed follow-up and were included in the primary analysis (200 μg [n=39], 50 μg [n=39], placebo [n=37]). Median follow-up was 25·0 weeks (IQR 24·7-26·0). In the 200 μg group, mean serum selenium increased from 78·8 (95% CI 73·5-84·2) to 105·7 μg/L (99·5-111·9). Urine NTx to creatinine ratio (nmol bone collagen equivalent:mmol creatinine) did not differ significantly between treatment groups at 26 weeks: 40·5 (95% CI 34·9-47·0) for placebo, 43·4 (37·4-50·5) for 50 μg, and 42·2 (37·5-47·6) for 200 μg. None of the secondary or mechanistic endpoint measurements differed between treatment groups at 26 weeks. Seven (6%) of 120 participants were withdrawn from treatment at week 13 due to abnormal thyroid-stimulating hormone concentrations (one in the 200 μg group, three in the 50 μg group, and three in the placebo group) and abnormal blood glucose (one in the 50 μg group). There were three serious adverse events: a non-ST elevation myocardial infarction at week 18 (in the 50 μg group), a diagnosis of bowel cancer after routine population screening at week 2 (in the placebo group), and a pulmonary embolus due to metastatic bowel cancer at week 4 (in the 200 μg group). All severe adverse events were judged by the principal investigator as unrelated to trial medication.

Interpretation: Selenium supplementation at these doses does not affect musculoskeletal health in postmenopausal women.

Funding: UK National Institute for Health Research Efficacy and Mechanism Evaluation programme.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S2666-7568(21)00051-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020713PMC
April 2021

A Scoping Review of Selected Studies on Predictor Variables Associated with the Malaria Status among Children under Five Years in Sub-Saharan Africa.

Int J Environ Res Public Health 2021 02 22;18(4). Epub 2021 Feb 22.

Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK.

Background/purpose: In recent times, Sub-Saharan Africa (SSA) had been rated by the World Health Organization (WHO) as the most malaria-endemic region in the world. Evidence synthesis of the factors associated with malaria among children aged under-five in SSA is urgently needed. This would help to inform decisions that policymakers and executors in the region need to make for the effective distribution of scarce palliative resources to curb the spread of the illness. This scoping review is aimed at identifying studies that have used multivariate classical regression analysis to determine the predictors associated with malaria among children under five years old in SSA.

Methods/design: The search terms followed population, intervention, comparator, outcome, timing, setting (PICOTS), and were used in searching through the following databases: PubMed, MEDLINE, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, and Measure DHS. The databases were searched for published articles from January 1990 to December 2020.

Results: Among the 1154 studies identified, only thirteen (13) studies met the study's inclusion criteria. Narrative syntheses were performed on the selected papers to synchronize the various predictors identified. Factors ranging from child-related (age, birth order and use of a bed net), parental/household-related (maternal age and education status, household wealth index) and community-related variables (community wealth status, free bed net distribution) were some of the identified significant predictors.

Conclusions: It is timely to have a synthesis of predictors that influence the malaria status of children under-five in SSA. The outcome of the review will increase the knowledge of the epidemiology of morbidity that will form the basis for designing efficient and cost-effective distribution of palliatives and control of malaria in SSA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph18042119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927088PMC
February 2021

Accelerating functional gene discovery in osteoarthritis.

Nat Commun 2021 01 20;12(1):467. Epub 2021 Jan 20.

Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK.

Osteoarthritis causes debilitating pain and disability, resulting in a considerable socioeconomic burden, yet no drugs are available that prevent disease onset or progression. Here, we develop, validate and use rapid-throughput imaging techniques to identify abnormal joint phenotypes in randomly selected mutant mice generated by the International Knockout Mouse Consortium. We identify 14 genes with functional involvement in osteoarthritis pathogenesis, including the homeobox gene Pitx1, and functionally characterize 6 candidate human osteoarthritis genes in mouse models. We demonstrate sensitivity of the methods by identifying age-related degenerative joint damage in wild-type mice. Finally, we phenotype previously generated mutant mice with an osteoarthritis-associated polymorphism in the Dio2 gene by CRISPR/Cas9 genome editing and demonstrate a protective role in disease onset with public health implications. We hope this expanding resource of mutant mice will accelerate functional gene discovery in osteoarthritis and offer drug discovery opportunities for this common, incapacitating chronic disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41467-020-20761-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817695PMC
January 2021

The Use of Dyadic Reading in Stimulating the Comprehension of Emotions.

J Genet Psychol 2021 Mar-Apr;182(2):75-88. Epub 2021 Jan 8.

Department of Psychology, Laurentian University, Sudbury, Ontario, Canada.

According to the model proposed by Pons, Doudin, and Harris , children develop nine components of emotion comprehension between the ages of three to twelve. Studies reveal that children's comprehension of emotions can be stimulated by adults reading books designed for this purpose to preschool-aged children. The aim of this study is to explore whether dyadic reading is an effective strategy for stimulating emotion comprehension in school-aged children. Elementary school children (3rd, 4th and 5th grade) participated in the experimental or the control group. The Test of Emotion Comprehension (TEC) was administered at pretest and post-test. Participants in the experimental group read the books on emotion comprehension for five sessions, while participants in the control group read classroom books. Results revealed that reading the emotion comprehension books increased the TEC post-test scores significantly from pretest for children in the experimental group, compared to the control group. For the Components and scores at post-test were significantly increased from pretest for children in the experimental group, compared to the control group. Results suggest that dyadic book readings are successful in helping children with both complex components of their emotion comprehension and simpler ones. This intervention could be of use for teaching school-aged children emotion comprehension easily, effectively, and at low-cost.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/00221325.2020.1868969DOI Listing
January 2021

A Scoping Review of the Risk Factors Associated with Anaemia among Children Under Five Years in Sub-Saharan African Countries.

Int J Environ Res Public Health 2020 11 27;17(23). Epub 2020 Nov 27.

Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK.

Globally, anaemia is a severe public health condition affecting over 24% of the world's population. Children under five years old and pregnant women are the most vulnerable to this disease. This scoping review aimed to evaluate studies that used classical statistical regression methods on nationally representative health survey data to identify the individual socioeconomic, demographic and contextual risk factors associated with developing anaemia among children under five years of age in sub-Saharan Africa (SSA). The reporting pattern followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The following databases were searched: MEDLINE, EMBASE (OVID platform), Web of Science, PUBMED, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus, Cochrane library, African Journal of online (AJOL), Google Scholar and Measure DHS. The review identified 20 relevant studies and the risk factors for anaemia were classified as child-related, parental/household-related and community- or area-related factors. The risk factors for anaemia identified included age, birth order, sex, comorbidities (such as fever, diarrhoea and acute respiratory infection), malnutrition or stunting, maternal education, maternal age, mother's anaemia status, household wealth and place of residence. The outcome of this review is of significant value for health policy and planners to enable them to make informed decision that will correct any imbalances in anaemia across socioeconomic, demographic and contextual characteristics, with the view of making efficient distributions of health interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph17238829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731158PMC
November 2020

Risk Factors Associated with Malnutrition among Children Under-Five Years in Sub-Saharan African Countries: A Scoping Review.

Int J Environ Res Public Health 2020 11 26;17(23). Epub 2020 Nov 26.

Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK.

: Malnutrition is a significant global public health burden with greater concern among children under five years in Sub-Saharan Africa (SSA). To effectively address the problem of malnutrition, especially in resource-scarce communities, knowing the prevalence, causes and risk factors associated with it are essential steps. This scoping review aimed to identify the existing literature that uses classical regression analysis on nationally representative health survey data sets to find the individual socioeconomic, demographic and contextual risk factors associated with malnutrition among children under five years of age in Sub-Sahara Africa (SSA). : The electronic databases searched include EMBASE (OVID platform), PubMed (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science (WoS) and Cochrane Library. Only papers written in the English language, and for which the publication date was between 1 January 1990 and 31 July 2020, were included. : A total of 229 papers were identified, of which 26 were studies that have been included in the review. The risk factors for malnutrition identified were classified as child-related, parental/household-related and community or area-related. : Study-interest bias toward stunting over other anthropometric indicators of malnutrition could be addressed with a holistic research approach to equally address the various dimension of the anthropometric indicators of malnutrition in a population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph17238782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731119PMC
November 2020

Impact of Type 1 Diabetes Mellitus on Skeletal Integrity and Strength in Adolescents as Assessed by HRpQCT.

JBMR Plus 2020 Nov 2;4(11):e10422. Epub 2020 Nov 2.

Department of Paediatric Endocrinology Sheffield Children's NHS Foundation Trust Sheffield UK.

Adults with type 1 diabetes mellitus (T1DM) are at risk of premature osteoporosis and fractures. The onset of T1DM typically starts during childhood and adolescence. Thus, the effects of DM on the skeleton may be established during this period. Studies in children with T1DM primarily use DXA with conflicting results. We present the first study in adolescents assessing the impact of T1DM on skeletal microstructure and strength using HRpQCT. We recruited 22 patients aged 12 to 16 years with T1DM who were matched by age, gender, and pubertal stage with healthy controls. Paired tests were applied to assess differences in cortical and trabecular microarchitecture measurements from HRpQCT, and skeletal strength from HRpQCT-derived microfinite element analysis. Subtotal body, lumbar, and pelvic parameters were assessed using DXA. There was no significant difference in subtotal body, lumbar spine, and pelvic BMD between T1DM and control pairs. However, tibial trabecular thickness was lower (-0.005 mm; 95% CI, -0.01 to -0.001; = 0.029) and trabecular loading was lower at the distal radius (ratio of the load taken by the trabecular bone in relation to the total load at the distal end (Tb.F/TF) distal: -6.2; 95% CI, -12.4 to -0.03; = 0.049), and distal and proximal tibia (Tb.F/TF distal: -5.2, 95% CI, -9.2 to -1.2; = 0.013; and Tb.F/TF proximal: -5.0, 95% CI, -9.8 to -0.1; = 0.047) in T1DM patients. A subanalysis of radial data of participants with duration of T1DM of at least 2 years and their matched controls demonstrated a reduced trabecular bone number (-0.15, 95% CI, -0.26 to -0.04; = 0.012), increased trabecular separation (0.041 mm, 95% CI, 0.009-0.072; = 0.015), an increased trabecular inhomogeneity (0.018, 95% CI, 0.003-0.034; = 0.021). Regression models demonstrated a reduction in tibial stiffness (-0.877 kN/mm; = 0.03) and tibial failure load (-0.044 kN; = 0.03) with higher HbA1C. Thus, in adolescents with T1DM, detrimental changes are seen in tibial and radial microarchitecture and tibial and radial strength before changes in DXA occur and may result from poor diabetic control. © 2020 The Authors. published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jbm4.10422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657396PMC
November 2020

Physicochemical Characterization of Mining Waste from the Betare-Oya Gold Area (East Cameroon) and an Adsorption Test by Sabga Smectite (North-West Cameroon).

Scientifica (Cairo) 2020 9;2020:6293819. Epub 2020 Oct 9.

Department of Mining Engineering, School of Geology and Mining Engineering, University of Ngaoundéré, P.O. Box 115, Meiganga, Cameroon.

This paper, firstly, characterizes the mining waste of the Betare-Oya gold area (East Cameroon). Surface waters are sampled and characterized physically (pH, electrical conductivity, turbidity, and suspended solids) and chemically by the determination of trace metals (Cu, Zn, Ni, Mn, Fe, Cr, As, and Pb). The concentrations of heavy metals in sediment samples are determined by X-ray Fluorescence Spectrometry (XRF) analysis. The statistical analysis tool is used to determine the existing correlation between the different physicochemical parameters. Secondly, an adsorption test for heavy metals determined is carried out on smectic clay of Sabga (North-West Cameroon) at ambient temperature. The results of physicochemical characterization of water samples reveal that waters of this gold mining zone are slightly acidic to neutral (6.3 pH < 7.1), mineralized (18.54 EC < 43 s.cm), turbid (60 SS < 237.67 NTU), and polluted by suspended solids (50.5 < SS < 666.6 mg L).The determination of heavy metals in water samples shows that manganese, iron, arsenic, and lead concentrations are above the World Health Organization (WHO) limits. This indicates pollution. High concentrations of heavy metals as Cu, Ni, Mn, Fe, and Cr are observed in sediment samples. The correlation analysis indicates high correlations between turbidity and suspended solids; cadmium and lead in water samples; and copper and iron in sediment samples. The adsorption test reveals that the maximum percentage removal is 60, 89, 55, -89.74, and 100% for Cu, Zn, Mn, Fe, and Pb, respectively, after adding 0.5 g of Sabga smectic clay. This clay has a good potential adsorption of lead, zinc, manganese, and copper. However, the operating conditions favored desorption of iron.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2020/6293819DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568780PMC
October 2020

Normocalcaemic hyperparathyroidism and primary hyperparathyroidism: least significant change for adjusted serum calcium.

Eur J Endocrinol 2021 Jan;184(1):K7-K10

Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.

Introduction: The least significant change (LSC) is a term used in individuals in order to evaluate whether one measurement has changed significantly from the previous one. It is widely used when assessing bone mineral density (BMD) scans. To the best of our knowledge, there no such estimate available in the literature for patients with disorders of calcium metabolism. Our aim was to provide an estimate of the least significant change for albumin-adjusted calcium in patients with normocalcaemic hyperparathyroidism (NPHPT) and primary hyperparathyroidism (PHPT).

Methods: We used the within-subject standard deviatio calculated in a population of NPHPT and PHPT patients and multiplied it by 2.77.

Results: The LSC for NPHPT and PHPT were found to be 0.25 and 0.24 mmol/L, respectively (1.00 and 0.96 mg/dL). In clinical practice, the value of 0.25 mmol/L could be used.

Discussion: The least significant change given, could be used in two ways in these patients. First, it gives a range to which values are expected. This can provide some reassurance for the patient and the physician in cases of intermittent hypercalcaemia. Moreover, it can be a marker of whether an individual has an actual significant change of his calcium after parathyroid surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1530/EJE-20-0634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7707804PMC
January 2021

Impact of social prescribing to address loneliness: A mixed methods evaluation of a national social prescribing programme.

Health Soc Care Community 2020 Oct 20. Epub 2020 Oct 20.

School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK.

Loneliness is considered a global public health issue because of its detrimental impact on physical and mental health but little is known about which interventions can reduce loneliness. One potential intervention is social prescribing, where a link worker helps service-users to access appropriate support such as community activities and social groups. Some qualitative studies have identified that social prescribing may help to reduce service-users' loneliness. Given this, the British Red Cross (a third sector organisation) developed and delivered a national social prescribing service in the United Kingdom to support people who were experiencing, or at risk of, loneliness. Service-users could receive up to 12 weeks of support from a link worker. A mixed methods study was conducted to understand the impact of the support on loneliness, and to identify the facilitators and barriers to service delivery. The study included: (a) analysis of quantitative data collected routinely between May 2017 and December 2019 (n = 10,643) including pre-post analysis of UCLA data (n = 2,250) and matched comparator work to measure changes in loneliness; (b) semi-structured interviews with service-users, link workers and volunteers (n = 60) and (c) a Social Return on Investment Analysis. The majority of the service-users (72.6%, n = 1634/2250) felt less lonely after receiving support. The mean change in UCLA score was -1.84 (95% CI -1.91 to -1.77) of a maximum change of 6.00 (decrease indicates an improvement). Additional benefits included improved wellbeing, increased confidence and life having more purpose. The base case analysis estimated a social return on investment of £3.42 per £1 invested in the service. Having skilled link workers and support tailored to individual needs appeared key. However, challenges included utilising volunteers, meeting some service-users' needs in relation to signposting and sustaining improvements in loneliness. Nonetheless, the service appeared successful in supporting service-users experiencing loneliness.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/hsc.13200DOI Listing
October 2020

Using machine-learning risk prediction models to triage the acuity of undifferentiated patients entering the emergency care system: a systematic review.

Diagn Progn Res 2020 2;4:16. Epub 2020 Oct 2.

School of Health and Related Research, 3rd Floor, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA UK.

Background: The primary objective of this review is to assess the accuracy of machine learning methods in their application of triaging the acuity of patients presenting in the Emergency Care System (ECS). The population are patients that have contacted the ambulance service or turned up at the Emergency Department. The index test is a machine-learning algorithm that aims to stratify the acuity of incoming patients at initial triage. This is in comparison to either an existing decision support tool, clinical opinion or in the absence of these, no comparator. The outcome of this review is the calibration, discrimination and classification statistics.

Methods: Only derivation studies (with or without internal validation) were included. MEDLINE, CINAHL, PubMed and the grey literature were searched on the 14th December 2019. Risk of bias was assessed using the PROBAST tool and data was extracted using the CHARMS checklist. Discrimination (C-statistic) was a commonly reported model performance measure and therefore these statistics were represented as a range within each machine learning method. The majority of studies had poorly reported outcomes and thus a narrative synthesis of results was performed.

Results: There was a total of 92 models (from 25 studies) included in the review. There were two main triage outcomes: hospitalisation (56 models), and critical care need (25 models). For hospitalisation, neural networks and tree-based methods both had a median C-statistic of 0.81 (IQR 0.80-0.84, 0.79-0.82). Logistic regression had a median C-statistic of 0.80 (0.74-0.83). For critical care need, neural networks had a median C-statistic of 0.89 (0.86-0.91), tree based 0.85 (0.84-0.88), and logistic regression 0.83 (0.79-0.84).

Conclusions: Machine-learning methods appear accurate in triaging undifferentiated patients entering the Emergency Care System. There was no clear benefit of using one technique over another; however, models derived by logistic regression were more transparent in reporting model performance. Future studies should adhere to reporting guidelines and use these at the protocol design stage.

Registration And Funding: This systematic review is registered on the International prospective register of systematic reviews (PROSPERO) and can be accessed online at the following URL: https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42020168696This study was funded by the NIHR as part of a Clinical Doctoral Research Fellowship.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s41512-020-00084-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531169PMC
October 2020

Is short-term-variation of fetal-heart-rate a better predictor of fetal acidaemia in labour? A feasibility study.

PLoS One 2020 3;15(8):e0236982. Epub 2020 Aug 3.

Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Tree Root Walk, Sheffield, United Kingdom.

Background: Continuous intrapartum fetal monitoring is challenging and its clinical benefits are debated. The project evaluated whether short-term-variation (STV) and other computerised fetal heart rate (FHR) parameters (baseline FHR, long-term-variation, accelerations and decelerations) predicted acidaemia at birth. The aims of the study were to assess the changes in FHR pattern during labour and determine the feasibility of undertaking a definitive trial by reporting the practicalities of using the monitoring device, participant recruitment, data collection and staff training.

Methods: 200 high-risk women carrying a term singleton, non-anomalous fetus, requiring continuous FHR monitoring in labour were consented to participate from the Jessop Wing maternity unit, Sheffield, UK. The trans-abdominal fetal ECG monitor was placed as per clinical protocol. During the monitoring session, clinicians were blinded to the computerised FHR parameters. We analysed the last hour of the FHR and its ability to predict umbilical arterial blood pH <7.20 using receiver operator characteristics (ROC) curves.

Results: Of 200 women, 137 cases were excluded as either the monitor did not work from the onset of labour (n = 30), clinical staff did not return or used the monitor on another patient (n = 37), umbilical cord blood not obtained (n = 25), FHR data not recorded within an hour of birth (n = 34) and other reasons (n = 11). In 63 cases included in the final analysis, the computer-derived FHR parameters did not show significant correlation with umbilical artery cord pH <7.20. Labour was associated with a significant increase in short and long term variation of FHR and number of deceleration (P<0.001). However, baseline FHR decreased significantly before delivery (P<0.001).

Conclusions: The project encountered a number of challenges, with learning points crucial to informing the design of a large study to evaluate the potential place of intrapartum computerised FHR parameters, using abdominal fetal ECG monitor before its clinical utility and more widespread adoption can be ascertained.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236982PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398510PMC
October 2020

Longitudinal examination of youth readmission to mental health inpatient units.

Child Adolesc Ment Health 2020 11 3;25(4):238-248. Epub 2020 Mar 3.

Sobey School of Business, Saint Mary's University, Halifax, NS, Canada.

Objective: Significant barriers exist for youth in obtaining mental health services. These barriers are exacerbated by growing demand, attributed partially to children and adolescents who have repeat hospital admissions. The purpose of this study was to identify demographic, socioeconomic and clinical predictors of readmission to inpatient psychiatric services in New Brunswick, Canada.

Method: Key demographic, support and clinical predictors of readmission were identified. The New Brunswick Discharge Abstract Database (DAD) was used to compile a cohort of all children and adolescents ages 3-19 years with psychiatric hospital admissions between 1 April 2003 and 31 March 2014 (N = 3825). Primary analyses consisted of Kaplan-Meier survival methods with log-rank tests to assess time-to-readmission variability, and Cox regression to identify significant predictors of readmission.

Results: In total, 27.8% of admitted children and adolescents experienced at least one readmission within the 10-year period, with 57.3% readmitted to hospital within 90 days following discharge. Bivariate results indicated that male, upper-middle socioeconomic status (SES) youths aged 11-15 years from nonrural communities were most likely to be readmitted. Notable predictors of increased readmission likelihood were older age, being male, higher SES, referral to care by medical practitioner, discharge to another health facility, psychosis, and previous psychiatric admission.

Conclusion: A significant portion of the variance in readmission was accounted for by youth demographic characteristics (i.e. age, SES, geographic location) and various support structures, including referrals to inpatient care and aftercare support services.

Key Practitioner Message: Readmission to inpatient psychiatric care among youth is affected by a number of multifaceted risk factors across individual, environmental and clinical domains. This study used provincial population-scale longitudinal administrative data to demonstrate the influence of various individual and demographic factors on likelihood of readmission, which is notably absent from the majority of studies that make use of smaller, short-term data samples. Ensuring that multiple factors outside of the clinical context are considered when examining readmission among youth may contribute to a more thorough understanding of youth hospitalization patterns.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/camh.12371DOI Listing
November 2020

Molecular basis of mood and cognitive adverse events elucidated via a combination of pharmacovigilance data mining and functional enrichment analysis.

Arch Toxicol 2020 08 5;94(8):2829-2845. Epub 2020 Jun 5.

Department of Pharmacology, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11000, Belgrade, Serbia.

Drug-induced Mood- and Cognition-related adverse events (MCAEs) are often only detected during the clinical trial phases of drug development, or even after marketing, thus posing a major safety concern and a challenge for both pharmaceutical companies and clinicians. To fill some gaps in the understanding and elucidate potential biological mechanisms of action frequently associated with MCAEs, we present a unique workflow linking observational population data with the available knowledge at molecular, cellular, and psychopharmacology levels. It is based on statistical analysis of pharmacovigilance reports and subsequent signaling pathway analyses, followed by evidence-based expert manual curation of the outcomes. Our analysis: (a) ranked pharmaceuticals with high occurrence of such adverse events (AEs), based on disproportionality analysis of the FDA Adverse Event Reporting System (FAERS) database, and (b) identified 120 associated genes and common pathway nodes possibly underlying MCAEs. Nearly two-thirds of the identified genes were related to immune modulation, which supports the critical involvement of immune cells and their responses in the regulation of the central nervous system function. This finding also means that pharmaceuticals with a negligible central nervous system exposure may induce MCAEs through dysregulation of the peripheral immune system. Knowledge gained through this workflow unravels putative hallmark biological targets and mediators of drug-induced mood and cognitive disorders that need to be further assessed and validated in experimental models. Thereafter, they can be used to substantially improve in silico/in vitro/in vivo tools for predicting these adversities at a preclinical stage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00204-020-02788-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395038PMC
August 2020

The prevalence and natural history of normocalcaemic hypoparathyroidism in a United Kingdom referral population.

Clin Endocrinol (Oxf) 2020 08 1;93(2):119-126. Epub 2020 Jun 1.

Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.

Context: Normocalcaemic hypoparathyroidism (NHYPO) is characterized by low levels of parathyroid hormone (PTH) with normal levels of calcium. There is little in the current literature on this disease, with only two studies published on its prevalence, while its natural history remains relatively unknown.

Objectives: To identify the prevalence of NHYPO in a UK referral population and to study the natural history of the disorder.

Design: Retrospective study. Five-year follow-up.

Patients: 6280 patients referred for a BMD measurement in a Metabolic Bone referral centre.

Measurements: Prevalence of NHYPO and variability of calcium.

Results: Based on laboratory results on the index day, 22 patients with NHYPO were identified. Four patients were excluded due to non-PTH-induced hypocalcaemia and unconfirmed data. The final prevalence was 0.29%. Only 67% had persistent normocalcaemia, and the rest had intermittent hypocalcaemia. Two of these patients also had persistently low PTH on two occasions. Most of the patients had one PTH measurement available. No patient developed permanent hypoparathyroidism.

Conclusions: The prevalence calculated from this UK referral population is lower when compared to results from previous studies. NHYPO patients often have episodes of hypocalcaemia with some cases having no apparent reason for calcium levels below the reference range.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cen.14209DOI Listing
August 2020

Opportunities for use of one species for longer-term toxicology testing during drug development: A cross-industry evaluation.

Regul Toxicol Pharmacol 2020 Jun 29;113:104624. Epub 2020 Feb 29.

Cytokinetics, South San Francisco, CA, 94080, USA.

An international expert working group representing 37 organisations (pharmaceutical/biotechnology companies, contract research organisations, academic institutions and regulatory bodies) collaborated in a data sharing exercise to evaluate the utility of two species within regulatory general toxicology studies. Anonymised data on 172 drug candidates (92 small molecules, 46 monoclonal antibodies, 15 recombinant proteins, 13 synthetic peptides and 6 antibody-drug conjugates) were submitted by 18 organisations. The use of one or two species across molecule types, the frequency for reduction to a single species within the package of general toxicology studies, and a comparison of target organ toxicities identified in each species in both short and longer-term studies were determined. Reduction to a single species for longer-term toxicity studies, as used for the development of biologicals (ICHS6(R1) guideline) was only applied for 8/133 drug candidates, but might have been possible for more, regardless of drug modality, as similar target organ toxicity profiles were identified in the short-term studies. However, definition and harmonisation around the criteria for similarity of toxicity profiles is needed to enable wider consideration of these principles. Analysis of a more robust dataset would be required to provide clear, evidence-based recommendations for expansion of these principles to small molecules or other modalities where two species toxicity testing is currently recommended.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.yrtph.2020.104624DOI Listing
June 2020

Paediatric emergency department utilisation rates and maternal migration status in the Born in Bradford cohort: A cross-sectional study.

PLoS Med 2020 03 3;17(3):e1003043. Epub 2020 Mar 3.

School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.

Background: Globally, international migration is increasing. Population growth, along with other demographic changes, may be expected to put new pressures on healthcare systems. Some studies across Europe suggest that emergency departments (EDs) are used more, and differently, by migrants compared to non-migrant populations, which may be a result of unfamiliarity with the healthcare systems and difficulties accessing primary healthcare. However, little evidence exists to understand how migrant parents, who are typically young and of childbearing age, utilise EDs for their children. This study aimed to examine the association between paediatric ED utilisation in the first 5 years of life and maternal migration status in the Born in Bradford (BiB) cohort study.

Methods And Findings: We analysed linked data from the BiB study-an ongoing, multi-ethnic prospective birth cohort study in Bradford. Bradford is a large, ethnically diverse city in the north of England. In 2017, more than a third of births in Bradford were to mothers who were born outside the UK. Between March 2007 and December 2010, pregnant women were recruited to BiB during routine antenatal care, and the children born to these mothers have been, and continue to be, followed over time to assess how social, genetic, environmental, and behavioural factors impact on health from childhood to adulthood. Data analysed in this study included baseline questionnaire data from BiB mothers, and Bradford Royal Infirmary ED episode data for their children. Main outcomes were likelihood of paediatric ED use (no visits versus at least 1 ED visit in the first 5 years of life) and ED utilisation rates (number and frequency of ED visits) for children who have accessed the ED. The main explanatory variable was mother's migrant status (foreign-born versus UK/Irish-born). Multivariable analyses (logistic and zero-truncated negative binomial regression) were conducted adjusting for socio-demographic and socio-economic factors. The final dataset included 10,168 children born between April 2007 and June 2011, of whom 35.6% were born to migrant mothers. Foreign-born mothers originated from South Asia (28.6%), Europe/Central Asia (3.2%), Africa (2.1%), East Asia/Pacific (1.1%), and the Middle East (0.6%). At recruitment the mothers ranged in age from 15 to 49 years old. Overall, 3,104 (30.5%) children had at least 1 ED visit in the first 5 years of life, with the highest proportion of visits being in the first year of life (36.7%). The proportion of children who visited the ED at least once was lower for children of migrant mothers as compared to children of non-migrant mothers (29.4% versus 31.2%). Children of migrant mothers were found to be less likely to visit the ED (odds ratio 0.88 [95% CI 0.80 to 0.97], p = 0.012). However, among children who visited the ED, the utilisation rate was significantly higher for children of migrant mothers (incidence rate ratio [IRR] 1.19 [95% CI 1.01 to 1.40], p = 0.040). Utilisation rates were higher for children born to mothers from Europe (IRR 1.71 [95% CI 1.07 to 2.71], p = 0.024) and established migrants (≥5 years living in UK) (IRR 1.24 [95% CI 1.02 to 1.51], p = 0.032) compared to UK/Irish-born mothers. Important limitations include being unable to measure children's underlying health status and the urgency of ED attendance, as well as the analysis being limited by missing data.

Conclusions: In this study we observed that there is no higher likelihood of first paediatric ED attendance in the first 5 years of life for children in the BiB cohort for migrant mothers. However, among ED users, children of migrant mothers attend the service more frequently than children of UK/Irish-born mothers. Our findings show that patterns of ED utilisation differ by mother's region of origin and time since arrival in the UK.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1371/journal.pmed.1003043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053707PMC
March 2020

Normocalcemic Hyperparathyroidism: Study of its Prevalence and Natural History.

J Clin Endocrinol Metab 2020 04;105(4)

Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.

Context: Normocalcemic hyperparathyroidism (NPHPT) is characterized by persistently normal calcium levels and elevated parathyroid hormone (PTH) values, after excluding other causes of secondary hyperparathyroidism. The prevalence of the disease varies greatly and the data on the natural history of this disease are sparse and inconclusive.

Objectives: The objectives of this study are to describe the prevalence of NPHPT and its natural history in a referral population and to compare the variability of serum calcium with a group of patients with primary hyperparathyroidism (PHPT).

Design: A retrospective study was conducted over 5 years.

Setting: The setting for this study was a metabolic bone referral center.

Patients: A total of 6280 patients were referred for a bone mineral density measurement (BMD).

Main Outcome Measures: The prevalence and natural history of NPHPT and variability of calcium were the main outcome measures.

Results: We identified NPHPT patients using data from the day of the BMD measurement. We excluded patients with low estimated glomerular filtration rate (eGFR) or vitamin D, or with no measurements available. Based on the evaluation of their medical files, we identified 11 patients with NPHPT (prevalence 0.18%). Only 4 patients had consistent normocalcemia throughout their follow-up, with only 2 also having consistently high PTH. None had consistently normal eGFR or vitamin D.Intermittent hypercalcemia was present in 7 of the 11 NPHPT patients. The mean adjusted calcium was found to be significantly lower in the NPHPT group compared with the PHPT group but higher than the control group. PTH was similar for NPHPT and PHPT. These 2 groups had similar variability in serum calcium.

Conclusions: NPHPT patients often have episodes of hypercalcemia. We believe that NPHPT is a mild form of PHPT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1210/clinem/dgaa084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069345PMC
April 2020

Correction to: Sample size estimation for randomised controlled trials with repeated assessment of patient-reported outcomes: what correlation between baseline and follow-up outcomes should we assume?

Trials 2019 Oct 28;20(1):611. Epub 2019 Oct 28.

School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.

Following publication of the original article [1], we have been notified that one of an error in the Conclusions section of the Abstract.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13063-019-3732-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816146PMC
October 2019

Sample size estimation for randomised controlled trials with repeated assessment of patient-reported outcomes: what correlation between baseline and follow-up outcomes should we assume?

Trials 2019 Sep 13;20(1):566. Epub 2019 Sep 13.

School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.

Background: Patient-reported outcome measures (PROMs) are now frequently used in randomised controlled trials (RCTs) as primary endpoints. RCTs are longitudinal, and many have a baseline (PRE) assessment of the outcome and one or more post-randomisation assessments of outcome (POST). With such pre-test post-test RCT designs there are several ways of estimating the sample size and analysing the outcome data: analysis of post-randomisation treatment means (POST); analysis of mean changes from pre- to post-randomisation (CHANGE); analysis of covariance (ANCOVA). Sample size estimation using the CHANGE and ANCOVA methods requires specification of the correlation between the baseline and follow-up measurements. Other parameters in the sample size estimation method being unchanged, an assumed correlation of 0.70 (between baseline and follow-up outcomes) means that we can halve the required sample size at the study design stage if we used an ANCOVA method compared to a comparison of POST treatment means method. So what correlation (between baseline and follow-up outcomes) should be assumed and used in the sample size calculation? The aim of this paper is to estimate the correlations between baseline and follow-up PROMs in RCTs.

Methods: The Pearson correlation coefficients between the baseline and repeated PROM assessments from 20 RCTs (with 7173 participants at baseline) were calculated and summarised.

Results: The 20 reviewed RCTs had sample sizes, at baseline, ranging from 49 to 2659 participants. The time points for the post-randomisation follow-up assessments ranged from 7 days to 24 months; 464 correlations, between baseline and follow-up, were estimated; the mean correlation was 0.50 (median 0.51; standard deviation 0.15; range - 0.13 to 0.91).

Conclusions: There is a general consistency in the correlations between the repeated PROMs, with the majority being in the range of 0.4 to -0.6. The implications are that we can reduce the sample size in an RCT by 25% if we use an ANCOVA model, with a correlation of 0.50, for the design and analysis. There is a decline in correlation amongst more distant pairs of time points.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13063-019-3671-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6743178PMC
September 2019

Exploring the characteristics, acuity and management of adult ED patients at night-time.

Emerg Med J 2019 Sep 30;36(9):554-557. Epub 2019 Jul 30.

School of Health and Related Research, University of Sheffield, Sheffield, UK.

Objectives: ED care is required for acutely unwell and injured patients 24 hours a day, 7 days a week. The aim of this study was to compare characteristics and activity of type 1 ED attendances according to whether their time of arrival was during the day (08:00-18:00) or at night (18:00-08:00).

Methods: Hospital Episode Statistics (HES) data from NHS Digital for all A&E and admitted patient care activity provided by all acute (not mental health or primary care) NHS hospital trusts in Yorkshire and Humber (1 April 2011 to 31 March 2014) for adult patients were analysed. Adjusted linear and logistic regression was used to model the data.

Results: Adjusted regression analysis results show that patients who attended ED at night waited an extra 18.76 (95% CI 18.62 to 18.89) min to be seen by a clinician. They also spent an additional 13.64 (95% CI 13.47 to 13.81) min total in ED. Patients who attended at night were OR 2.20 (95% CI 2.17 to 2.23) times more likely to leave without being seen. They were also OR 1.26 (95% CI 1.25 to 1.27) times more likely to re-attend the ED and were OR 1.20 (95% CI 1.19 to 1.21) times more likely to present with non-urgent conditions. Overnight patients were more likely to be admitted to hospital, OR 1.09 (95% CI 1.09 to 1.10) times, however, those admitted were more likely to have a short-stay admission.

Conclusion: There is an 'overnight effect' of patients attending EDs. Patients wait longer, leave without being seen, attend with non-urgent problems and are more likely to be admitted for a short stay. Further work is required to identify the potential underlying causes of these differences.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/emermed-2018-208248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818519PMC
September 2019

Nanowire forest of pnictogen-chalcogenide alloys for thermoelectricity.

Nanoscale 2019 Jul;11(28):13423-13430

Institut Néel, CNRS, 25 avenue des Martyrs, F-38042 Grenoble, France. and Univ. Grenoble Alpes, Grenoble, France.

Pnictogen and chalcogenide compounds have been seen as high-potential materials for efficient thermoelectric conversion over the past few decades. It is also known that with nanostructuration, the physical properties of these pnictogen-chalcogenide compounds can be further enhanced towards a more efficient heat conversion. Here, we report the reduced thermal conductivity of a large ensemble of Bi2Te3 alloy nanowires (70 nm in diameter) with selenium for n-type and antimony for p-type (Bi2Te3-ySey and Bi2-xSbxTe3 respectively). The nanowire growth was carried out through electrodeposition in nanoporous aluminium oxide templates with high aspect ratios leading to a forest (109 per centimetre square) of nearly identical nanowires. The temperature dependence of thermal conductivity for the nanowire ensembles was acquired through a highly sensitive 3ω measurement technique. The change in the thermal conductivity of nanowires is largely affected by the roughness in addition to the size effect due to enhanced boundary scattering. The major factor that influences the thermal conductivity was found to be the ratio of the rms roughness to the correlation length of the nanowire. With a high Seebeck coefficient and electrical conductivity at room temperature, the overall thermoelectric figure of merit ZT allows the consideration of such forests of nanowires as efficient potential building blocks of future TE devices.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1039/c9nr01566cDOI Listing
July 2019

Using vignettes to assess the accuracy and rationale of paramedic decisions on conveyance to the emergency department.

Br Paramed J 2019 Jun;4(1):6-13

University of Sheffield.

Introduction: Paramedics make important decisions about whether a patient needs transport to hospital, or can be discharged on scene. These decisions require a degree of accuracy, as taking low acuity patients to the emergency department (ED) can support ambulance ramping. In contrast, leaving mid-high acuity patients on scene can lead to incidents and recontact. This study aims to investigate the accuracy of conveyance decisions made by paramedics when looking at real life patient scenarios with known outcomes. It also aims to explore how the paramedic made the decision.

Methods: We undertook a prospective mixed method triangulation design. Six individual patient vignettes were created using linked ambulance and ED data. These were then presented in an online survey to paramedics in Yorkshire. Half the vignettes related to mid-high acuity attendances at the ED and the other half were low acuity. Vignettes were validated by a small expert panel. Participants were asked to determine the appropriate conveyance decision and to explain the rationale behind their decisions using a free-text box.

Results: A total of 143 paramedics undertook the survey and 858 vignettes were completed. There was clear agreement between paramedics for transport decisions (ƙ = 0.63). Overall accuracy was 0.69 (95% CI 0.66-0.73). Paramedics were better at 'ruling in' the ED, with sensitivity of 0.89 (95% CI 0.86-0.92). The specificity of 'ruling out' the ED was 0.51 (95% CI 0.46-0.56). Text comments were focused on patient safety and risk aversion.

Discussion: Paramedics make accurate conveyance decisions but are more likely to over-convey than under-convey, meaning that while decisions are safe they are not always appropriate. It is important that paramedics feel supported by the service to make safe and confident non-conveyance decisions. Reducing over-conveyance is a potential method of reducing demand in the urgent and emergency care system.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.29045/14784726.2019.06.4.1.6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706772PMC
June 2019

Outcomes for Patients Who Contact the Emergency Ambulance Service and Are Not Transported to the Emergency Department: A Data Linkage Study.

Prehosp Emerg Care 2019 Jul-Aug;23(4):566-577. Epub 2019 Jan 7.

: Emergency ambulance services do not transport all patients to hospital. International literature reports non-transport rates ranging from 3.7-93.7%. In 2017, 38% of the 11 million calls received by ambulance services in England were attended by ambulance but not transported to an Emergency Department (ED). A further 10% received clinical advice over the telephone. Little is known about what happens to patients following a non-transport decision. We aimed to investigate what happens to patients following an emergency ambulance telephone call that resulted in a non-transport decision, using a linked routine data-set. : Six-months individual patient level data from one ambulance service in England, linked with Hospital Episode Statistics and national mortality data, were used to identify subsequent health events (ambulance re-contact, ED attendance, hospital admission, death) within 3 days (primary analysis) and 7 days (secondary analysis) of an ambulance call ending in non-transport to hospital. Non-clinical staff used a priority dispatch system e.g. Medical Priority Dispatch System to prioritize calls for ambulance dispatch. Non-transport to ED was determined by ambulance crew members at scene or clinicians at the emergency operating center when an ambulance was not dispatched (telephone advice). : The data linkage rate was 85% for patients who were discharged at scene (43,108/50,894). After removal of deaths associated with end of life care ( = 312), 9% (3,861/42,796) re-contacted the ambulance service, 12.6% (5,412/42,796) attended ED, 6.3% (2,694/42,796) were admitted to hospital, and 0.3% (129/42,796) died within 3 days of the call. Rates were higher for events occurring within 7 days. For example, 12% re-contacted the ambulance service, 16.1% attended ED, 9.3% were admitted to hospital, and 0.5% died. The linkage rate for telephone advice calls was low because ambulance services record less information about these patients (24% 2,514/10,634). A sensitivity analysis identified a range of subsequent event rates: 2.5-10.5% of patients were admitted to hospital and 0.06-0.24% of patient died within 3 days of the call. : Most non-transported patients did not have subsequent health events. Deaths after non-transport are an infrequent event that could be selected for more detailed review of individual cases, to facilitate learning and improvement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/10903127.2018.1549628DOI Listing
January 2020

Emergency hospital care for adults with suspected seizures in the NHS in England 2007-2013: a cross-sectional study.

BMJ Open 2018 10 21;8(10):e023352. Epub 2018 Oct 21.

Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

Aims: To quantify the frequency, characteristics, geographical variation and costs of emergency hospital care for suspected seizures.

Design: Cross-sectional study using routinely collected data (Hospital Episode Statistics).

Setting: The National Health Service in England 2007-2013.

Participants: Adults who attended an emergency department (ED) or were admitted to hospital.

Results: In England (population 2011: 53.11 million, 41.77 million adults), suspected seizures gave rise to 50 111 unscheduled admissions per year among adults (≥18 years). This is 47.1% of unscheduled admissions for neurological conditions and 0.71% of all unscheduled admissions. Only a small proportion of admissions for suspected seizures were coded as status epilepticus (3.5%) and there were a very small number of dissociative (non-epileptic) seizures. The median length of stay for each admission was 1 day, the median cost for each admission was £1651 ($2175) and the total cost of all admissions for suspected seizures in England was £88.2 million ($116.2 million) per year. 16.8% of patients had more than one admission per year. There was significant geographical variability in the rate of admissions corrected for population age and gender differences and some areas had rates of admission which were consistently higher than the average.

Conclusions: Our data show that suspected seizures are the most common neurological cause of admissions to hospital in England, that readmissions are common and that there is significant geographical variability in admission rates. This variability has not previously been reported in the published literature. The cause of the geographical variation is unknown; important factors are likely to include prevalence, deprivation and clinical practice and these require further investigation. Dissociative seizures are not adequately diagnosed during ED attendances and hospital admissions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2018-023352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196871PMC
October 2018