The evolution of primary care databases in UK: a scientometric analysis of research output

Objective:To identify publication and citation trends, most productive institutions and countries, top journals, most cited articles and authorship networks from articles that used and analysed data from primary care databases (CPRD, THIN, QResearch) of pseudonymised electronic health records in UK. Methods: Descriptive statistics and scientometric tools were used to analyse a SCOPUS dataset of 1891 articles. Open access software was used to extract networks from the dataset (Table2Net), visualise and analyse co-authorship networks of scholars and countries (Gephi) and, density maps (VOSviewer) of research topics co-occurrence and journal co-citation. Results: Research output increased overall at a yearly rate of 18.65%. While medicine is the main field of research, studies in more specialised areas include biochemistry and pharmacology. Researchers from UK, USA and Spanish institutions have published the most papers. Most of the journals that publish this type of research and most cited papers come from UK and USA. Authorship varied between 3-6 authors. Keyword analyses show that smoking, diabetes, cardiovascular diseases and mental illnesses, as well as medication that can treat such medical conditions, such as non-steroid anti-inflammatory agents, insulin and antidepressants constitute the main topics of research. Co-authorship network analyses show that lead scientists, directors or founders of these databases are, to various degrees, at the centre of clusters in this scientific community. Conclusions: There is a considerable increase of publications in primary care research from electronic health records. The UK has been well placed at the centre of an expanding global scientific community, facilitating international collaborations and bringing together international expertise in medicine, biochemical and pharmaceutical research

National targets, process transformation and local consequences in an NHS emergency department (ED): a qualitative study

BACKGROUND: In the attempt to reduce waiting times in emergency departments, various national health services have used benchmarking and the optimisation of patient flows. The aim of this study was to examine staff attitudes and experience of providing emergency care following the introduction of a 4 hour wait target, focusing on clinical, organisational and spatial issues. METHODS: A qualitative research design was used and semi-structured interviews were conducted with 28 clinical, managerial and administrative staff members working in an inner-city emergency department. A thematic analysis method was employed and NVivo 8 qualitative data analysis software was used to code and manage the emerging themes. RESULTS: The wait target came to regulate the individual and collective timescales of healthcare work. It has compartmentalised the previous unitary network of emergency department clinicians and their workspace. It has also speeded up clinical performance and patient throughput. It has disturbed professional hierarchies and facilitated the development of new professional roles. A new clinical information system complemented these reconfigurations by supporting advanced patient tracking, better awareness of time, and continuous, real-time management of emergency department staff. The interviewees had concerns that this target-oriented way of working forces them to have a less personal relationship with their patients. CONCLUSIONS: The imposition of a wait-target in response to a perceived “crisis” of patients’ dissatisfaction led to the development of a new and sophisticated way of working in the emergency department, but with deep and unintended consequences. We show that there is a dynamic interrelation of the social and the technical in the complex environment of the ED. While the 4 hour wait target raised the profile of the emergency department in the hospital, the added pressure on clinicians has caused some concerns over the future of their relationships with their patients and colleagues. To improve the sustainability of such sudden changes in policy direction, it is important to address clinicians’ experience and satisfaction

Dissenting from care.data: an analysis of opt-out forms

Background Care.data was a programme of work led by NHS England for the extraction of patient-identifiable and coded information from general practitioner GP records for secondary uses. This study analyses the forms (on the websites of GP practices) which enabled patients to opt out. Methods Theoretical sampling and summative content analysis were used to collect and analyse dissent forms used by patients to opt out from care.data. Domains included basic information about the programme, types of objections and personal details required for identification purposes. Results One hundred opt out forms were analysed. Fifty-four forms mentioned that this programme was run by NHS England. Eighty-one forms provided 2 types of objections to data sharing and 15 provided only one objection. Only 26 forms mentioned that direct care would not be affected and 32 that patients maintain their right to opt back in anytime. All but one of the opt out forms we reviewed requested the name of the person wishing to opt out. Ninety-four required a date of birth and 33 an NHS number. Eighty-two required an address, 42 a telephone number and 7 an email address. Conclusion Numbers of patients (not) opting out should be treated with caution because the variability of information provided and the varied options for dissent may have caused confusion among patients. To ensure that dissent is in accordance with individual preferences and moral values, we recommend that well-designed information material and standardised opt out forms be developed for such data sharing initiatives

E-Infrastructures and the divergent assetization of public health data: Expectations, uncertainties, and asymmetries

Normative, scientific and economic pledges to Electronic Health Record (EHR) data-driven research (for health and wealth) attempt to reconfigure public health data as an asset for realising multiple values across healthcare, research and finance. In this paper, we examine some of the expectations, frictions and uncertainties involved with the assetisation of de-identified NHS patient data by (primary care) research services in UK. We introduce the concept of 'asymmetric assetisation divergence' to study the various practices of configuring and using this data, both as a continuously generated resource to be extracted and as an asset to be circulated in the knowledge economy. As data assetisation and exploitations grow bigger and more diverse, the capitalisation of these datasets may constitute EHR data-driven research in healthcare as an attractive technoscientific activity, but one limited to those actors with specific sociotechnical resources in place to fully exploit them at the required scale

Interventions for Childhood Obesity Control in Cyprus: An analysis and Evaluation of Programmes and Protocols

In the last twenty years, there has been an increase in the prevalence of obesity with a simultaneous increase in chronic diseases.Aim: The aim of this literature review is to discuss available interventions for childhood obesity (2-11 years) and to propose effective prevention policies for the Republic of Cyprus.Methods: Childhood obesity prevention and intervention programs in Cyprus were analysed using SWOT analysis and evaluation protocols for compatibility and sustainability among health professionals andgovernment partners.Results: The preliminary literature review reveals that there are specific short comings with regards to the existing NHS and public health. The sustainability of existing health policies and implemented programs is questionable as there are no coherent monitoring systems in place. There are many worthwhile programsand organizations that are often delayed due to conflict of interest.Conclusions: Analysis shows that the implementation, via a Cypriot National Health System, of public health strategies could be effective means of addressing specifically childhood obesity. This includes a more active role for the family physician and policies of a multi- level strategy, aiming as fostering innovative public-private healthcare collaborations, supported by educational institutions, infrastructure, legislation and the wider society.However, such strategies are needed on a long-term basis and throughout a person’s life span

Building and sustaining collaboration in cross sector e-learning development

This chapter will focus on the process of building and sustaining collaborative reusable e-learning object development across three educational sectors, Higher Education (HE), the UK National Health Service (NHS) and Further Education (FE) Colleges, using the LOLA project as a case study. A qualitative evaluation of ‘process’ ran alongside the entirety of the LOLA project. This chapter reports the findings of this qualitative research, and analyses how collaboration was achieved between the diverse institutions who were project partners. The strengths of this approach included the commitment of the team members to collaboration, while practical challenges included the location of the team members, but also wider issues in the institutions involved, and in particular, the role of the Media Developer and the perception of it by other team members

Market-driven production of biospecimens and the role of NHS hospital-led biobanks

Biobanks are vital for biospecimen production in research, despite the regulatory, recruitment and commercial difficulties they face. We conducted interviews with clinicians, researchers, volunteers who recruit biobank participants, regulators and NHS managers about the integration of a biobank into an NHS hospital. We show that medical waste collected for biomedical research acquires its socio-ethical and economic value from the level of integration (both technologically and organisationally) of the biobank into the NHS hospital. There is extensive investment in a range of intellectual and commercial relationships and labour among stakeholders involved in the production of biospecimens. It is not only the boundaries of research, clinical care and commercialisation of biospecimens that blur but also those of volunteerism and citizenship. Hospital-led biobanks provide an opportunity to study the intertwining of biomedical innovation and healthcare

‘Kindling the fire’ of NHS patient data exploitations: The care.data controversy in news media discourses

This paper explores news media discourse about care.data: an NHS England programme of work for amalgamating and sharing patient data from primary care for planning and research. It was scrapped in 2016 after three years of public outcry, delays and around 1.5 million opt-outs. I examine UK news media coverage of this programme through the ‘fire object’ metaphor, focusing upon the visions of purpose and value it inspired, the abrupt discontinuities, juxtapositions and transformations it performed, and the matters of concern that went unheeded. Findings suggest that, in care.data's pursuit of a societal consensus on NHS patient data exploitations, various visions for new and fluid data flows brought to presence narratives of transforming the NHS, saving lives, and growing the economy. Other realities and concerns that mattered for certain stakeholders, such as data ownership and commercialisation, public engagement and informed consent, commitment and leadership, operational capabilities, and NHS privatisation agendas, remained absent or unsettled. False dichotomies kept the controversy alive, sealing its fate. I conclude by arguing that such failed programmes can turn into phantom-like objects, haunting future patient data schemes of similar aspirations. The paper highlights the role news media can have in understanding such energetic public controversies

Technological innovation and change of nursing work in an emergency department : a sociotechnical perspective

This thesis evolves around the identification and analysis of the particular sociotechnical factors and conditions that facilitate the implementation of new information and communication technologies (lCT) in complex clinical settings. Today most national health systems around the world link the need for best healthcare provision with the overall efficiency of their institutions. Such orientations undoubtedly require outcomes linked to lCTs so as to assign them with criteria and measures of success. On the other hand, implementations of such technologies in healthcare organisations, particularly under the Connecting for Health (CfH) IT programme, have not been equally successful. As science and technology studies (STS) scholarship shows, these technologies, despite their technical robustness, do not guarantee successful implementations. It is rather the intertwining of people, machines and spaces at the local setting that determines the fate of the new system. The four-hour waiting target (now a standard of hospital performance) for patients attending an Accident & Emergency Department (A&E) has undoubtedly become the most important catalyst of effective change towards a "whole system" approach in the provision of unscheduled care. This is, partially, because waiting times in A&Es have been acknowledged as one of the most prominent causes of dissatisfaction for patients interacting with the National Health Service (NHS). From the mid-1990s, Conservative and Labour, governments in the UK have developed and implemented a series of reform programmes to address this issue. After a long series of negotiations, which were intensified at the dawn of the new century, the Department of Health (DH), in accordance with the recommendations of relevant emergency clinical bodies and patient advocacy groups, stabilised, in 2004, the target (now a standard of hospital performance) to 98% of patients attending A&Es to be treated and admitted or discharged within four hours. During that time the DH also released a report with key recommendations on building layouts for these 3 hospital departments in order to positively influence efficient patient care by appropriating circulation spaces for patients, clinicians and visitors. This thesis uses a case study of the implementation of a clinical information system for patient registration and tracking in the busy emergency department of a large Acute Care University Trust in the East Midlands, UK. It explores the complexity of relations and subsequent negotiations between these heterogeneous elements during the formation of a new practice ordering for nursing work. For this, I draw on the work of ANT research, firstly, within the broad field of geography. I conceptualise space and time as invaluable non-human entities that need to be enrolled and converged at the local level in order for the inhabitants (clinicians, administrators, managers) and the visitors (patients and their carers) of this temporal network to enact prescribed movements, interactions, communications and relationships. From there, this thesis examines the way the above national policies (i.e. waiting time targets, built environment design) have come to facilitate the introduction, and subsequent stabilisation, of a clinical lCT in the local clinical setting. Based on the findings from the analysis of 30 semi-structured interviews with nurses, the change manager, the system administrator and assistants as well as from relevant policy documents, internal reports, building blueprints and implementation studies, I argue that the re-engineering of healthcare practice with the diffusion of a new technology is not a fixed and linear process, but more of an interplay of various fluctuant, performative and eo-constitutive technical and social factors. In particular, I first show that the DH strategically attempted at ordering the A&E towards specific outcomes of performativity by formalising procedures, interactions and generally the behaviours of these peripheral networks. Rooms and corridors were redesigned and timestamps are now being applied to every process so as to effect a new spatio-temporality in the planned circulation of patients and hospital staff in the A&E department. As a result, groups of users are being integrated or segregated according to particular (and rationalistic) conceptions of patient flows. 4 For the above purposes, the specific technology under examination arrives in the A&E as an efficient technological solution to a given waiting time problem. While issues of computer literacy and interaction with complex technologies remained a concern for the nursing staff during the implementation phase, these were substantially downgraded in the face of a new rigid policy which aimed at addressing one of the most prominent causes of patient dissatisfaction. The technology was gradually translated and transformed into an invaluable ally. Conversely, success includes not only the appropriate use of the system, but also the users' high dependence on it and finally the network's ability to act as a platform for continual, technologically mediated, reformation of its practices under specific strategic policies. Through an ANT conceptualisation, the thesis concludes by arguing that despite the various negotiations that take part between the centre of calculation (DH) and the local setting (A&E) offering, to the latter, some room for manoeuvre and discretion, in the end, the former is constantly enhancing its instrumental and obligatory passage role in shaping local action. It does this by strategically organising the opening of the black-box of its constituted healthcare institutions through the enrolment, the re-skilling and, after that, the mobilisation of specific intra-organisational networks. 5.EThOS - Electronic Theses Online ServiceGBUnited Kingdo