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Article
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Background: Health services interventions are typically more effective in randomised controlled trials than in routine healthcare. One explanation for this 'voltage drop', i.e. reduction in effectiveness, is a reduction in intervention fidelity, i.e. the extent to which a programme is implemented as intended. This article discusses how to optimise...
Article
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Background: Investigating perceptions of control over mortality risk may be fundamental to understanding health behaviours and tackling socioeconomic gradients in health. Few studies have explored perceptions of control over different causes of death and there is a lack of qualitative risk research. Our aim was to examine participants' perceptions...
Article
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Objectives Hospital Episode Statistics (HES) are routinely recorded at every hospital admission within the National Health Service (NHS) in England. This study validates diagnostic ICD-10 codes within HES as a method of identifying cases of idiopathic inflammatory myopathies (IIMs). Methods All in-patient admissions at one NHS trust between 2010–2...
Article
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Background The aims of this study were to establish epidemiology, clinical management and outcomes in cases of adult out-of-hospital cardiac arrest complicated by hyperthermia attended by the London Ambulance Service NHS Trust between January 2018 and December 2019. Where evidence is available in relation to this sub-set of cardiac arrest patients...
Article
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This work presents an innovative ultra-sensitive biosensor having the Spike protein on carbon-based screen-printed electrodes (SPEs), for monitoring in point-of-care antibodies against SARS-CoV-2, a very important tool for epidemiological monitoring of COVID-19 infection and establishing vaccination schemes. In an innovative and simple approach, a...
Article
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Background Congenital disorders of glycosylation (CDG) are a large family of rare genetic diseases for which therapies are virtually nonexistent. However, CDG therapeutic research has been expanding, thanks to the continuous efforts of the CDG medical/scientific and patient communities. Hence, CDG drug development is a popular research topic. The m...
Article
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Introduction Drugs for rare diseases (DRDs) offer important health benefits, but challenge traditional health technology assessment, reimbursement, and pricing processes due to limited effectiveness evidence. Recently, modified processes to address these challenges while improving patient access have been proposed in Canada. This review examined pr...
Article
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Background Forecasting healthcare demand is essential in epidemic settings, both to inform situational awareness and facilitate resource planning. Ideally, forecasts should be robust across time and locations. During the COVID-19 pandemic in England, it is an ongoing concern that demand for hospital care for COVID-19 patients in England will exceed...
Article
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Background Large lung nodules (≥15 mm) have the highest risk of malignancy, and may exhibit important differences in phenotypic or clinical characteristics to their smaller counterparts. Existing risk models do not stratify large nodules well. We aimed to develop and validate an integrated segmentation and classification pipeline, incorporating dee...
Article
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Background Within the current context of continued austerity and post-pandemic recovery, it remains important that Local Government services address the increasing needs of residents as cost-effectively as possible. Alliancing, whereby services work collaboratively focusing on the ‘whole-system’, has gained popularity as a tool with the potential t...
Article
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Background Artificial intelligence and automated technology were first reported more than 70 years ago and nowadays provide unprecedented diagnostic accuracy, screening capacity, risk stratification, and workflow optimization. Diabetic retinopathy is an important cause of preventable blindness worldwide, and artificial intelligence technology provi...
Article
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Background Neuromyelitis optica spectrum disorder (NMOSD) is a rare, neurological disease that places a significant burden on patients, their carers, and healthcare systems. Objectives To estimate patient and carer health utilities and costs of NMOSD within the UK setting. Methods Patients with NMOSD and their carers, recruited via a regional spe...
Article
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Background Attention deficit hyperactivity disorder (ADHD) is associated with poor educational outcomes that can have long-term negative effects on the mental health, wellbeing, and socio-economic outcomes of university students. Mental health provision for university students with ADHD is often inadequate due to long waiting times for access to di...
Article
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Background COVID-19 has overwhelmed health services across the world; its global death toll has exceeded 5.3 million and continues to grow. There have been almost 15 million cases of COVID-19 in the UK. The need for rapid accurate identification, appropriate clinical care and decision making, remains a priority for UK ambulance service. To support...
Article
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Background Abbreviated breast MRI (abMRI) is being introduced in breast screening trials and clinical practice, particularly for women with dense breasts. Upscaling abMRI provision requires the workforce of mammogram readers to learn to effectively interpret abMRI. The purpose of this study was to examine the diagnostic accuracy of mammogram reader...
Article
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Background Limited data indicate that patients with colorectal cancer (CRC) are at higher risk of developing type 2 diabetes (T2D). We prospectively examined the risk of T2D between individuals with and without CRC in three large cohorts and conducted a meta-analysis. Methods We assessed the diagnosis of CRC and T2D among 111,485 women from the Nu...
Article
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Background 2022 marks a decade since the profession of podiatry secured independent prescribing rights in the UK. Widely viewed as a significant milestone, its advent appeared to herald a new age of practice, with increased autonomy, a broader scope of practice and improved patient care. Access to any medicine within the British National Formulary...
Article
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Background Surgeons are commonly evaluated by surgical skills and outcomes rather than their character traits. We sought to examine role model behaviours of senior surgeons through the lens of Aristotelian (virtue) ethics. Methods Semi-structured focus group interviews were undertaken of anaesthetic trainees at a large university hospital NHS Foun...
Preprint
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Background Previous studies have found an association between warm temperature and asthma hospitalisation. They have reported different sex- and age-related vulnerabilities, nevertheless little is known about how this effect has changed over time and how it varies in space. This study aims to evaluate the association between asthma hospitalisation...
Article
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In 2017, the NHS 111 telephone service was augmented by an online service. This is an exemplar of 'digital-first', the push to enrol digital technologies to deliver services, and is viewed by policymakers as an important vehicle for managing demand for overburdened health services. This article reports the qualitative component of a larger multi-me...
Preprint
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Introduction Online NHS111 was introduced in 2018 in response to increasing and unsustainable demand for Telephone NHS111. We explored user and staff perspectives of telephone and online NHS111 to understand how the two services were used, and whether and how online NHS111 had potential to reduce demand for telephone NHS111. Methods We used a conve...
Article
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Background: Standardization of access to treatment and compliance with clinical guidelines are important to ensure the delivery of high-quality care to people with varicose veins. In the National Health Service (NHS) in England, commissioning of care for people with varicose veins is performed by Clinical Commissioning Groups (CCGs) and clinical g...
Poster
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Tissue engineering (TE) is the science of combining engineering and biological approaches to fabricate bioartificial organs to replace injured tissues. Scaffold is one of the main parts of this science. High porosity and interconnectivity of 3D scaffolds are crucial due to enhanced support of cell diffusion and nutrient transfer. The polymers used...
Preprint
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Introduction: There is limited real-world evidence surrounding the effectiveness of early, mild-to-moderate COVID-19 treatments following the emergence and dominance of Omicron SARS-CoV-2 subvariants. Here, characteristics and acute clinical outcomes are described for patients with COVID-19 treated with sotrovimab, nirmatrelvir/ritonavir or molnupi...
Preprint
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Ambulance waiting times across the UK have increased in recent years. The numbers of ambulance staff leaving services across the UK is increasing every year. Strategies to help recruit and retain all ambulance staff, including paramedics are important. This rapid evidence summary aimed to investigate what innovations can help with their recruitment...
Article
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This study explored healthcare professionals’ perceived role in talking to adult patients about sharing their diagnosis with children. Semi-structured interviews were conducted to explore healthcare professionals’ beliefs about how families could and should be supported when a parent has a serious illness. Participants were 24 healthcare profession...
Article
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus responsible for the coronavirus disease 2019 (COVID-19) pandemic. Although COVID-19 is a viral illness, many patients admitted to hospital are prescribed antibiotics, based on concerns that COVID-19 patients may experience secondary bacterial infections, and the assumptio...
Preprint
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The unsustainable take-make-dispose linear economy prevalent in healthcare contributes 4.4% to global Greenhouse Gas emissions. A popular but not yet widely-embraced solution is to remanufacture common single-use medical devices like electrophysiology catheters, significantly extending their lifetimes by enabling a circular life cycle. To support t...
Article
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Background: This study assessed whether there is an association between changes in publicly and privately funded care for procedures classified as low value by the National Health Service (NHS) in England following implementation of the Evidence-Based Intervention (EBI) programme. Category 1 procedures should not be conducted and are no longer rei...
Article
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There are 11,619 community pharmacies in England which dispense over 1 billion prescriptions each year, providing essential primary care to NHS (National Health Service) patients. These pharmacies are facing pressure from a number of sources including funding cuts and high demands on services, while trying to deliver the highest standards of care....
Article
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The interaction between nanoplastics and bacteria remains still largely unclear. In this study, we determined the effect of nanopolystyrene particle (NP) on a bacterial pathogen of Acinetobacter johnsonii AC15. Scanning electron microscopy (SEM) analysis indicated the aggregation of NPs from 10 μg/L to 100 μg/L on surface of A. johnsonii AC15, sugg...
Article
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Over 5.5 million tons of plastic waste are generated globally from the research sectors. A university laboratory, e.g., pathology, can generate 250 tons of clinical plastic waste annually. The UK National Health Service (NHS) generates 133 kilotons (kt) of clinical plastic waste annually. Healthcare facilities in the US generate 1.7 million tons of...
Article
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Background Randomised controlled trials of non-pharmacological interventions in children’s therapy are rare. This is, in part, due to the challenges of the acceptability of common trial designs to therapists and service users. This study investigated the acceptability of participation in cluster randomised controlled trials to therapists and servic...
Article
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Background/objective Sexually transmitted infections (STIs) not only have an impact on the health sector but also the private resources of those affected, their families and other sectors of society (i.e. labour, education). This study aimed to i) review and identify economic evaluations of interventions relating to STIs, which aimed to include a s...
Article
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Knee pain is a common musculoskeletal disorder and contributes a large socio-economic burden to health systems around the world. The traditional strategy to manage knee pain has been exercise. However, there is growing recognition to include coping and self-management educational strategies to improve psychosocial outcomes. Purpose: The purpose of...
Article
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Objectives To describe the inpatient population, establish patterns in admission and mortality over a 4-year period in different cohorts and assess the prognostic ability and workload implications of introducing the National Early Warning Score 2 (NEWS2) and associated escalation protocol. Design Retrospective cohort analyses of medical and surgic...
Article
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Background: Approximately 23% of myeloma patients have cytogenetic abnormalities which confer a significantly poorer prognosis, and therefore they are defined as “high-risk myeloma” (HRC+) patients. Objective: To estimate the economic impact of a large-scale use of the fluorescence in situ hybridization (FISH) test for the identification of HRC+ p...
Preprint
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Background Hospital decision-makers have limited resources to implement quality improvement projects. To decide which interventions to take forward, trade-offs must be considered that inevitably turn on stakeholder preferences. The multi-criteria decision analysis (MCDA) approach could make this decision process more transparent. Method An MCDA was...
Article
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In view of the staggering disease and economic burden of mental disorders, internet and mobile-based interventions (IMIs) targeting mental disorders have often been touted to be cost-effective; however, available evidence is inconclusive and outdated. This review aimed to provide an overview of the cost-effectiveness of IMIs for mental disorders an...
Article
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Rice grain amylose contents (ACs) is a key quantitative trait influencing eating and cooking quality. Regulating the expression level of Waxy, a key gene controlling ACs, and in turn fine-tuning the grain ACs, is an ideal approach to improve grain quality of rice varieties. Based on CRISPR/Cas9 genome editing technology, we designed eight targets i...
Article
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Background The rapid identification and adoption of effective innovations in healthcare is a known challenge. The strongest evidence base for innovations can be provided by evidence synthesis, but this is frequently a lengthy process and even rapid versions of this can be time-consuming and complex. In the UK, the Accelerated Access Review and Acad...
Article
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Background Undertaking randomized clinical trials (RCTs) in emergency surgical settings is associated with methodological and practical challenges. This study explored patients’ and clinicians’ perspectives associated with the conduct of an RCT comparing laparoscopic and open colorectal surgery in the acute setting. Methods All eligible patients s...
Article
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Objectives Some pregnant women are not ready or do not want to quit smoking completely, and currently there is no support provided for these women in the UK. Offering help to reduce smoking could reduce the health risks associated with smoking and increase the limited reach of the NHS Stop Smoking Services (SSS) for pregnant women. This study aimed...
Article
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Background Head injury (HI) in older adults due to low-energy falls result in a substantial number of emergency department (ED) attendances. However, mortality associated with minor HI is very low. Reducing conveyance to hospital is important for older adults and is a priority for the National Health Service (NHS). Therefore, paramedics are require...
Article
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Background: Ageing is a heterogenous process characterised by cellular and molecular hallmarks, including changes to haematopoietic stem cells and is a primary risk factor for chronic diseases. X chromosome inactivation (XCI) randomly transcriptionally silences either the maternal or paternal X in each cell of 46, XX females to balance the gene exp...
Article
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Purpose Out of Pocket costs (OOP) sustained by cancer patients also in public NHS contribute to disease-related financial toxicity. Aim of the study was to investigate the amount and the types of OOP sustained by Italian cancer patients for care services. Methods A sample survey was conducted by FAVO in December 2017-June 2018, in 39 adhering hosp...
Preprint
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Introduction Obsolete bleep/long-range pager equipment remains firmly embedded in the NHS. Objective To introduce a secure, chart-integrated messaging system (Epic Secure Chat) in a large NHS tertiary referral centre to replace non-emergency bleeps/long-range pagers. Methods The system was socialised in the months before go-live. Operational readin...
Article
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Background The national shielding programme was introduced by UK Government at the beginning of the COVID-19 pandemic, with individuals identified as clinically extremely vulnerable (CEV) offered advice and support to stay at home and avoid all non-essential contact. This study aimed to explore the impact and responses of “shielding” on the health...
Article
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Objective To estimate continuous positive airway pressure (CPAP) length of treatment effect on survival of hospitalised COVID-19 patients in a medium-sized UK Hospital, and how this effect changes according to the patient’s comorbidity and COVID-19 route of acquisition (community or nosocomial) during the two waves in 2020. Setting The acute inpat...
Article
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Background Weight gain is commonly observed during and after breast cancer treatment and is associated with poorer survival outcomes, particularly in women with oestrogen receptor-positive (ER +) disease. The aim of this study was to co-design (with patients) a programme of tailored, personalised support (intervention), including high-quality suppo...
Article
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COVID-19 restrictions drove rapid adaptations to service delivery and new ways of working within Scotland’s mental health sector. This study explores mental health workers’ (MHWs’) experiences of delivering their services remotely. Twenty participants, who had worked in mental health professions in the National Health Service (NHS) in Scotland thro...
Article
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Introduction: A recent meta-analysis [1] has confirmed high sensitivity of indocyanine green (ICG) fluorescence mapping for sentinel node detection in early breast cancer. Concerns have previously been raised regarding the efficacy in patients with high body mass index (BMI). Materials and methods: All consecutive patients undergoing sentinel ly...
Article
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Many genetic testing methodologies are biased towards picking up structural variants (SVs) that alter copy number. Copy-neutral rearrangements such as inversions are therefore likely to suffer from underascertainment. In this study, manual review prompted by a virtual multidisciplinary team meeting and subsequent bioinformatic prioritisation of dat...
Article
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Objectives Missing data is the most common data quality issue in electronic health records (EHRs). Missing data checks implemented in common analytical software are typically limited to counting the number of missing values in individual fields, but researchers and organisations also need to understand multifield missing data patterns to better inf...
Article
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Background Online Consultation (OC) was previously promoted by the NHS to solve primary care workload challenges. Its implementation was sped up during the COVID-19 pandemic. Workload effects are widely debated. Using a job design perspective may enhance understandings of workload effect. Aim To qualitatively interrogate the workload experiences o...
Article
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Autistic people are on average more likely to experience poor health than people who are not autistic. Health checks have been shown to improve access to effective healthcare. This study investigated people's views about a primary care health check for autistic adults. We held discussion groups and interviewed autistic adults, adults with intellect...
Preprint
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Background: Kidney disease is a key risk factor for COVID-19-related mortality and suboptimal vaccine response. Optimising vaccination strategies is essential to reduce the disease burden in this vulnerable population. Methods: With the approval of NHS England, we performed a retrospective cohort study to estimate the comparative effectiveness of s...
Preprint
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Background: Deaths from opioids have increased in England and Wales, despite recognition of their harms. Coroners Prevention of Future Death reports (PFDs) provide important insights that may enable safer use and avert harms, yet these reports involving opioids have not been synthesised. We, therefore, aimed to identify opioid-related PFDs and expl...
Article
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Introduction University Hospitals of Leicester (UHL) has co-developed and deployed a novel Electronic Prescribing and Medicines Administration (EPMA) application as part of the trust electronic patient record (EPR) programme that meets specific clinical demands and interoperability standards of the National Health Service (NHS) despite clinical pre...
Article
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The UK government implemented national social-distancing measures in response to the global COVID19 pandemic. As a result,