Patient level analytics using self-organising maps: a case study on type-1 diabetes self-care survey responses

Survey questionnaires are often heterogeneous because they contain both quantitative (numeric) and qualitative (text) responses, as well as missing values. While traditional, model-based methods are commonly used by clinicians, we deploy Self Organizing Maps (SOM) as a means to visualise the data. In a survey study aiming at understanding the self-care behaviour of 611 patients with Type-1 Diabetes, we show that SOM can be used to (1) identify co-morbidities; (2) to link self-care factors that are dependent on each other; and (3) to visualise individual patient profiles; In evaluation with clinicians and experts in Type-1 Diabetes, the knowledge and insights extracted using SOM correspond well to clinical expectation. Furthermore, the output of SOM in the form of a U-matrix is found to offer an interesting alternative means of visualising patient profiles instead of a usual tabular form

The impact of co-located NHS walk-in centres on emergency departments

Objectives: To determine the impact of establishing walk-in centres alongside emergency departments on attendance rates, visit duration, process, costs and outcome of care. Methods: Eight hospitals with co-located emergency departments and walk-in centres were compared with eight matched emergency departments without walk-in centres. Site visits were conducted. Routine data about attendance numbers and use of resources were analysed. A random sample of records of patients attending before and after walk-in centres opened were also assessed. Patients who had not been admitted to hospital were sent a postal questionnaire. Results: In most sites, the walk-in centres did not have a distinct identity and there were few differences in the way services were provided compared with control sites. Overall, there was no evidence of an increase in attendance at sites with walk-in centres, but considerable variability across sites. The proportion of patients managed within the four-hour NHS target improved at sites both with and without walk-in centres. There was no evidence of any difference in re-consultation rates, costs of care or patient outcomes at sites with or without walk-in centres. Conclusions: Most hospitals in this study implemented the walk-in centre concept to a very limited extent. Consequently there was no evidence of any impact on attendance rates, process, costs or outcome of care

Comparing care at walk-in centres and at accident and emergency departments: an exploration of patient choice, preference and satisfaction

Objectives: To explore the impact of establishing walk-in centres alongside emergency departments on patient choice, preference and satisfaction. Methods: A controlled, mixed-method study comparing eight emergency departments with co-located walk-in centres with the same number of ‘traditional’ emergency departments. This paper focuses on the results of a cross-sectional questionnaire survey of users. Results: Survey data demonstrated that patients were frequently unable to distinguish between being treated at a walk-in centre or an A&E department, and even where this was the case, opportunities to exercise choice about their preferred care provider were often limited. Few made an active choice to attend a co-located walk-in centre. Patients attending walk-in centres were just as likely to be satisfied overall with the care they received as their counterparts who were treated in the co-located A&E facility, although a small proportion of walk-in centre users did report greater satisfaction with some specific aspects of their care and consultation. Conclusions: Whilst one of the key policy goals underpinning the co-location of walk-in centres next to an A&E department was to provide patients with more options for accessing healthcare and greater choice, leading in turn to increased satisfaction, this evaluation was able to provide little evidence to support this. The high percentage of patients expressing a preference for care in an established emergency department compared to a new walk-in centre facility raises questions for future policy development. Further consideration should therefore be given to the role that A&E focused walk-in centres play in the Department of Health’s current policy agenda, as far as patient choice is concerned

Renal impairment in a rural African antiretroviral programme

Background: There is little knowledge regarding the prevalence and nature of renal impairment in African populations initiating antiretroviral treatment, nor evidence to inform the most cost effective methods of screening for renal impairment. With the increasing availability of the potentially nephrotixic drug, tenofovir, such information is important for the planning of antiretroviral programmes Methods: (i) Retrospective review of the prevalence and risk factors for impaired renal function in 2189 individuals initiating antiretroviral treatment in a rural African setting between 2004 and 2007 (ii) A prospective study of 149 consecutive patients initiating antiretrovirals to assess the utility of urine analysis for the detection of impaired renal function. Severe renal and moderately impaired renal function were defined as an estimated GFR of ≤ 30 mls/min/1.73 m2 and 30–60 mls/min/1.73 m2 respectively. Logistic regression was used to determine odds ratio (OR) of significantly impaired renal function (combining severe and moderate impairment). Co-variates for analysis were age, sex and CD4 count at initiation. Results: (i) There was a low prevalence of severe renal impairment (29/2189, 1.3% 95% C.I. 0.8–1.8) whereas moderate renal impairment was more frequent (287/2189, 13.1% 95% C.I. 11.6–14.5) with many patients having advanced immunosuppression at treatment initiation (median CD4 120 cells/μl). In multivariable logistic regression age over 40 (aOR 4.65, 95% C.I. 3.54–6.1), male gender (aOR 1.89, 95% C.I. 1.39–2.56) and CD4<100 cells/ul (aOR 1.4, 95% C.I. 1.07–1.82) were associated with risk of significant renal impairment (ii) In 149 consecutive patients, urine analysis had poor sensitivity and specificity for detecting impaired renal function. Conclusion: In this rural African setting, significant renal impairment is uncommon in patients initiating antiretrovirals. Urine analysis alone may be inadequate for identification of those with impaired renal function where resources for biochemistry are limited

Design and implementation of a national program to monitor the prevalence of SARS-CoV-2 IgG antibodies in England using self-testing: the REACT-2 study

Data System. The UK Department of Health and Social Care funded the REal-time Assessment of Community Transmission-2 (REACT-2) study to estimate community prevalence of SARS-CoV-2 IgG (immunoglobulin G) antibodies in England. Data Collection/Processing. We obtained random cross-sectional samples of adults from the National Health Service (NHS) patient list (near-universal coverage). We sent participants a lateral flow immunoassay (LFIA) self-test, and they reported the result online. Overall, 905 991 tests were performed (28.9% response) over 6 rounds of data collection (June 2020–May 2021). Data Analysis/Dissemination. We produced weighted estimates of LFIA test positivity (validated against neutralizing antibodies), adjusted for test performance, at local, regional, and national levels and by age, sex, and ethnic group and area-level deprivation score. In each round, fieldwork occurred over 2 weeks, with results reported to policymakers the following week. We disseminated results as preprints and peer-reviewed journal publications. Public Health Implications. REACT-2 estimated the scale and variation in antibody prevalence over time. Community self-testing and -reporting produced rapid insights into the changing course of the pandemic and the impact of vaccine rollout, with implications for future surveillance

Managing Injuries of the Neck Trial (MINT) : design of a randomised controlled trial of treatments for whiplash associated disorders

Background: A substantial proportion of patients with whiplash injuries develop chronic symptoms. However, the best treatment of acute injuries to prevent long-term problems is uncertain. A stepped care treatment pathway has been proposed, in which patients are given advice and education at their initial visit to the emergency department (ED), followed by review at three weeks and physiotherapy for those with persisting symptoms. MINT is a two-stage randomised controlled trial to evaluate two components of such a pathway: 1. use of The Whiplash Book versus usual advice when patients first attend the emergency department; 2. referral to physiotherapy versus reinforcement of advice for patients with continuing symptoms at three weeks. Methods: Evaluation of the Whiplash Book versus usual advice uses a cluster randomised design in emergency departments of eight NHS Trusts. Eligible patients are identified by clinicians in participating emergency departments and are sent a study questionnaire within a week of their ED attendance. Three thousand participants will be included. Patients with persisting symptoms three weeks after their ED attendance are eligible to join an individually randomised study of physiotherapy versus reinforcement of the advice given in ED. Six hundred participants will be randomised. Follow-up is at 4, 8 and 12 months after their ED attendance. Primary outcome is the Neck Disability Index (NDI), and secondary outcomes include quality of life and time to return to work and normal activities. An economic evaluation is being carried out. Conclusion: This paper describes the protocol and operational aspects of a complex intervention trial based in NHS emergency and physiotherapy departments, evaluating two components of a stepped-care approach to the treatment of whiplash injuries. The trial uses two randomisations, with the first stage being cluster randomised and the second individually randomised

Weaving Indigenous knowledge systems and Western sciences in terrestrial research, monitoring and management in Canada: A protocol for a systematic map

Human activities and development have contributed to declines in biodiversity across the globe.Understanding and addressing biodiversity loss will require the mobilization of diverse knowledge systems. While calls for interdisciplinary practices in environmental research date back decades, there has been a more recent push for weaving multiple knowledge systems in environmental research and management, specifically Indigenous knowledge systems (IKS) and Western sciences. The use of multiple knowledge systems in environmental research can improve understanding of socio-ecological connections, build trust in research findings and help implement evidence-based action towards biodiversity conservation. Mobilizing multiple types of knowledge in environmental research and management can be beneficial; however, challenges remain. There is a need to understand how and where studies have woven IKS and Western sciences together in order to learn about frameworks and processes used, and identify best practices. Here, we present a protocol for a systematic map that will examine the extent, range and nature of the published literature that weaves IKS and Western sciences in terrestrial ecosystems research, monitoring and management in Canada. The systematic map will aim to capture all available and relevant studies found in the published academic and grey literature. The search will use standardized search terms across four publication databases, four specialized websites and one web-based search engine. Bibliographies of relevant review articles captured by our search strategy will be cross-checked to identify additional studies. Calls for evidence among professional networks will also complement the search strategy. All searches will be conducted in English. Search results will be reviewed in two stages: (1) title and abstract and (2) full text. All screening decisions at the full-text stage will be included into the map database. The systematic map will use a narrative synthesis approach employing descriptive tables, statistics and figures (including a map with geospatially referenced studies) to summarize findings. Results from this mapping exercise can serve to support environmental research and management efforts working across IKS and Western sciences by highlighting best practices, as well as evidence gaps

Detection of Mycobacterium bovis in nasal swabs from communal goats (Capra hircus) in rural KwaZulu-Natal, South Africa

Animal tuberculosis, caused by Mycobacterium bovis, presents a significant threat to both livestock industries and public health. Mycobacterium bovis tests rely on detecting antigen specific immune responses, which can be influenced by exposure to non-tuberculous mycobacteria, test technique, and duration and severity of infection. Despite advancements in direct M. bovis detection, mycobacterial culture remains the primary diagnostic standard. Recent efforts have explored culture-independent PCR-based methods for identifying mycobacterial DNA in respiratory samples. This study aimed to detect M. bovis in nasal swabs from goats (Capra hircus) cohabiting with M. bovis-infected cattle in KwaZulu-Natal, South Africa. Nasal swabs were collected from 137 communal goats exposed to M. bovis-positive cattle and 20 goats from a commercial dairy herd without M. bovis history. Swabs were divided into three aliquots for analysis. The first underwent GeneXpert® MTB/RIF Ultra assay (Ultra) screening. DNA from the second underwent mycobacterial genus-specific PCR and Sanger sequencing, while the third underwent mycobacterial culture followed by PCR and sequencing. Deep sequencing identified M. bovis DNA in selected Ultra-positive swabs, confirmed by region-of-difference (RD) PCR. Despite no other evidence of M. bovis infection, viable M. bovis was cultured from three communal goat swabs, confirmed by PCR and sequencing. Deep sequencing of DNA directly from swabs identified M. bovis in the same culture-positive swabs and eight additional communal goats. No M. bovis was found in commercial dairy goats, but various NTM species were detected. This highlights the risk of M. bovis exposure or infection in goats sharing pastures with infected cattle. Rapid Ultra screening shows promise for selecting goats for further M. bovis testing. These techniques may enhance M. bovis detection in paucibacillary samples and serve as valuable research tools