From Data to Knowledge in Secondary Health Care Databases

The advent of big data in health care is a topic receiving increasing attention worldwide. In the UK, over the last decade, the National Health Service (NHS) programme for Information Technology has boosted big data by introducing electronic infrastructures in hospitals and GP practices across the country. This ever growing amount of data promises to expand our understanding of the services, processes and research. Potential bene�ts include reducing costs, optimisation of services, knowledge discovery, and patient-centred predictive modelling. This thesis will explore the above by studying over ten years worth of electronic data and systems in a hospital treating over 750 thousand patients a year. The hospital's information systems store routinely collected data, used primarily by health practitioners to support and improve patient care. This raw data is recorded on several di�erent systems but rarely linked or analysed. This thesis explores the secondary uses of such data by undertaking two case studies, one on prostate cancer and another on stroke. The journey from data to knowledge is made in each of the studies by traversing critical steps: data retrieval, linkage, integration, preparation, mining and analysis. Throughout, novel methods and computational techniques are introduced and the value of routinely collected data is assessed. In particular, this thesis discusses in detail the methodological aspects of developing clinical data warehouses from routine heterogeneous data and it introduces methods to model, visualise and analyse the journeys that patients take through care. This work has provided lessons in hospital IT provision, integration, visualisation and analytics of complex electronic patient records and databases and has enabled the use of raw routine data for management decision making and clinical research in both case studies

Alargando os espaços de aprendizagem na formação inicial de professores em regime de blended learning

This paper aims to offer and discuss a qualitative case study involving use of communication tools in a blended learning system (b-learning) for an initial context of Teacher’s Science/Technology (Sc/T). Therefore, we aim to contribute to the distance learning concept (b-learning context) through finding answers of questions asked about prospective digital technologies for starting teacher training, particularly a way to blend and overcome restrictions. We search tools available online in platform as a helper at classroom training in order to provide: i) guidelines to develop planned tasks and records available as well as literature and web-references; ii) discuss issues related to classes and/ or recommended topics; iii) share and discuss tasks given by students. This paper contextualizes analysis, but objectives and operating strategies are described in order to offer a reflection based on that experience. Results by perception and mediated by technologies, and a questionnaire to students and interviews applied to teachers give us a good acceptance of strategies designed and greater interaction levels, especially on issues related to topics covered at conferences. It can also be concluded that technologies fostered an expansion of learning scopes.Este trabajo tiene como objetivo presentar y discutir un estudio de caso de carácter cualitativo que implica la explotación de las herramientas de comunicación en el sistema de enseñanza mixta (b-learning) en el contexto de la Ciencia/Tecnología inicial del profesorado (C/T). Se pretende, por tanto, contribuir al campo de la educación a distancia (contexto b-learning), mediante la búsqueda de respuestas a las preguntas relacionadas con el potencial de las tecnologías digitales en materia de formación inicial del profesorado, en particular, cómo integrar y superar las limitaciones. Se exploraron las herramientas disponibles en la plataforma online como un complemento a la formación presencial, con el fin de proporcionar: i) directrices para el desarrollo de las tareas previstas y los registros disponibles para la lectura, así como bibliografía y Webgrafía; ii) discutir cuestiones relacionadas con las clases y/o recomendados; lecturas iii) compartir y discutir el trabajo realizado por los alumnos. En el artículo se contextualiza el estudio, se describen los objetivos y las estrategias de explotación y presenta una reflexión sobre la experiencia. Los resultados obtenidos por medio de observación mediada por las tecnologías utilizadas, la aplicación de un cuestionario a los estudiantes y profesores entrevistas, indican una buena aceptación de las estrategias diseñadas y niveles considerables de interacción, sobre todo en torno a cuestiones relacionadas con los temas tratados en las conferencias. También se puede concluir que el uso de tecnologías fomentó la expansión de los espacios de aprendizaje.O presente trabalho visa a apresentação e discussão de um estudo de caso de natureza qualitativa que envolveu a exploração de ferramentas de comunicação a distância em regime de blended learning, num contexto de formação inicial de professores de Ciências/Tecnologias (C/T). Pretende-se, desta forma, contribuir para a área da educação a distância (em regime de blended learning), através da procura de respostas para questões relacionadas com as potencialidades das tecnologias digitais ao nível da formação inicial de professores, em particular, como as integrar e os constrangimentos a ultrapassar. As ferramentas disponíveis numa plataforma online foram exploradas, enquanto complemento da formação presencial, tendo em vista fornecer: i) orientações para o desenvolvimento das tarefas previstas e disponibilizar fichas de leitura, bem como bibliografia e webgrafia; ii) discutir dúvidas relacionadas com as aulas e/ou as leituras recomendadas; iii) partilhar e discutir trabalhos desenvolvidos pelos alunos. No artigo contextualiza-se o estudo, descrevem-se os objectivos e estratégias explorados e apresenta-se uma reflexão sobre a experiência. Os resultados, recolhidos através de observação mediada pelas tecnologias utilizadas, da aplicação de um questionário aos alunos e de entrevistas a docentes, apontam para uma boa aceitação das estratégias concebidas e níveis de interação consideráveis, em particular em torno de dúvidas relacionadas com os temas abordados nas aulas teóricas. Pode ainda indicar-se que a utilização das tecnologias fomentou o alargamento dos espaços de aprendizagem

Low estimated glomerular filtration rate and pneumonia in stroke patients: findings from a prospective stroke registry in the East of England

Purpose: Low estimated glomerular filtration rate (eGFR) (<60 mL/min/1.73 m2) is a recognized risk factor for pneumonia in general population. While pneumonia is common after stroke, the association between levels of eGFR and pneumonia in stroke patient population has not yet been examined thoroughly. Patients and methods: Using data of 10,329 patients from the Norfolk and Norwich Stroke Registry between January 2003 and April 2015, we examined the association of poststroke pneumonia (in-hospital and after discharge) with low eGFR and when eGFR is divided into the complete spectrum of clinically relevant categories; (≥90) (ref.), 60–89, 45–59, 30–44, 15–30, and <15 mL/min/1.73 m2). Results: In all, 1,519 (14.7%) developed in-hospital pneumonia and 1,037 (12.9%) developed pneumonia after hospital discharge. In age- and sex-adjusted model, low eGFR was associated with in-hospital pneumonia (subdistribution hazard ratio (sHR): 1.13; 95% CI: 1.01–1.25) and pneumonia after discharge (sHR: 1.20; 95% CI: 1.07–1.38). In fully adjusted model, association remained significant for pneumonia after hospital discharge. When eGFR was categorized in all clinically relevant categories, association with in-hospital pneumonia tended to be “U” shaped (eg, compared to eGFR ≥90, sHR for 60–89 was 0.78; 95% CI: 0.62–0.99 and for <15 was 1.06; 95% CI: 0.71–1.60) and association with pneumonia after discharge tended to increase with decline in eGFR level such that risk was almost two fold higher at eGFR <15 (sHR: 1.85; 95% CI: 1.01–3.51). Association for in-hospital pneumonia was driven mainly by aspiration pneumonia, whereas association in stroke survivors was predominantly for nonaspiration pneumonia. Conclusion: In stroke patients, low eGFR at admission was associated with pneumonia, particularly severely reduced eGFR with nonaspiration pneumonia after hospital discharge. eGFR could form the basis for identifying patients at high risk of poststroke pneumonia

Closure methods of the appendix stump for complications during laparoscopic appendectomy

BACKGROUND: Laparoscopic appendectomy is amongst the most common general surgical procedures performed in the developed world. Arguably, the most critical part of this procedure is effective closure of the appendix stump to prevent catastrophic intra-abdominal complications from a faecal leak into the abdominal cavity. A variety of methods to close the appendix stump are used worldwide; these can be broadly divided into traditional ligatures (such as intracorporeal or extracorporeal ligatures or Roeder loops) and mechanical devices (such as stapling devices, clips, or electrothermal devices). However, the optimal method remains unclear. OBJECTIVES: To compare all surgical techniques now used for appendix stump closure during laparoscopic appendectomy. SEARCH METHODS: In June 2017, we searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 6) in the Cochrane Library, MEDLINE Ovid (1946 to 14 June 2017), Embase Ovid (1974 to 14 June 2017), Science Citation Index - Expanded (14 June 2017), China Biological Medicine Database (CBM), the World Health Organization International Trials Registry Platform search portal, ClinicalTrials.gov, Current Controlled Trials, the Chinese Clinical Trials Register, and the EU Clinical Trials Register (all in June 2017). We searched the reference lists of relevant publications as well as meeting abstracts and Conference Proceedings Citation Index to look for additional relevant clinical trials. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) that compared mechanical appendix stump closure (stapler, clips, or electrothermal devices) versus ligation (Endoloop, Roeder loop, or intracorporeal knot techniques) for uncomplicated appendicitis. DATA COLLECTION AND ANALYSIS: Two review authors identified trials for inclusion, collected data, and assessed risk of bias independently. We performed the meta-analysis using Review Manager 5. We calculated the odds ratio (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes, with 95% confidence intervals (CIs). MAIN RESULTS: We included eight randomised studies encompassing 850 participants. Five studies compared titanium clips versus ligature, two studies compared an endoscopic stapler device versus ligature, and one study compared an endoscopic stapler device, titanium clips, and ligature. In our analyses of primary outcomes, we found no differences in total complications (OR 0.97, 95% CI 0.27 to 3.50, 8 RCTs, very low-quality evidence), intraoperative complications (OR 0.93, 95% CI 0.34 to 2.55, 8 RCTs, very low-quality evidence), or postoperative complications (OR 0.80, 95% CI 0.21 to 3.13, 8 RCTs, very low-quality evidence) between ligature and all types of mechanical devices. However, our analyses of secondary outcomes revealed that use of mechanical devices saved approximately nine minutes of total operating time when compared with use of a ligature (mean difference (MD) -9.04 minutes, 95% CI -12.97 to -5.11 minutes, 8 RCTs, very low-quality evidence). However, this finding did not translate into a clinically or statistically significant reduction in inpatient hospital stay (MD 0.02 days, 95% CI -0.12 to 0.17 days, 8 RCTs, very low-quality evidence). Available information was insufficient for reliable comparison of total hospital costs and postoperative pain/quality of life between the two approaches. Overall, evidence across all analyses was of very low quality, with substantial potential for confounding factors. Given the limitations of all studies in terms of bias and the low quality of available evidence, a clear conclusion regarding superiority of any one particular type of mechanical device over another is not possible. AUTHORS' CONCLUSIONS: Evidence is insufficient at present to advocate omission of conventional ligature-based appendix stump closure in favour of any single type of mechanical device over another in uncomplicated appendicitis

Predictors of mortality and disability in stroke-associated pneumonia

Whilst stroke-associated pneumonia (SAP) is common and associated with poor outcomes, less is known about the determinants of these adverse clinical outcomes in SAP. To identify the factors that influence mortality and morbidity in SAP. Data for patients with SAP (n = 854) were extracted from a regional Hospital Stroke Register in Norfolk, UK (2003-2015). SAP was defined as pneumonia occurring within 7 days of admission by the treating clinicians. Mutlivariable regression models were constructed to assess factors influencing survival and the level of disability at discharge using modified Rankin Scale [mRS]. Mean (SD) age was 83.0 (8.7) years and ischaemic stroke occurred in 727 (85.0%). Mortality was 19.0% at 30 days and 44.0% at 6 months. Stroke severity assessment using National Institutes of Health Stroke Scale was not recorded in the data set although Oxfordshire Community Stroke Project was Classification. In the multivariable analyses, 30-day mortality was independently associated with age (OR 1.04, 95% CI 1.01-1.07, p = 0.01), haemorrhagic stroke (2.27, 1.07-4.78, p = 0.03) and pre-stroke disability (mRS 4-5 v 0-1: 6.45, 3.12-13.35, p < 0.001). 6-month mortality was independently associated with age (< 0.001), pre-stroke disability (p < 0.001) and certain comorbidities, including the following: dementia (6.53, 4.73-9.03, p < 0.001), lung cancer (2.07, 1.14-3.77, p = 0.017) and previous transient ischemic attack (1.94, 1.12-3.36, p = 0.019). Disability defined by mRS at discharge was independently associated with age (1.10, 1.05-1.16, p < 0.001) and plasma C-reactive protein (1.02, 1.01-1.03, p = 0.012). We have identified non-modifiable determinants of poor prognosis in patients with SAP. Further studies are required to identify modifiable factors which may guide areas for intervention to improve the prognosis in SAP in these patients

Estimated glomerular filtration rate and risk of poor outcomes after stroke

We thank the data team of the Norfolk and Norwich University Hospital Stroke Services.Peer reviewedPostprin

Key physical processes and their model representation for projecting climate impacts on subarctic Atlantic net primary production: A synthesis

Oceanic net primary production forms the foundation of marine ecosystems. Understanding the impact of climate change on primary production is therefore critical and we rely on Earth System Models to project future changes. Stemming from their use of different physical dynamics and biogeochemical processes, these models yield a large spread in long-term projections of change on both the global and regional scale. Here we review the key physical processes and biogeochemical parameterizations that influence the estimation of primary production in Earth System Models and synthesize the available projections of productivity in the subarctic regions of the North Atlantic. The key processes and modelling issues we focus on are mixed layer depth dynamics, model resolution and the complexity and parameterization of biogeochemistry. From the model mean of five CMIP6 models, we found a large increase in PP in areas where the sea ice retreats throughout the 21st century. Stronger stratification and declining MLD in the Nordic Seas, caused by sea ice loss and regional freshening, reduce the vertical flux of nutrients into the photic zone. Following the synthesis of the primary production among the CMIP6 models, we recommend a number of measures: constraining model hindcasts through the assimilation of high-quality long-term observational records to improve physical and biogeochemical parameterizations in models, developing better parameterizations for the sub-grid scale processes, enhancing the model resolution, downscaling and multi-model comparison exercises for improved regional projections of primary production.publishedVersio

The impact of genetic groups (Alentejano and F1 Landrace x Large White pigs) and body weight (90, 120 and 160kg) on blood metabolites

Áreas de pesquisa: AgricultureThis research work was carried out with the goal of studying the impact of genetic groups-GG (Alentejano-AL, n = 30, and F1 Landrace*Large White-F1 pigs, n = 30) and body weight-BW (90, 120 and 160 kg) on plasma metabolites. Blood parameters were correlated with animal production traits, carcass measurements and meat quality. Individual records for feed conversion index (CI) and daily feed intake were recorded on a weekly basis, for a period of 15 weeks. Compared to the F1, AL pigs displayed (P <0.05) higher average levels of glucose, total cholesterol-TC, triglycerides-TG, HDL-cholesterol (HDL), LDL-cholesterol (LDL) and total protein (TP), by about 14.0, 21.0, 42.2, 18.2, 21.2 and 5.0%, respectively. AL pigs (120–160 kg) showed higher TG levels, when compared to the values at 90 kg (2.6 and 1.6 times higher). High TG levels occurred when animals exhibited high daily feed intake (0.450 and 1.810 kg, for AL and F1 pigs). In the AL high TG levels were correlated with high fat deposition, at 120 kg (r = 0.51). At 90 kg, however, high fat deposition was related to HDL (r = 0.59), a lipoprotein associated to cholesterol transport. A progressive increase in ALB was found in the F1, as expected, but AL pigs showed higher and similar ALB means at 90, 120 and 160 kg. As for meat color, AL pigs with high cholesterol were negatively associated to L*, while high TG levels were associated to low b*. Animals with high ALB produced more tender meats (low shear force). Pigs with higher levels of lipid metabolism showed Longissimus thoracis muscles with decreased luminosity and yellowness (meats of a less attractive appearance). However, these meats were tenderer.info:eu-repo/semantics/publishedVersio

Serum albumin and post stroke outcomes : Analysis of UK Regional Registry Data, Systematic Review, and Meta-analysis

Acknowledgments We would like to acknowledge the Norfolk and Norwich Stroke and TIA Register for providing the data. We would also like to acknowledge the valuable input of Melanie Bickerton, the University of Aberdeen Medical Library, for ensuring a comprehensive and well-designed search strategy.Peer reviewe

Association of chronic kidney disease with outcomes in acute stroke

Previous studies have found an association between chronic kidney disease and poor outcomes in stroke patients. However, there is a paucity of literature evaluating this association by stroke type. We therefore aimed to explore the association between CKD and stroke outcomes according to type of stroke. The data consisting of 594,681 stroke patients were acquired from Universal Coverage Health Security Insurance Scheme Database in Thailand. Binary logistic regression was used to assess the relationship of CKD and outcomes, which were as follows; in-hospital mortality, long length of stay (>3 days), pneumonia, sepsis, respiratory failure and myocardial infarction. Results: after fully adjusting for covariates, CKD was associated with increased odds of in-hospital mortality in patients with ischemic (OR 1.32; 95% CI = 1.27–1.38), haemorrhagic (OR 1.31; 95% CI = 1.24–1.39), and other undetermined stroke type (OR 1.44; 95% CI = 1.21–1.73). CKD was found to be associated with increased odds of pneumonia, sepsis, respiratory failure and myocardial infarction in ischaemic stroke. While CKD was found to be associated with increase odds of sepsis, respiratory failure, and myocardial infarction, decrease odds of pneumonia was observed in patients with haemorrhagic stroke. In other undetermined stroke type, CKD was found to only be associated with increase odds of sepsis and respiratory failure, while there is no significant association of CKD and increase or decrease odds with pneumonia and myocardial infarction. CKD was associated with poor outcomes in all stroke types. CKD should be considered as part of stroke prognosis as well as identifying at risk patient population for in-hospital complications