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  • 1
    In: JMIR Public Health and Surveillance, JMIR Publications Inc., Vol. 8, No. 12 ( 2022-12-19), p. e39141-
    Abstract: The Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) is one of Europe’s oldest sentinel systems, working with the UK Health Security Agency (UKHSA) and its predecessor bodies for 55 years. Its surveillance report now runs twice weekly, supplemented by online observatories. In addition to conducting sentinel surveillance from a nationally representative group of practices, the RSC is now also providing data for syndromic surveillance. Objective The aim of this study was to describe the cohort profile at the start of the 2021-2022 surveillance season and recent changes to our surveillance practice. Methods The RSC’s pseudonymized primary care data, linked to hospital and other data, are held in the Oxford-RCGP Clinical Informatics Digital Hub, a Trusted Research Environment. We describe the RSC’s cohort profile as of September 2021, divided into a Primary Care Sentinel Cohort (PCSC)—collecting virological and serological specimens—and a larger group of syndromic surveillance general practices (SSGPs). We report changes to our sampling strategy that brings the RSC into alignment with European Centre for Disease Control guidance and then compare our cohort’s sociodemographic characteristics with Office for National Statistics data. We further describe influenza and COVID-19 vaccine coverage for the 2020-2021 season (week 40 of 2020 to week 39 of 2021), with the latter differentiated by vaccine brand. Finally, we report COVID-19–related outcomes in terms of hospitalization, intensive care unit (ICU) admission, and death. Results As a response to COVID-19, the RSC grew from just over 500 PCSC practices in 2019 to 1879 practices in 2021 (PCSC, n=938; SSGP, n=1203). This represents 28.6% of English general practices and 30.59% (17,299,780/56,550,136) of the population. In the reporting period, the PCSC collected 〉 8000 virology and 〉 23,000 serology samples. The RSC population was broadly representative of the national population in terms of age, gender, ethnicity, National Health Service Region, socioeconomic status, obesity, and smoking habit. The RSC captured vaccine coverage data for influenza (n=5.4 million) and COVID-19, reporting dose one (n=11.9 million), two (n=11 million), and three (n=0.4 million) for the latter as well as brand-specific uptake data (AstraZeneca vaccine, n=11.6 million; Pfizer, n=10.8 million; and Moderna, n=0.7 million). The median (IQR) number of COVID-19 hospitalizations and ICU admissions was 1181 (559-1559) and 115 (50-174) per week, respectively. Conclusions The RSC is broadly representative of the national population; its PCSC is geographically representative and its SSGPs are newly supporting UKHSA syndromic surveillance efforts. The network captures vaccine coverage and has expanded from reporting primary care attendances to providing data on onward hospital outcomes and deaths. The challenge remains to increase virological and serological sampling to monitor the effectiveness and waning of all vaccines available in a timely manner.
    Type of Medium: Online Resource
    ISSN: 2369-2960
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2022
    detail.hit.zdb_id: 2874192-4
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  • 2
    In: Journal of Infection, Elsevier BV, Vol. 87, No. 4 ( 2023-10), p. 315-327
    Type of Medium: Online Resource
    ISSN: 0163-4453
    RVK:
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2012883-6
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  • 3
    Online Resource
    Online Resource
    Royal College of General Practitioners ; 2022
    In:  British Journal of General Practice Vol. 72, No. 724 ( 2022-11), p. 512-513
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 72, No. 724 ( 2022-11), p. 512-513
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    RVK:
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2022
    detail.hit.zdb_id: 2097982-4
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  • 4
    In: JMIR Research Protocols, JMIR Publications Inc., Vol. 12 ( 2023-6-16), p. e46938-
    Abstract: Molecular point-of-care testing (POCT) used in primary care can inform whether a patient presenting with an acute respiratory infection has influenza. A confirmed clinical diagnosis, particularly early in the disease, could inform better antimicrobial stewardship. Social distancing and lockdowns during the COVID-19 pandemic have disturbed previous patterns of influenza infections in 2021. However, data from samples taken in the last quarter of 2022 suggest that influenza represents 36% of sentinel network positive virology, compared with 24% for respiratory syncytial virus. Problems with integration into the clinical workflow is a known barrier to incorporating technology into routine care. Objective This study aims to report the impact of POCT for influenza on antimicrobial prescribing in primary care. We will additionally describe severe outcomes of infection (hospitalization and mortality) and how POCT is integrated into primary care workflows. Methods The impact of POCT for influenza on antimicrobial stewardship (PIAMS) in UK primary care is an observational study being conducted between December 2022 and May 2023 and involving 10 practices that contribute data to the English sentinel network. Up to 1000 people who present to participating practices with respiratory symptoms will be swabbed and tested with a rapid molecular POCT analyzer in the practice. Antimicrobial prescribing and other study outcomes will be collected by linking information from the POCT analyzer with data from the patient’s computerized medical record. We will collect data on how POCT is incorporated into practice using data flow diagrams, unified modeling language use case diagrams, and Business Process Modeling Notation. Results We will present the crude and adjusted odds of antimicrobial prescribing (all antibiotics and antivirals) given a POCT diagnosis of influenza, stratifying by whether individuals have a respiratory or other relevant diagnosis (eg, bronchiectasis). We will also present the rates of hospital referrals and deaths related to influenza infection in PIAMS study practices compared with a set of matched practices in the sentinel network and the rest of the network. We will describe any difference in implementation models in terms of staff involved and workflow. Conclusions This study will generate data on the impact of POCT testing for influenza in primary care as well as help to inform about the feasibility of incorporating POCT into primary care workflows. It will inform the design of future larger studies about the effectiveness and cost-effectiveness of POCT to improve antimicrobial stewardship and any impact on severe outcomes. International Registered Report Identifier (IRRID) DERR1-10.2196/46938
    Type of Medium: Online Resource
    ISSN: 1929-0748
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2023
    detail.hit.zdb_id: 2719222-2
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  • 5
    In: Yearbook of Medical Informatics, Georg Thieme Verlag KG, Vol. 31, No. 01 ( 2022-08), p. 047-059
    Abstract: Objective: While the COVID-19 pandemic provided a global stimulus for digital health capacity, its development has often been inequitable, short-term in planning, and lacking in health system coherence. Inclusive digital health and the development of resilient health systems are broad outcomes that require a systematic approach to achieving them. This paper from the IMIA Primary Care Informatics Working Group (WG) provides necessary first steps for the design of a digital primary care system that can support system equity and resilience. Methods: We report on digital capability and growth in maturity in four key areas: (1) Vaccination/Prevention, (2) Disease management, (3) Surveillance, and (4) Pandemic preparedness for Australia, Canada, and the United Kingdom (data from England). Our comparison looks at seasonal influenza management prior to COVID-19 (2019-20) compared to COVID-19 (winter 2020 onwards). Results: All three countries showed growth in digital maturity from the 2019-20 management of influenza to the 2020-21 year and the management of the COVID-19 pandemic. However, the degree of progress was sporadic and uneven and has led to issues of system inequity across populations. Conclusion: The opportunity to use the lessons learned from COVID-19 should not be wasted. A digital health infrastructure is not enough on its own to drive health system transformation and to achieve desired outcomes such as system equity and resilience. We must define specific measures to track the growth of digital maturity, including standardized and fit-for-context data that is shared accurately across the health and socioeconomic sectors.
    Type of Medium: Online Resource
    ISSN: 0943-4747 , 2364-0502
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2022
    detail.hit.zdb_id: 2251229-9
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  • 6
    Online Resource
    Online Resource
    Royal College of General Practitioners ; 2023
    In:  British Journal of General Practice Vol. 73, No. suppl 1 ( 2023-07), p. bjgp23X734361-
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 73, No. suppl 1 ( 2023-07), p. bjgp23X734361-
    Abstract: Mounting evidence for poorer seroconversion and accelerating vaccine waning in clinical risk groups (CRGs) suggests that, even if vaccinated, monoclonals and antivirals may still be required. However, the efficacy of said alternatives are highly time sensitive. As such, a clinical workflow that unlocks access to these treatments in both a timely and antimicrobially-responsible manner is essential. In-practice point-of-care testing (POCT) may offer a solution to this dual challenge. Aim The present study investigated the uptake and prescription outcomes of POCT in a past patient cohort that attended primary care with symptoms of influenza-like illness (ILI). This work extracted CRG patient data from the overall cohort with a special emphasis on the immunosuppressed. Method Researchers utilised data gathered between October 2019 and March 2020 where POCT was instituted in 12 practices within the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network. Researchers subdivided full cohort data ( n = 648) by CRG and, specifically, immunosuppressed status. Results Patients in CRGs constituted 24.8% of swabbed patients; the immunosuppressed constituted 1.9%. Key predictors for POCT positivity in CRG patients were similar to those of the underlying cohort. Evidence was found for increased — and sometimes inappropriate — antibiotic prescription in CRGs via inflated odds ratios (ORs) between POCT positivity and antibiotic prescribing in these patients versus the full cohort (OR 0.75, 95% confidence interval [CI] = 0.31 to 1.80, P = 0.52 versus OR 0.61, 95% CI = 0.38 to 0.99, P = 0.03). Antivirals were consistently underutilised. Conclusion This work highlights the value of POCT for vulnerable patients.
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    RVK:
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2023
    detail.hit.zdb_id: 2097982-4
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  • 7
    Online Resource
    Online Resource
    American Psychiatric Association Publishing ; 1990
    In:  American Journal of Psychiatry Vol. 147, No. 2 ( 1990-02), p. 248-248
    In: American Journal of Psychiatry, American Psychiatric Association Publishing, Vol. 147, No. 2 ( 1990-02), p. 248-248
    Type of Medium: Online Resource
    ISSN: 0002-953X , 1535-7228
    RVK:
    Language: English
    Publisher: American Psychiatric Association Publishing
    Publication Date: 1990
    detail.hit.zdb_id: 1500554-9
    SSG: 5,2
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