857 research outputs found
Progress in using the electronic health record to improve primary care.
Improvement science has been transformed by the electronic health record (EHR) making it
possible to share data for patient and population benefit across primary and secondary care
organisations, with further linkage to public health, social services, and national registries.
Health data analysis is an enabling technology for systems of improvement, promoting
behavioural change in professionals and social change and innovation in organisations for
patient and citizen benefit. The ability to learn from every patient contact and provide
appropriate organisational responses to population needs has been termed a learning health
system. The development of IT enabled learning health systems is a journey on which health
services have only recently begun.
This report describes the impact trajectory over three decades of the Clinical Effectiveness
Group (CEG), a quality improvement (QI) organisation serving a population of 2 million in east
London. The core aims include delivering improvements to primary care disease management
and reducing health inequalities. Commissioning support, public health and research linkage
are further derivatives enabled from the curated EHR. CEG has built capacity for real-time
monitoring of services from all inner east London GP practices, with support for QI
programmes helping to transform service delivery across the primary/secondary interface.
The clinical performance of these localities now rank top in national and some international
performance metrics. CEG also supports new initiatives to deliver an integrated EHR platform
for all primary, secondary and other health and social data sources to provide both direct
clinical care and data for secondary uses. This agenda is aligned with national strategy in the
NHS England Forward View and the Wachter Report both of which highlight the synergistic
gains from aligning improved data uses, quality improvement and health data science
Patient safety and estimation of renal function in patients prescribed new oral anticoagulants for stroke prevention in atrial fibrillation
Patient safety and estimation of renal function in patients prescribed new oral anticoagulants for stroke prevention in atrial fibrillation
OBJECTIVE: In clinical trials of dabigatran and rivaroxaban for stroke prevention in atrial fibrillation (AF), drug eligibility and dosing were determined using the Cockcroft-Gault equation to estimate creatine clearance as a measure of renal function. This cross-sectional study aimed to compare whether using estimated glomerular filtration rate (eGFR) by the widely available and widely used Modified Diet in Renal Disease (MDRD) equation would alter prescribing or dosing of the renally excreted new oral anticoagulants. PARTICIPANTS: Of 4712 patients with known AF within a general practitioner-registered population of 930 079 in east London, data were available enabling renal function to be calculated by both Cockcroft-Gault and MDRD methods in 4120 (87.4%). RESULTS: Of 4120 patients, 2706 were <80 years and 1414 were ≥80 years of age. Among those ≥80 years, 14.9% were ineligible for dabigatran according to Cockcroft-Gault equation but would have been judged eligible applying MDRD method. For those <80 years, 0.8% would have been incorrectly judged eligible for dabigatran and 5.3% would have received too high a dose. For rivaroxaban, 0.3% would have been incorrectly judged eligible for treatment and 13.5% would have received too high a dose. CONCLUSIONS: Were the MDRD-derived eGFR to be used instead of Cockcroft-Gault in prescribing these new agents, many elderly patients with AF would either incorrectly become eligible for them or would receive too high a dose. Safety has not been established using the MDRD equation, a concern since the risk of major bleeding would be increased in patients with unsuspected renal impairment. Given the potentially widespread use of these agents, particularly in primary care, regulatory authorities and drug companies should alert UK doctors of the need to use the Cockcroft-Gault formula to calculate eligibility for and dosing of the new oral anticoagulants in elderly patients with AF and not rely on the MDRD-derived eGFR
Reducing the use of inhaled corticosteroids in mild-moderate COPD: an observational study in east London
Inhaled corticosteroids (ICS) are often prescribed for worsening breathlessness, exacerbation frequency or lung function in chronic obstructive pulmonary disease (COPD). In mild-moderate disease and infrequent exacerbations, treatment risks may outweigh benefits and ICS may be withdrawn safely under supervision. A systematic ICS deprescribing programme for patients with mild-moderate COPD was introduced in an east London Clinical Commissioning Group (CCG) in April 2017. Primary care patient record analysis found that prescribing fell from 34.9% (n = 701) in the 18 months pre-intervention to 26.9% (n = 538) by the second year of implementation, decreasing 0.84% per quarter post intervention (p = 0.006, linear regression). The relative decrease was greater than the comparison CCG (23.0% vs. 9.9%). Only South Asian ethnicity was associated with increased cessation (odds ratio 1.48, confidence interval (CI) 1.09-2.01), p = 0.013, logistic regression). Patient outcome data were not collected. A primary care-led programme comprising local education, financial incentivisation and consultant support led to a significant decrease in ICS prescribing
Variation in prescribing for anxiety and depression: a reflection of health inequalities, cultural differences or variations in access to care?
BACKGROUND: There are large variations in mental health prescribing in UK populations. However the underlying reasons for these differences, which may be related to differences in prevalence, cultural expectations or practical difficulties in access to treatment, remain uncertain. METHODS: Linear modelling was used to investigate whether population characteristics or access to primary care account for variations in mental health prescribing across 39 deprived neighbourhoods. RESULTS: The proportion of sampled respondents whose first language was not English and the ratio of general practitioners to population explained 61% of variation. Deprivation and mental health status were not significant predictors of prescribing in these relatively deprived communities. CONCLUSION: These findings suggest that mental health prescribing, within deprived areas, as well as reflecting cultural and social differences in prescribing, may also be a proxy measure of access to care
Open String Creation by S-Branes
An sp-brane can be viewed as the creation and decay of an unstable
D(p+1)-brane. It is argued that the decaying half of an sp-brane can be
described by a variant of boundary Liouville theory. The pair creation of open
strings by a decaying s-brane is studied in the minisuperspace approximation to
the Liouville theory. In this approximation a Hagedorn-like divergence is found
in the pair creation rate, suggesting the s-brane energy is rapidly transferred
into closed string radiation.Comment: Talk presented at the Hangzhou String 2002 Conference, August 12-1
Patient safety and estimation of renal in function in patients prescribed new oral anticoagulants for stroke prevention in atrial fibrillation: a cross-sectional study
OBJECTIVE: In clinical trials of dabigatran and rivaroxaban for stroke prevention in atrial fibrillation (AF), drug eligibility and dosing were determined using the Cockcroft-Gault equation to estimate creatine clearance as a measure of renal function. This cross-sectional study aimed to compare whether using estimated glomerular filtration rate (eGFR) by the widely available and widely used Modified Diet in Renal Disease (MDRD) equation would alter prescribing or dosing of the renally excreted new oral anticoagulants. PARTICIPANTS: Of 4712 patients with known AF within a general practitioner-registered population of 930 079 in east London, data were available enabling renal function to be calculated by both Cockcroft-Gault and MDRD methods in 4120 (87.4%). RESULTS: Of 4120 patients, 2706 were <80 years and 1414 were ≥80 years of age. Among those ≥80 years, 14.9% were ineligible for dabigatran according to Cockcroft-Gault equation but would have been judged eligible applying MDRD method. For those <80 years, 0.8% would have been incorrectly judged eligible for dabigatran and 5.3% would have received too high a dose. For rivaroxaban, 0.3% would have been incorrectly judged eligible for treatment and 13.5% would have received too high a dose. CONCLUSIONS: Were the MDRD-derived eGFR to be used instead of Cockcroft-Gault in prescribing these new agents, many elderly patients with AF would either incorrectly become eligible for them or would receive too high a dose. Safety has not been established using the MDRD equation, a concern since the risk of major bleeding would be increased in patients with unsuspected renal impairment. Given the potentially widespread use of these agents, particularly in primary care, regulatory authorities and drug companies should alert UK doctors of the need to use the Cockcroft-Gault formula to calculate eligibility for and dosing of the new oral anticoagulants in elderly patients with AF and not rely on the MDRD-derived eGFR
Do virtual renal clinics improve access to kidney care? A preliminary impact evaluation of a virtual clinic in East London
Spatially Resolved Magnetic Field Structure in the Disk of a T Tauri Star
Magnetic fields in accretion disks play a dominant role during the star
formation process but have hitherto been observationally poorly constrained.
Field strengths have been inferred on T Tauri stars themselves and possibly in
the innermost part of the accretion disk, but the strength and morphology of
the field in the bulk of the disk have not been observed. Unresolved
measurements of polarized emission (arising from elongated dust grains aligned
perpendicular to the field) imply average fields aligned with the disks.
Theoretically, the fields are expected to be largely toroidal, poloidal, or a
mixture of the two, which imply different mechanisms for transporting angular
momentum in the disks of actively accreting young stars such as HL Tau. Here we
report resolved measurements of the polarized 1.25 mm continuum emission from
HL Tau's disk. The magnetic field on a scale of 80 AU is coincident with the
major axis (~210 AU diameter) of the disk. From this we conclude that the
magnetic field inside the disk at this scale cannot be dominated by a vertical
component, though a purely toroidal field does not fit the data well either.
The unexpected morphology suggests that the magnetic field's role for the
accretion of a T Tauri star is more complex than the current theoretical
understanding.Comment: Accepted for publication in Natur
Handwriting-Based Gender Classification Using End-to-End Deep Neural Networks
Handwriting-based gender classification is a well-researched problem that has
been approached mainly by traditional machine learning techniques. In this
paper, we propose a novel deep learning-based approach for this task.
Specifically, we present a convolutional neural network (CNN), which performs
automatic feature extraction from a given handwritten image, followed by
classification of the writer's gender. Also, we introduce a new dataset of
labeled handwritten samples, in Hebrew and English, of 405 participants.
Comparing the gender classification accuracy on this dataset against human
examiners, our results show that the proposed deep learning-based approach is
substantially more accurate than that of humans
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