Jan van der Meulen

Jan van der Meulen
London School of Hygiene and Tropical Medicine | LSHTM · Department of Health Services Research and Policy

PhD

About

566
Publications
40,632
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26,879
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Introduction
Skills and Expertise

Publications

Publications (566)
Article
Background Centralisation of specialist cancer services is occurring in many countries, often without evaluating the potential impact before implementation. We developed a health service planning model that can estimate the expected impacts of different centralisation scenarios on travel time, equity in access to services, patient outcomes, and hos...
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Objective To determine the association between ethnic group and risk of postpartum haemorrhage in women giving birth. Design Cohort study. Setting Maternity units in England. Sample A total of 981 801 records of births between 1 April 2015 and 31 March 2017 in a national clinical database. Methods Multivariable logistic regression analyses with...
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Objectives: To assess the association between hospital-level rates of induction of labour and emergency caesarean section, as measures of "practice style", and rates of adverse perinatal outcomes. Design: National study using electronic maternity records. Setting: English National Health Service. Participants: Hospitals providing maternity c...
Article
Organisational surveys are a critical process to assess the configuration and availability of services within health care systems. Cancer service organizational surveys enable understanding of variation in structure, processes and outcomes of cancer care according to the availability of facilities and their geographical organisation. This is critic...
Article
Objective: To assess the impact of centralisation of prostate cancer surgery and radiotherapy services on the choice of prostate cancer treatment. Patients and methods: This national population-based study used linked cancer registry data and administrative hospital-level data for all 16,621 men who were diagnosed between 1st Jan 2017 and 31st D...
Article
Background The capture of toxicities from systemic anti-cancer therapy (SACT) in real-world data will complement results from clinical trials. The aim of this study was to develop and validate a comprehensive coding framework to identify severe acute toxicity in hospital administrative data. Methods A coding framework was developed to identify dia...
Article
Aim: To compare early postoperative outcomes and 2-year cancer-specific survival following colorectal cancer (CRC) resection in patients with and without inflammatory bowel disease (IBD) in England and Wales. Method: Records for patients in the National Bowel Cancer Audit who had major CRC resection between April 2014 and December 2017 were link...
Article
Objectives: Upper tract obstructive uropathy (UTOU) is a complication of advanced prostate cancer (PCa) that may require urinary tract decompression. There are no population-based studies on the incidence, treatment, and outcomes of this complication. We developed and validated a coding framework to identify procedures for UTOU in men with locally...
Article
Measuring treatment-related quality of life (QOL) has become an increasingly requisite component of delivering high-quality care for patients with prostate cancer. Patient-reported outcome measures (PROMs) have, therefore, become an important tool for understanding the adverse effects of radical prostate cancer treatment and have been widely integr...
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Objective: To compare the incidence of systemic conditions between women who had surgical treatment for stress incontinence with mesh and without mesh. Design: National cohort study. Setting: English National Health Service. Population: Women with no previous record of systemic disease who had first-time urinary incontinence surgery between...
Article
Objective: To determine the impact of the COVID-19 pandemic on diagnostic and treatment activity in 2020 across hospital providers of prostate cancer (PCa) care in the English National Health Service. Methods: Diagnostic and treatment activity between 23 March (start of first national lockdown in England) and 31 December 2020 was compared with t...
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Introduction The treatment of prostate cancer varies between the United States (US) and England, however this has not been well characterised using recent data. We therefore investigated the extent of the differences between US and English patients with respect to initial treatment. Methods We used the Surveillance, Epidemiology, and End Results (...
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Background The COVID-19 pandemic has disrupted maternity services worldwide and imposed restrictions on societal behaviours. This national study aimed to compare obstetric intervention and pregnancy outcome rates in England during the pandemic and corresponding pre-pandemic calendar periods, and to assess whether differences in these rates varied a...
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Background: Compared with the United States, risk-adjusted mortality in the United Kingdom has historically been worse in the first 90 d following liver transplantation (LT) and better thereafter. In the last decade, there has been considerable change in the practice of LT internationally, but no contemporary large-scale international comparison o...
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Background Despite high waiting list mortality rates, concern still exists on the appropriateness of using livers donated after circulatory death (DCD). We compared mortality and graft loss in recipients of livers donated after circulatory or brainstem death (DBD) across two successive time periods. Methods Observational multinational data from th...
Article
Objectives: To investigate whether patient-reported urinary incontinence (UI) and bother scores after radical prostatectomy (RP) result in subsequent intervention with UI surgery. Patients and methods: Men diagnosed with prostate cancer in the English National Health Service between April 2014 and January 2016 were identified. Administrative dat...
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The impact of cycle completion rates of oxaliplatin-based adjuvant chemotherapy for stage III colon cancer in real-world practice is unknown. We assessed its impact, and that of treatment modification, on 3-year cancer-specific mortality. 4147 patients with pathological stage III colon cancer undergoing major resection from 2014 to 2017 in the Engl...
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Improvements in short-term outcomes have been reported for hospitals with higher radical prostatectomy (RP) volumes. However, the association with longer-term functional outcomes is unknown. All patients diagnosed with non-metastatic prostate cancer in the English NHS between 2014 and 2016 who underwent RP (N = 10,089) were mailed a survey ≥18 mont...
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Many factors are implicated in the potential ‘under-treatment’ of prostate cancer but little is known about the between-hospital variation. The National Prostate Cancer Audit (NPCA) database was used to identify high-risk localised or locally advanced prostate cancer patients in England, between January 2014 and December 2017, and the treatments re...
Article
Background Graft loss incidence is reported to be inversely related to recipient age. We used a national cohort of liver transplant (LT) recipients from the UK & Ireland to compare the age-dependent risk of graft failure in different post-transplantation time-periods (‘epochs’). Methods A cohort of first-time LT recipients (1995-2016) were identif...
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Background There is debate about the safety and effectiveness of surgical treatments for stress urinary incontinence. Controversy about the use of synthetic mesh sling insertion has led to increased uptake of retropubic colposuspension and autologous sling procedures. Comparative evidence on long-term outcomes from these procedures is needed. Obje...
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Background: The COVID-19 pandemic has had a profound impact on healthcare systems globally, with a worrying increase in adverse maternal and foetal outcomes. We aimed to assess the changes in maternity healthcare provision and healthcare-seeking by pregnant women during the COVID-19 pandemic. Methods: We performed a systematic review and meta-an...
Article
To compare the management and outcomes of colorectal cancer (CRC) patients during the first 2 months of the COVID-19 pandemic with the preceding 6 months. Background: The pandemic has affected the diagnosis and treatment of CRC patients worldwide. Little is known about the safety of major resection and whether creating "cold" sites (COVID-free ho...
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Background The Obstetric Anal Sphincter Injury (OASI) Care Bundle comprises four primary and secondary prevention practices that target the rising rates of severe perineal tearing during childbirth, which can have severe debilitating consequences for women. The OASI Care Bundle was implemented in 16 maternity units in Britain in the OASI1 project (...
Article
3596 Background: The optimal duration of adjuvant combination chemotherapy administered to patients with stage III colon cancer is debated. Our study assessed the effect of completed chemotherapy cycles on 3-year colon cancer-specific mortality, as well as the effect of dose reduction and early discontinuation of oxaliplatin in patients with 100% c...
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Rising rates of obstetric anal sphincter injury (OASI) led to a collaborative effort by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) to develop and evaluate the OASI Care Bundle (OASI-CB). The OASI-CB comprises four practices (antenatal discussion about OASI, manual perineal protection, mediol...
Article
Objective The aim of this study was to determine the association between SARS-CoV-2 infection at the time of birth and maternal and perinatal outcomes. Methods This is a population-based cohort study in England. The inclusion criteria were women with a recorded singleton birth between 29th May 2020 and 31st January 2021 in a national database of h...
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Background The COVID-19 pandemic has had a profound impact on health-care systems and potentially on pregnancy outcomes, but no systematic synthesis of evidence of this effect has been undertaken. We aimed to assess the collective evidence on the effects on maternal, fetal, and neonatal outcomes of the pandemic. Methods We did a systematic review a...
Article
The public reporting of patient outcomes is crucial for quality improvement and informing patient choice. However, outcome reporting in radiotherapy, despite being a major component of cancer control, is extremely sparse globally. Public reporting has many challenges, including difficulties in defining meaningful measures of treatment quality, limi...
Article
Objectives: To evaluate the accuracy and completeness of surgeon reported radical prostatectomy outcome data across a national health system by comparison with a national dataset gathered independently from clinicians directly involved in patient care. Patients and methods: Data submitted by surgeons to the British Association of Urological Surg...
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Background Urinary incontinence affects between 25% and 45% of women. The availability and quality of services is variable and inequitable, but our understanding of the drivers is incomplete. Objectives The objectives of the study were to model patient, specialist clinician, primary and secondary care, and geographical factors associated with refe...
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Objective: To evaluate the impact of a care bundle (antenatal information to women, manual perineal protection and mediolateral episiotomy when indicated) on obstetric anal sphincter injury (OASI) rates. Design: Multicentre stepped-wedge cluster design. Setting: Sixteen maternity units located in four regions across England, Scotland and Wales...
Article
Background and purpose Little is known about the functional outcomes and health-related quality of life (HRQoL) following external beam radiation therapy (EBRT) combined with a high-dose rate brachytherapy boost (EBRT-BB) for the treatment of prostate cancer. We aimed to compare patient-reported outcomes of EBRT to those of EBRT-BB. Methods and ma...
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Background: Existing studies evaluating the association between maternal risk factors and specific infant outcomes such as birthweight, injury admissions, and mortality have mostly focused on single risk factors. We aimed to identify routinely recorded psychosocial characteristics of pregnant women most at risk of adverse infant outcomes to inform...
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Introduction and hypothesis Obstetric anal sphincter injury (OASI) is a severe form of perineal trauma that can occur during vaginal birth. Long-term morbidities include anal incontinence and psychosocial disorders. To reduce these injuries within England, Scotland and Wales, the OASI Care Bundle was introduced to 16 maternity units (January 2017–M...
Article
Aims Access to joint replacement is being restricted for patients with comorbidities in a number of high-income countries. However, there is little evidence on the impact of comorbidities on outcomes. The purpose of this study was to determine the safety and effectiveness of hip and knee arthroplasty in patients with and without comorbidities. Met...
Article
Objective: To compare the performance of logistic regression and boosted trees for predicting patient mortality from large sets of diagnosis codes in electronic healthcare records. Study design and setting: We analysed national hospital records and official death records for patients with myocardial infarction (n=200,119), hip fracture (n=169,64...
Article
Purpose External beam radiotherapy (EBRT) with brachytherapy boost reduces cancer recurrence in patients diagnosed with prostate cancer compared to EBRT monotherapy. However, randomised controlled trials or large-scale observational studies have not compared brachytherapy boost types directly. Methods and Materials This observational cohort study...
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Background Female urinary incontinence is underdiagnosed and undertreated in primary care. There is little evidence on factors that determine whether women with urinary incontinence are referred to specialist services. This study aimed to investigate characteristics associated with referrals from primary to specialist secondary care for urinary inc...
Article
Background: Impaired pretransplant performance status (PS) is associated with chronic liver disease (CLD). We studied its impact on hospital length of stay (LOS), complications and readmissions in the first year after liver transplantation. Method: The Standard National Liver Transplant Registry was linked to a hospital administrative dataset an...
Conference Paper
Background The National Prostate Cancer Audit (NPCA) reports publicly performance indicators for all hospitals in England and Wales providing radical prostate cancer treatment, identifying those with results that fall outside the ‘accepted range’ as ‘potential negative outliers’. Hospitals with outlying results are requested to provide a formal res...
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The existing literature does not provide a prediction model for mortality of all colorectal cancer patients using contemporary national hospital data. We developed and validated such a model to predict colorectal cancer death within 90, 180 and 365 days after diagnosis. Cohort study using linked national cancer and death records. The development po...
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Background: An increasing number of patients undergoing hip or knee replacement have chronic diseases. It has been suggested that the presence of chronic diseases may affect access to this type of surgery in the English National Health Service (NHS). We examined the access to hip and knee replacement surgery in patients with and without chronic di...
Article
Purpose Little is known about the toxicity of additional pelvic lymph node irradiation in men receiving intensity-modulated radiotherapy (IMRT) for prostate cancer. The aim of this study was to compare patient-reported outcomes following IMRT to the prostate only (PO-IMRT) versus the prostate and pelvic lymph nodes (PPLN-IMRT). Methods and Materia...
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Introduction Almost 20 000 babies are born to teenage mothers each year in England, with poorer outcomes for mothers and babies than among older mothers. A nurse home visitation programme in the USA was found to improve a wide range of outcomes for young mothers and their children. However, a randomised controlled trial in England found no effect o...
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Background Young maternal age is associated with lower birthweight and higher rates of preterm birth and childhood hospitalisations. Internationally, teen pregnancy rates vary widely, reflecting differences in social, welfare, and health care factors in different cultural contexts. Objectives To determine whether the increased risk of adverse infa...
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Introduction There is limited evidence on the impact of centralization of cancer treatment services on patient travel burden and access to treatment. Using prostate cancer surgery as an example, this national study analysis aims to simulate the effect of different centralization scenarios on the number of center closures, patient travel times, and...
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Full-text available
IntroductionThe aim of this study was to determine how recommendations of gynaecologists on surgical treatment for stress urinary incontinence (SUI) were influenced by patient characteristics.Methods Two hundred forty-five gynaecologists in the UK fully responded to an online questionnaire including 18 vignettes describing 7 clinical characteristic...
Article
Objectives: To assess the complications of transrectal (TR) compared to transperineal prostate (TP) biopsies. Patients and methods: Men diagnosed with prostate cancer between 1st April 2014 and 2017 in England were identified by the National Prostate Cancer Audit. Administrative hospital data were then used to categorise the type of prostate bio...
Article
Background and aims: Identifying how the prognostic impact of performance status (PS) differs according to indication, era, and time period ("epoch") after liver transplantation (LT) could have implications for selection and treatment of patients on the waitlist. We used national data from the United Kingdom and Ireland to assess impact of PS on m...
Article
PURPOSE The aim of the current study was to determine patient-reported functional outcomes in men with prostate cancer (PCa) undergoing moderately hypofractionated (H-RT) or conventionally fractionated radiation therapy (C-RT) in a national cohort study. PATIENDS AND METHODS All men diagnosed with PCa between April 2014 and September 2016 in the E...
Article
Background: Non-osteoporotic skeletal-related events (SREs) are clinically important markers of disease progression in prostate cancer. We developed and validated an approach to identify SREs in men with prostate cancer using routinely-collected data. Methods: Patients diagnosed with prostate cancer between January 2010 and December 2013 were id...
Article
Purpose: There is a debate about the effectiveness and toxicity of pelvic lymph node (PLN) irradiation for the treatment of men with high-risk prostate cancer. This study compared the toxicity of intensity-modulated radiation therapy (IMRT) to the prostate and the pelvic lymph nodes (PPLN-IMRT) with prostate-only IMRT (PO-IMRT). Materials and met...