Supplemental Material - Variations in policies for accessing elective musculoskeletal procedures in the English National Health Service: A documentary analysis

Supplementary Material for Variations in policies for accessing elective musculoskeletal procedures in the English National Health Service: A documentary analysis by Leila Rooshenas, Sharea Ijaz, Alison Richards, Alba Realpe, Jelena Savovic, Tim Jones, William Hollingworth and Jenny Donovan in Journal of Health Services Research & Policy

Supplemental Material - Variations in policies for accessing elective musculoskeletal procedures in the English National Health Service: A documentary analysis

Supplementary Material for Variations in policies for accessing elective musculoskeletal procedures in the English National Health Service: A documentary analysis by Leila Rooshenas, Sharea Ijaz, Alison Richards, Alba Realpe, Jelena Savovic, Tim Jones, William Hollingworth and Jenny Donovan in Journal of Health Services Research & Policy

Data from: Prevalence and outcomes of multimorbidity in South Asia: a systematic review

Objective: To systematically review the studies of prevalence, patterns and consequences of multimorbidity reported from South Asia. Design: Systematic review. Setting: South Asia. Data sources: Articles were retrieved from two electronic databases (PubMed and Embase) and from the relevant references lists. Methodical data extraction according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was followed. English-language studies published between 2000 and March 2015 were included. Eligibility criteria: Studies addressing prevalence, consequences and patterns of multimorbidity in South Asia. Articles documenting presence of two or more chronic conditions were included in the review. The quality and risk of bias were assessed using STROBE criteria. Data selection: Two reviewers independently assessed studies for eligibility, extracted data and assessed study quality. Due to heterogeneity in methodologies among reported studies, only narrative synthesis of the results was carried out. Results: Of 11 132, 61 abstracts were selected and 13 were included for final data synthesis. The number of health conditions analysed per study varied from 7 to 22, with prevalence of multimorbidity from 4.5% to 83%. The leading chronic conditions were hypertension, arthritis, diabetes, cardiac problems and skin diseases. The most frequently reported outcomes were increased healthcare utilisation, lowered physical functioning and quality of life, and psychological distress. Conclusions: Our study, a comprehensive mapping of multimorbidity research in South Asia, reveals the insufficient volume of work carried out in this domain. The published studies are inadequate to provide an indication of the magnitude of multimorbidity in these countries. Research into clinical and epidemiological aspects of multimorbidity is warranted to build up scientific evidence in this geographic region. The wide heterogeneity observed in the present review calls for greater methodological rigour while conducting these epidemiological studies. Trial registration number: CRD42013005456.,Data extractionExtracted data for the systematic review.

A longitudinal study of the associations of children's body mass index and physical activity with blood pressure – dataset

B-Proact1v is a longitudinal study examining changes in children’s physical activity and sedentary behaviours as they progress through primary school. In 2012-2013, 1299 Year 1 children (median age: 6 years) were recruited from 57 schools in greater Bristol, UK (total number of eligible children: 2600; recruitment rate: 50.0%). Following this, data were collected from 1223 Year 4 children (median age: 9 years) from 47 of the original schools between March 2015 and July 2016 (total number of eligible children: 2047; recruitment rate: 59.7%). This included 685 children from the original sample. This dataset represents a subset of the B-Proact1v data to examine the longitudinal associations of children’s body mass index and physical activity with blood pressure. Included in this repository is the dataset and a data dictionary. The dataset includes the variables that underlie the findings in a manuscript entitled ‘A longitudinal study of the associations of children’s body mass index and physical activity with blood pressure’ that has been submitted to PLOS ONE. This dataset has been made available so that future researchers can replicate the study findings using the data. If you wish to use the data for any purpose other than replicating the study findings, please contact the Principal Investigator Professor Russ Jago ([email protected]) to discuss this

B-Proact1v Year 4 & Year 6 Blood Pressure, BMI & PA dataset

B-Proact1v is a longitudinal study examining changes in children’s physical activity and sedentary behaviours as they progress through primary school. In 2012-2013, 1299 Year 1 children (median age: 6 years) were recruited from 57 schools in greater Bristol, UK (total number of eligible children: 2600; recruitment rate: 50.0%). Following this, data were collected from 1223 Year 4 children (median age: 9 years) from 47 of the original schools between March 2015 and July 2016 (total number of eligible children: 2047; recruitment rate: 59.7%). Between March 2017 and July 2018, 50 of the original schools were re-recruited and data collected from 1296 Year 6 children (median age: 11 years). In total, 2132 children participated, of whom 958 participated at one time-point, 662 at two time-points, and 512 at three time-points. This dataset represents a subset of the B-Proact1v data to examine the prospective associations of children’s body mass index and physical activity at age 9 and 11 with blood pressure at age 11. Included in this repository is the dataset and a data dictionary. The dataset includes the variables that underlie the findings in a manuscript entitled ‘Associations of body mass index, physical activity and sedentary time with blood pressure in primary school children from south-west England: a prospective study’ that has been submitted to PLOS ONE. This dataset has been made available so that future researchers can replicate the study findings using the data. If you wish to use the data for any purpose other than replicating the study findings, please contact the Principal Investigator Professor Russ Jago ([email protected]) to discuss this

Data from: Increasing compliance with low tidal volume ventilation in the ICU with two nudge-based interventions: evaluation through intervention time-series analyses

Objectives: Low tidal volume (TVe) ventilation improves outcomes for ventilated patients, and the majority of clinicians state they implement it. Unfortunately, most patients never receive low TVes. ‘Nudges’ influence decision-making with subtle cognitive mechanisms and are effective in many contexts. There have been few studies examining their impact on clinical decision-making. We investigated the impact of 2 interventions designed using principles from behavioural science on the deployment of low TVe ventilation in the intensive care unit (ICU). Setting: University Hospitals Bristol, a tertiary, mixed medical and surgical ICU with 20 beds, admitting over 1300 patients per year. Participants: Data were collected from 2144 consecutive patients receiving controlled mechanical ventilation for more than 1 hour between October 2010 and September 2014. Patients on controlled mechanical ventilation for more than 20 hours were included in the final analysis. Interventions: (1) Default ventilator settings were adjusted to comply with low TVe targets from the initiation of ventilation unless actively changed by a clinician. (2) A large dashboard was deployed displaying TVes in the format mL/kg ideal body weight (IBW) with alerts when TVes were excessive. Primary outcome measure: TVe in mL/kg IBW. Findings: TVe was significantly lower in the defaults group. In the dashboard intervention, TVe fell more quickly and by a greater amount after a TVe of 8 mL/kg IBW was breached when compared with controls. This effect improved in each subsequent year for 3 years. Conclusions: This study has demonstrated that adjustment of default ventilator settings and a dashboard with alerts for excessive TVe can significantly influence clinical decision-making. This offers a promising strategy to improve compliance with low TVe ventilation, and suggests that using insights from behavioural science has potential to improve the translation of evidence into practice.,newalldata_corrected

Data from: Novel methods to define invasive procedures at the end-of-life were developed to improve quality of end of life care research: A population-based cohort study in colorectal cancer

Background Understanding the use of invasive procedures (IPs) at the end-of-life (EoL) is important to avoid under- and overtreatment, but epidemiologic analysis is hampered by limited methods to define treatment intent and EoL phase. This study applied novel methods to report IPs at the EoL using a colorectal cancer (CRC) case study. Methods An English population-based cohort of adult patients diagnosed between 2013 and 2015 was used with follow-up to 2018. Procedure intent (curative, non-curative, diagnostic) by cancer site and stage at diagnosis was classified by two surgeons independently. Joinpoint regression modelled weekly rates of IPs for 36 sub-cohorts of patients with incremental survival of 0-36 months. EoL phase was defined by a significant IP rate change before death. Zero-inflated Poisson regression explored associations between IP rates and clinical/sociodemographic variables. Results Of 87,731 patients included, 41,972 (48%) died. 9,492 procedures were classified by intent (interrater agreement 99.8%). Patients received 502,895 IPs (1.39 and 3.36 per person year for survivors and decedents). Joinpoint regression identified significant increases in IPs four weeks before death in those living 3-6 months, and eight weeks before death in those living 7–36 months from diagnosis. 7,908 (18.8%) patients underwent IPs at the EoL, with stoma formation the most common major procedure. Younger age, early-stage disease, men, lower comorbidity, those receiving chemotherapy and living longer from diagnosis were associated with IPs. Conclusions Methods to identify and classify IPs at the EoL were developed and tested within a CRC population. This approach can be now extended and validated to identify potential under- and overtreatment

Data from: Novel methods to define invasive procedures at the end-of-life were developed to improve quality of end of life care research: A population-based cohort study in colorectal cancer

Background Understanding the use of invasive procedures (IPs) at the end-of-life (EoL) is important to avoid under- and overtreatment, but epidemiologic analysis is hampered by limited methods to define treatment intent and EoL phase. This study applied novel methods to report IPs at the EoL using a colorectal cancer (CRC) case study. Methods An English population-based cohort of adult patients diagnosed between 2013 and 2015 was used with follow-up to 2018. Procedure intent (curative, non-curative, diagnostic) by cancer site and stage at diagnosis was classified by two surgeons independently. Joinpoint regression modelled weekly rates of IPs for 36 sub-cohorts of patients with incremental survival of 0-36 months. EoL phase was defined by a significant IP rate change before death. Zero-inflated Poisson regression explored associations between IP rates and clinical/sociodemographic variables. Results Of 87,731 patients included, 41,972 (48%) died. 9,492 procedures were classified by intent (interrater agreement 99.8%). Patients received 502,895 IPs (1.39 and 3.36 per person year for survivors and decedents). Joinpoint regression identified significant increases in IPs four weeks before death in those living 3-6 months, and eight weeks before death in those living 7–36 months from diagnosis. 7,908 (18.8%) patients underwent IPs at the EoL, with stoma formation the most common major procedure. Younger age, early-stage disease, men, lower comorbidity, those receiving chemotherapy and living longer from diagnosis were associated with IPs. Conclusions Methods to identify and classify IPs at the EoL were developed and tested within a CRC population. This approach can be now extended and validated to identify potential under- and overtreatment

Data from: Olfactory testing in Parkinson’s disease & REM behavior disorder: a machine learning approach

Objective: We sought to identify an abbreviated test of impaired olfaction, amenable for use in busy clinical environments in prodromal (isolated REM sleep Behavior Disorder (iRBD)) and manifest Parkinson’s. Methods: 890 PD and 313 control participants in the Discovery cohort study underwent Sniffin’ stick odour identification assessment. Random forests were initially trained to distinguish individuals with poor (functional anosmia/hyposmia) and good (normosmia/super-smeller) smell ability using all 16 Sniffin’ sticks. Models were retrained using the top 3 sticks ranked by order of predictor importance. One randomly selected 3-stick model was tested in a second independent Parkinson’s dataset (n=452) and in two iRBD datasets (Discovery n=241; Marburg n=37) before being compared to previously described abbreviated Sniffin’ stick combinations. Results: In differentiating poor from good smell ability, the overall area under the curve (AUC) value associated with the top 3 sticks (Anise, Licorice and Banana) was 0.95 in the development dataset (sensitivity:90%, specificity:92%, PPV:92%, NPV:90%). Internal and external validation confirmed AUCs≥0.90. The combination of 3-stick model determined poor smell and an RBD screening questionnaire score of ≥5, separated iRBD from controls with a sensitivity, specificity, PPV and NPV of 65%, 100%, 100% and 30%. Conclusions: Our 3-Sniffin’-stick model holds potential utility as a brief screening test in the stratification of individuals with Parkinson’s and iRBD according to olfactory dysfunction. Classification of Evidence: This study provides Class III evidence that a 3-Sniffin’-stick model distinguishes individuals with poor and good smell ability and can be used to screen for individuals with iRBD

PROSPERO_registration.pdf, Underlying data for: The impact of the Covid-19 pandemic on suicidal behaviour: a living systematic review protocol

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