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

Οι έννομες συνέπειες από την ακυρότητα της καταπλεονεκτικής δικαιοπραξίας κατ' άρθρο 179 ΑΚ

Την παρούσα διπλωματική εργασία απασχολεί το ζήτημα των εν γένει εννόμων συνεπειών της καταπλεονεκτικής και άρα άκυρης δικαιοπραξίας. Ειδικότερα, εκκινώντας από την προβληματική του αν είναι δυνατόν να θεωρηθεί αποκλειστικά και μόνο άκυρο το μέρος εκείνο της παροχής που βρίσκεται σε προφανή δυσαναλογία εν σχέση με την αντιπαροχή του έτερου, περνά στην εξέταση του προβλήματος του ενδεχόμενου αναφυόμενου κενού της σύμβασης, συνεπεία της μερικής ακυρότητας. Εξετάζονται οι τρόποι κάλυψης αυτού του κενού εάν και εφόσον υπάρξει, ενώ καταγράφεται και μια τυπολογία των δυνάμενων, να προκύψουν, περιπτώσεων καταπλεονέκτησης. Τέλος, εξετάζεται το ζήτημα της προστασίας των καλόπιστων τρίτων (συνήθως αγοραστών) από μια τέτοια σύμβαση, καθώς και γενικότερα το ζήτημα του αδικαιολογήτου πλουτισμού.This diploma thesis deals with the question of the general legal consequences of the long-term and thus invalid legal act. In particular, starting from the problem of whether the part of the provision which is in obvious disproportion with regard to the consideration of the other is to be regarded as invalid, it goes to the examination of the problem of the eventually emerging gap of the contract as a result of partial invalidity. We examine the ways to cover this gap if and when there is a typology of possible emerging cases of overfishing. Lastly, the question of the protection of bona fide third parties (usually buyers) from such a contract, as well as the question of unjust enrichment, is examined

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

Resisting big data exploitations in public healthcare: free riding or distributive justice?

We draw on findings from qualitative interviews with health data researchers, GPs and citizens who opted out from NHS England's care.data programme to explore controversies and negotiations around data sharing in the NHS. Drawing on theoretical perspectives from science and technology studies, we show that the new socio-technical, ethical and economic arrangements were resisted not only on the basis of individual autonomy and protection from exploitation, but also as a collective effort to protect NHS services and patient data. We argue that the resulting opt-outs were a call for more personal control over data uses. This was not because these citizens placed their personal interests above those of society. It was because they resisted proposed arrangements by networks of stakeholders, not seen as legitimate, to control flows and benefits of NHS patient data. Approaching informed consent this way helps us to explore resistance as a collective action for influencing the direction of such big data programmes towards the preservation of public access to healthcare as well as the distribution of ethical decision-making between independent, trustworthy institutions and individual citizens

The Norwich Patellar Instability Score:validity, internal consistency and responsiveness for people conservatively-managed following first-time patellar dislocation

Background: This paper assessed the validity, internal consistency, responsiveness and floor-ceiling effects of the Norwich Patellar Instability (NPI) Score for a cohort of conservatively managed people following first-time patellar dislocation (FTPD).  Methods: Fifty patients were recruited, providing 130 completed datasets over 12 months. The NPI Score, Lysholm Knee Score, Tegner Level of Activity Score and isometric knee extension strength were assessed at baseline, six weeks, six and 12 months post-injury.  Results: There was high convergent validity with a statistically significant correlation between the NPI Score and the Lysholm Knee Score (p < 0.001), Tegner Level of Activity Score (p < 0.001) and isometric knee extension strength (p < 0.002). Principal component analysis revealed that the NPI Score demonstrated good concurrent validity with four components account for 70.4% of the variability. Whilst the NPI Score demonstrated a flooring-effect for 13 of the 19 items, no ceiling effect was reported. There was high internal consistency with a Cronbach Alpha value of 0.93 (95% CI: 0.91 to 0.93). The NPI Score was responsive to change over the 12 months period with an effect size of 1.04 from baseline to 12 months post-injury.  Conclusions: The NPI Score is a valid tool to assess patellar instability symptoms in people conservatively managed following FTPD.  Level of evidence: Level I

Limitations for health research with restricted data collection from UK primary care

Purpose UK primary care provides a rich data source for research. The impact of proposed data collection restrictions is unknown. This study aimed to assess the impact of restricting the scope of electronic health record (EHR) data collection on the ability to conduct research. The study estimated the consequences of restricted data collection on published Clinical Practice Research Datalink studies from high impact journals or referenced in clinical guidelines. Methods A structured form was used to systematically analyse the extent to which individual studies would have been possible using a database with data collection restrictions in place: (1) retrospective collection of specified diseases only; (2) retrospective collection restricted to a 6‐ or 12‐year period; (3) prospective and retrospective collection restricted to non‐sensitive data. Outcomes were categorised as unfeasible (not reproducible without major bias); compromised (feasible with design modification); or unaffected. Results Overall, 91% studies were compromised with all restrictions in place; 56% studies were unfeasible even with design modification. With restrictions on diseases alone, 74% studies were compromised; 51% were unfeasible. Restricting collection to 6/12 years had a major impact, with 67 and 22% of studies compromised, respectively. Restricting collection of sensitive data had a lesser but marked impact with 10% studies compromised. Conclusion EHR data collection restrictions can profoundly reduce the capacity for public health research that underpins evidence‐based medicine and clinical guidance. National initiatives seeking to collect EHRs should consider the implications of restricting data collection on the ability to address vital public health questions