Comparing the clinical practice and prescribing safety of locum and permanent doctors:observational study of primary care consultations in England

Background: Temporary doctors, known as locums, are a key component of the medical workforce in the NHS but evidence on differences in quality and safety between locum and permanent doctors is limited. We aimed to examine differences in the clinical practice, and prescribing safety for locum and permanent doctors working in primary care in England. Methods: We accessed electronic health care records (EHRs) for 3.5 million patients from the CPRD GOLD database with linkage to Hospital Episode Statistics from 1st April 2010 to 31st March 2022. We used multi-level mixed effects logistic regression to compare consultations with locum and permanent GPs for several patient outcomes including general practice revisits; prescribing of antibiotics; strong opioids; hypnotics; A&E visits; emergency hospital admissions; admissions for ambulatory care sensitive conditions; test ordering; referrals; and prescribing safety indicators while controlling for patient and practice characteristics. Results: Consultations with locum GPs were 22% more likely to involve a prescription for an antibiotic (OR = 1.22 (1.21 to 1.22)), 8% more likely to involve a prescription for a strong opioid (OR = 1.08 (1.06 to 1.09)), 4% more likely to be followed by an A&E visit on the same day (OR = 1.04 (1.01 to 1.08)) and 5% more likely to be followed by an A&E visit within 1 to 7 days (OR = 1.05 (1.02 to 1.08)). Consultations with a locum were 12% less likely to lead to a practice revisit within 7 days (OR = 0.88 (0.87 to 0.88)), 4% less likely to involve a prescription for a hypnotic (OR = 0.96 (0.94 to 0.98)), 15% less likely to involve a referral (OR = 0.85 (0.84 to 0.86)) and 19% less likely to involve a test (OR = 0.81 (0.80 to 0.82)). We found no evidence that emergency admissions, ACSC admissions and eight out of the eleven prescribing safety indicators were different if patients were seen by a locum or a permanent GP. Conclusions: Despite existing concerns, the clinical practice and performance of locum GPs did not appear to be systematically different from that of permanent GPs. The practice and performance of both locum and permanent GPs is likely shaped by the organisational setting and systems within which they work

Combining data mining and text mining for detection of early stage dementia:the SAMS framework

In this paper, we describe the open-source SAMS framework whose novelty lies in bringing together both data collection (keystrokes, mouse movements, application pathways) and text collection (email, documents, diaries) and analysis methodologies. The aim of SAMS is to provide a non-invasive method for large scale collection, secure storage, retrieval and analysis of an individual’s computer usage for the detection of cognitive decline, and to infer whether this decline is consistent with the early stages of dementia. The framework will allow evaluation and study by medical professionals in which data and textual features can be linked to deficits in cognitive domains that are characteristic of dementia. Having described requirements gathering and ethical concerns in previous papers, here we focus on the implementation of the data and text collection components

Combining mouse and keyboard events with higher level desktop actions to detect mild cognitive impairment

We present a desktop monitoring application that combines keyboard, mouse, desktop and application-level activities. It has been developed to discover differences in cognitive functioning amongst older computer users indicative of mild cognitive impairment (MCI). Following requirements capture from clinical domain experts, the tool collects all Microsoft Windows events deemed potentially useful for detecting early clinical indicators of dementia, with a view to further analysis to determine the most pertinent. Further requirements capture from potential end-users has resulted in a system that has little impact on users? daily activities and ensures data security from initial recording of events through to data analysis. We describe two experiments: firstly, volunteers were asked to perform a short set of known tasks; the second (ongoing) experiment is a longitudinal study, with the software currently successfully running on participants? computers

Search for new physics in events with same-sign dileptons and b jets in pp collisions at s√=8 TeV

This is the publisher's version, also available electronically from http://link.springer.com/article/10.1007%2FJHEP03%282013%29037.A search for new physics is performed using events with isolated same-sign leptons and at least two bottom-quark jets in the final state. Results are based on a sample of proton-proton collisions collected at a center-of-mass energy of 8 TeV with the CMS detector and corresponding to an integrated luminosity of 10.5 fb(−1). No excess above the standard model background is observed. Upper limits are set on the number of events from non-standard-model sources and are used to constrain a number of new physics models. Information on acceptance and efficiencies is also provided so that the results can be used to confront an even broader class of new physics models

Which computer-use behaviours are most indicative of cognitive decline? Insights from an expert reference group

Computer use is becoming ubiquitous amongst older adults. As computer-use depends on complex cognitive functions, measuring individuals’ computer-use behaviours over time may provide a way to detect changes in their cognitive functioning. However, it is uncertain which computer-use behaviour changes are most likely to be associated with declines of particular cognitive functions. To address this, we convened six experts from clinical and cognitive neurosciences to take part in two workshops and a follow-up survey to gain consensus on which computer-use behaviours would likely be the strongest indicators of cognitive decline. This resulted in a list of twenty-one computer-use behaviours that the majority of experts agreed would offer a ‘strong indication’ of decline in a specific cognitive function, across Memory, Executive function, Language, and Perception and Action domains. This list enables a hypothesis-driven approach to analysing computer-use behaviours predicted to be markers of cognitive decline

Search for pair-produced dijet resonances in four-jet final states in pp collisions at s√=7 TeV

This is the publisher's version, also available electronically from http://journals.aps.org/prl/abstract/10.1103/PhysRevLett.110.141802.A search for the pair production of a heavy, narrow resonance decaying into two jets has been performed using events collected in s√=7  TeV pp collisions with the CMS detector at the LHC. The data sample corresponds to an integrated luminosity of 5.0  fb(−1). Events are selected with at least four jets and two dijet combinations with similar dijet mass. No resonances are found in the dijet mass spectrum. The upper limit at 95% confidence level on the product of the resonance pair production cross section, the branching fractions into dijets, and the acceptance varies from 0.22 to 0.005 pb, for resonance masses between 250 and 1200 GeV. Pair-produced colorons decaying into qq-bar are excluded for coloron masses between 250 and 740 GeV

Search for supersymmetry in final states with a single lepton, b-quark jets, and missing transverse energy in proton-proton collisions at s√=7 TeV

This is the publisher's version, also available electronically from http://journals.aps.org/prd/abstract/10.1103/PhysRevD.87.052006.A search motivated by supersymmetric models with light top squarks is presented using proton-proton collision data recorded with the CMS detector at a center-of-mass energy of s√=7  TeV during 2011, corresponding to an integrated luminosity of 4.98  fb(−1). The analysis is based on final states with a single lepton, b-quark jets, and missing transverse energy. Standard model yields are predicted from data using two different approaches. The observed event numbers are found to be compatible with these predictions. Results are interpreted in the context of the constrained minimal supersymmetric standard model and of a simplified model with four top quarks in the final state

Search for heavy quarks decaying into a top quark and a W or Z boson using lepton + jets events in pp collisions at s√=7 TeV

This is the publisher's version, also available electronically from http://link.springer.com/article/10.1007%2FJHEP01%282013%29154.Results are presented from a search for the pair-production of heavy quarks, QQ-bar , that decay exclusively into a top quark and a W or Z boson. The search is performed using a sample of proton-proton collisions at s√=7 TeV corresponding to an integrated luminosity of 5.0 fb(−1), collected by the Compact Muon Solenoid experiment. The signal region is defined using a sample of events containing one electron or muon, missing transverse momentum, and at least four jets with large transverse momenta, where one jet is likely to originate from the decay of a bottom quark. No significant excess of events is observed with respect to the standard model expectations. Assuming a strong pair-production mechanism, quark masses below 675 (625) GeV decaying into tW (tZ) are excluded at the 95 % confidence level

Study of the Mass and Spin-Parity of the Higgs Boson Candidate via Its Decays to Z Boson Pairs

This is the publisher's version, also available electronically from http://journals.aps.org/prl/abstract/10.1103/PhysRevLett.110.081803.A study is presented of the mass and spin-parity of the new boson recently observed at the LHC at a mass near 125 GeV. An integrated luminosity of 17.3  fb(−1), collected by the CMS experiment in proton-proton collisions at center-of-mass energies of 7 and 8 TeV, is used. The measured mass in the ZZ channel, where both Z bosons decay to e or μ pairs, is 126.2±0.6(stat)±0.2(syst)  GeV. The angular distributions of the lepton pairs in this channel are sensitive to the spin-parity of the boson. Under the assumption of spin 0, the present data are consistent with the pure scalar hypothesis, while disfavoring the pure pseudoscalar hypothesis