Continuity of care in general practice and secondary care: retrospective cohort study.

Background: Better continuity in primary and secondary care is linked to improved health outcomes, but it is unclear whether the sociodemographic determinants of continuity are the same in both settings and whether continuity measures in each setting are associated.

Aim: To examine the determinants of relational continuity in general practice (GP) and fragmented outpatient specialty care in people with clusters of Multiple Long-Term Conditions (LTCs) and the association between continuity in each setting.

Design And Setting: A cohort of patients ≥18 years registered to general practices in England throughout 2019, and with linked hospital outpatient records.

Polypharmacy in primary care: A population-based retrospective cohort study of electronic health records.

Background: Polypharmacy, prescription of multiple medications to a patient, is a major challenge for health systems. There have been no peer-reviewed studies of polypharmacy prevalence and medication cost at a population level in England.

Aims: To determine prevalence and medication cost of polypharmacy, by patient characteristics.

Uptake of COVID-19 vaccines and association with hospitalisation due to COVID-19 in pregnancy: Retrospective cohort study.

Objectives: To determine demographic and clinical characteristics associated with uptake of COVID-19 vaccines among pregnant women, and quantify the relationship between vaccine uptake and admission to hospital for COVID-19.

Background: Pregnant women are at increased risk of severe adverse outcomes from COVID-19. Since April 2021, COVID-19 vaccines were recommended for pregnant women in the UK.

Identifying multi-resolution clusters of diseases in ten million patients with multimorbidity in primary care in England.

Background: Identifying clusters of diseases may aid understanding of shared aetiology, management of co-morbidities, and the discovery of new disease associations. Our study aims to identify disease clusters using a large set of long-term conditions and comparing methods that use the co-occurrence of diseases versus methods that use the sequence of disease development in a person over time.

Methods: We use electronic health records from over ten million people with multimorbidity registered to primary care in England.

Comparing natural language processing representations of coded disease sequences for prediction in electronic health records.

Objective: Natural language processing (NLP) algorithms are increasingly being applied to obtain unsupervised representations of electronic health record (EHR) data, but their comparative performance at predicting clinical endpoints remains unclear. Our objective was to compare the performance of unsupervised representations of sequences of disease codes generated by bag-of-words versus sequence-based NLP algorithms at predicting clinically relevant outcomes.

Materials And Methods: This cohort study used primary care EHRs from 6 286 233 people with Multiple Long-Term Conditions in England.

Assigning disease clusters to people: A cohort study of the implications for understanding health outcomes in people with multiple long-term conditions.

Background: Identifying clusters of co-occurring diseases may help characterise distinct phenotypes of Multiple Long-Term Conditions (MLTC). Understanding the associations of disease clusters with health-related outcomes requires a strategy to assign clusters to people, but it is unclear how the performance of strategies compare.

Aims: First, to compare the performance of methods of assigning disease clusters to people at explaining mortality, emergency department attendances and hospital admissions over one year.

Treating insomnia in people who are incarcerated: a feasibility study of a multicomponent treatment pathway.

Around 60% of people who are incarcerated have insomnia; 6-10 times more prevalent than the general population. Yet, there is no standardized, evidence-based approach to insomnia treatment in prison. We assessed the feasibility of a treatment pathway for insomnia in a high-secure prison to inform a future randomized controlled trial (RCT) and initial efficacy data for sleep and mental health outcomes.

Effect of timeframes to define long term conditions and sociodemographic factors on prevalence of multimorbidity using disease code frequency in primary care electronic health records: retrospective study.

Objective: To determine the extent to which the choice of timeframe used to define a long term condition affects the prevalence of multimorbidity and whether this varies with sociodemographic factors.

Design: Retrospective study of disease code frequency in primary care electronic health records.

Data Sources: Routinely collected, general practice, electronic health record data from the Clinical Practice Research Datalink Aurum were used.

Effect of implementing a heart failure admission care bundle on hospital readmission and mortality rates: interrupted time series study.

This study aimed to evaluate the impact of developing and implementing a care bundle intervention to improve care for patients with acute heart failure admitted to a large London hospital. The intervention comprised three elements, targeted within 24 hours of admission: N-terminal pro-B-type natriuretic peptide (NT-proBNP) test, transthoracic Doppler two-dimensional echocardiography and specialist review by cardiology team. The SHIFT-Evidence approach to quality improvement was used.

Identifying potential biases in code sequences in primary care electronic healthcare records: a retrospective cohort study of the determinants of code frequency.

Objectives: To determine whether the frequency of diagnostic codes for long-term conditions (LTCs) in primary care electronic healthcare records (EHRs) is associated with (1) disease coding incentives, (2) General Practice (GP), (3) patient sociodemographic characteristics and (4) calendar year of diagnosis.

Design: Retrospective cohort study.

Setting: GPs in England from 2015 to 2022 contributing to the Clinical Practice Research Datalink Aurum dataset.

Characteristics associated with influenza vaccination uptake in pregnancy: a retrospective cohort study.

Background: Pregnant women are at increased risk from influenza, yet maternal influenza vaccination levels remain suboptimal.

Aim: To estimate associations between sociodemographic and health characteristics and seasonal influenza vaccination uptake among pregnant women, and to understand trends over time to inform interventions to improve vaccine coverage.

Design And Setting: Retrospective cohort study using linked electronic health records of women in North West London with a pregnancy overlapping an influenza season between September 2010 and February 2020.

Grand rounds in methodology: four critical decision points in statistical process control evaluations of quality improvement initiatives.

Quality improvement (QI) projects often employ statistical process control (SPC) charts to monitor process or outcome measures as part of ongoing feedback, to inform successive Plan-Do-Study-Act cycles and refine the intervention (formative evaluation). SPC charts can also be used to draw inferences on effectiveness and generalisability of improvement efforts (summative evaluation), but only if appropriately designed and meeting specific methodological requirements for generalisability. Inadequate design decreases the validity of results, which not only reduces the chance of publication but could also result in patient harm and wasted resources if incorrect conclusions are drawn.

Patient outcomes following emergency admission to hospital for COVID-19 compared with influenza: retrospective cohort study.

Background: We examine differences in posthospitalisation outcomes, and health system resource use, for patients hospitalised with COVID-19 during the UK's first pandemic wave in 2020, and influenza during 2018 and 2019.

Methods: This retrospective cohort study used routinely collected primary and secondary care data. Outcomes, measured for 90 days follow-up after discharge were length of stay in hospital, mortality, emergency readmission and primary care activity.

To what extent do callers follow the advice given by a non-emergency medical helpline (NHS 111): A retrospective cohort study.

National Health Service (NHS) 111 helpline was set up to improve access to urgent care in England, efficiency and cost-effectiveness of first-contact health services. Following trusted, authoritative advice is crucial for improved clinical outcomes. We examine patient and call-related characteristics associated with compliance with advice given in NHS 111 calls.

Measuring with quality: the example of person-centred care.

Qualitative data analysis should be embedded in routine health service measurement, management and organizational practices. The rigorous use of such analyses should become an institutional norm, comparable to the routine use of quantitative data. Our case is intended to have general relevance, but we develop it by reference to person-centred care and patient-centred outcome measures (PCOMs).

Factors associated with accessing long-term adult social care in people aged 75 and over: a retrospective cohort study.

Background: An ageing population and limited resources have put strain on state provision of adult social care (ASC) in England. With social care needs predicted to double over the next 20 years, there is a need for new approaches to inform service planning and development, including through predictive models of demand.

Objective: Describe risk factors for long-term ASC in two inner London boroughs and develop a risk prediction model for long-term ASC.

Patterns of healthcare utilisation in children and young people: a retrospective cohort study using routinely collected healthcare data in Northwest London.

Objectives: With a growing role for health services in managing population health, there is a need for early identification of populations with high need. Segmentation approaches partition the population based on demographics, long-term conditions (LTCs) or healthcare utilisation but have mostly been applied to adults. Our study uses segmentation methods to distinguish patterns of healthcare utilisation in children and young people (CYP) and to explore predictors of segment membership.

Advances in the Starling Principle and Microvascular Fluid Exchange; Consequences and Implications for Fluid Therapy.

Ernest Starling first presented a hypothesis about the absorption of tissue fluid to the plasma within tissue capillaries in 1896. In this Chapter we trace the evolution of Starling's hypothesis to a principle and an equation, and then look in more detail at the extension of the Starling principle in recent years. In 2012 Thomas Woodcock and his son proposed that experience and experimental observations surrounding clinical practices involving the administration of intravenous fluids were better explained by the revised Starling principle.

Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative.

Objective: Atrial fibrillation (AF) is the most common arrhythmia. Undiagnosed and poorly managed AF increases risk of stroke. The Hounslow AF quality improvement (QI) initiative was associated with improved quality of care for patients with AF through increased detection of AF and appropriate anticoagulation.

Predictors of children's health system use: cross-sectional study of linked data.

Background: Use of health services is increasing in many countries. Most health service research exploring determinants of use has focused on adults and on secondary care. Less is known about factors associated with the use of the emergency department (ED) and general practice (GP) among young children.

The Influence of Cu-Additions on the Microstructure, Mechanical and Magnetic Properties of MnAl-C Alloys.

Alloys of the form (MnAlC)Cu (with x = 0, 1, 2, 4 and 6) were produced by induction melting. After homogenisation and quenching, most of the alloys consist entirely of the retained ε-phase, except for x = 6, in which the κ-phase was additionally present. After subsequent annealing, the alloys with x ≤ 2 consist entirely of a Cu-doped, ferromagnetic τ-phase, whereas the alloys with x > 2 additionally contain the κ-phase.