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  • 1
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    Online Resource
    Research note: Exploring survey data for historical and anthropological research: Muslim–Christian relations in south-west Nigeria
    Oxford University Press (OUP) ; 2016
    In:  African Affairs Vol. 115, No. 460 ( 2016-07), p. 541-561
    Details
    In: African Affairs, Oxford University Press (OUP), Vol. 115, No. 460 ( 2016-07), p. 541-561
    Type of Medium: Online Resource
    ISSN: 0001-9909 , 1468-2621
    URL: Article
    DOI: 10.1093/afraf/adw035
    RVK:
    LA 1000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2016
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    detail.hit.zdb_id: 2097629-X
    SSG: 0
    SSG: 3,6
    SSG: 6,31
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  • 2
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    Development, implementation and evaluation of an early warning system improvement programme for children in hospital: the PUMA mixed-methods study
    National Institute for Health and Care Research ; 2022
    In:  Health and Social Care Delivery Research Vol. 10, No. 1 ( 2022-1), p. 1-308
    Details
    In: Health and Social Care Delivery Research, National Institute for Health and Care Research, Vol. 10, No. 1 ( 2022-1), p. 1-308
    Abstract: The Paediatric early warning system Utilisation and Morbidity Avoidance (PUMA) study was commissioned to develop, implement and evaluate a paediatric track-and-trigger tool for widespread adoption. Following findings from three systematic reviews, revised aims focused on implementation of a whole-systems improvement programme. Objectives (1) Identify, through systematic review, the following: evidence for core components of effective paediatric track-and-trigger tools and paediatric early warning systems, and contextual factors consequential for paediatric track-and-trigger tool and early warning system effectiveness. (2) Develop and implement an evidence-based paediatric early warning system improvement programme (i.e. the PUMA programme). (3) Evaluate the effectiveness of the PUMA programme by examining clinical practice and core outcomes trends. (4) Identify ingredients of successful implementation of the PUMA programme. Review methods The quantitative reviews addressed the following two questions: how well validated are existing paediatric track-and-trigger tools and their component parts for predicting inpatient deterioration? How effective are paediatric early warning systems (with or without a tool) at reducing mortality and critical events? The qualitative review addressed the following question: what sociomaterial and contextual factors are associated with successful or unsuccessful paediatric early warning systems (with or without tools)? Design Interrupted time series and ethnographic case studies were used to evaluate the PUMA programme. Qualitative methods were deployed in a process evaluation. Setting The study was set in two district general and two tertiary children’s hospitals. Intervention The PUMA programme is a paediatric early warning system improvement programme designed to harness local expertise to implement contextually appropriate interventions. Main outcome measures The primary outcome was a composite metric, representing children who experienced one of the following in 1 month: mortality, cardiac arrest, respiratory arrest, unplanned admission to a paediatric intensive care unit or unplanned admission to a high-dependency unit. Paediatric early warning system changes were assessed through ethnographic ward case studies. Results The reviews showed limited effectiveness of paediatric track-and-trigger tools in isolation, and multiple failure points in paediatric early warning systems. All sites made paediatric early warning system changes; some of the clearer quantitative findings appeared to relate to qualitative observations. Systems changed in response to wider contextual factors. Limitations Low event rates made quantitative outcome measures challenging. Implementation was not a one-shot event, creating challenges for the interrupted time series in conceptualising ‘implementation’ and ‘post-intervention’ periods. Conclusions Detecting and acting on deterioration in the acute hospital setting requires a whole-systems approach. The PUMA programme offers a framework to support ongoing system-improvement work; the approach could be used more widely. Organisational-level system change can affect clinical outcomes positively. Alternative outcome measures are required for research and quality improvement. Future work The following further research is recommended: a consensus study to identify upstream indicators of paediatric early warning system performance; an evaluation of OUTCOME approach in other clinical areas; an evaluation of supernumerary nurse co-ordinator role; and an evaluation of mandated system improvement. Study registration This study is registered as PROSPERO CRD42015015326. Funding This project was funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research ; Vol. 10, No. 1. See the NIHR Journals Library website for further project information.
    Type of Medium: Online Resource
    ISSN: 2755-0060 , 2755-0079
    URL: Article
    DOI: 10.3310/CHCK4556
    Language: English
    Publisher: National Institute for Health and Care Research
    Publication Date: 2022
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  • 3
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    Development, implementation and evaluation of an evidence-based paediatric early warning system improvement programme: the PUMA mixed methods study
    Springer Science and Business Media LLC ; 2022
    In:  BMC Health Services Research Vol. 22, No. 1 ( 2022-12)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2022-12)
    Abstract: Paediatric mortality rates in the United Kingdom are amongst the highest in Europe. Clinically missed deterioration is a contributory factor. Evidence to support any single intervention to address this problem is limited, but a cumulative body of research highlights the need for a systems approach. Methods An evidence-based, theoretically informed, paediatric early warning system improvement programme (PUMA Programme) was developed and implemented in two general hospitals (no onsite Paediatric Intensive Care Unit) and two tertiary hospitals (with onsite Paediatric Intensive Care Unit) in the United Kingdom. Designed to harness local expertise to implement contextually appropriate improvement initiatives, the PUMA Programme includes a propositional model of a paediatric early warning system, system assessment tools, guidance to support improvement initiatives and structured facilitation and support. Each hospital was evaluated using interrupted time series and qualitative case studies. The primary quantitative outcome was a composite metric (adverse events), representing the number of children monthly that experienced one of the following: mortality, cardiac arrest, respiratory arrest, unplanned admission to Paediatric Intensive Care Unit, or unplanned admission to Higher Dependency Unit. System changes were assessed qualitatively through observations of clinical practice and interviews with staff and parents. A qualitative evaluation of implementation processes was undertaken. Results All sites assessed their paediatric early warning systems and identified areas for improvement. All made contextually appropriate system changes, despite implementation challenges. There was a decline in the adverse event rate trend in three sites; in one site where system wide changes were organisationally supported, the decline was significant (ß = -0.09 (95% CI: − 0.15, − 0.05); p  =  〈  0.001). Changes in trends coincided with implementation of site-specific changes. Conclusions System level change to improve paediatric early warning systems can bring about positive impacts on clinical outcomes, but in paediatric practice, where the patient population is smaller and clinical outcomes event rates are low, alternative outcome measures are required to support research and quality improvement beyond large specialist centres, and methodological work on rare events is indicated. With investment in the development of alternative outcome measures and methodologies, programmes like PUMA could improve mortality and morbidity in paediatrics and other patient populations.
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/s12913-021-07314-2
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2050434-2
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  • 4
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    A tutorial comparing different covariate balancing methods with an application evaluating the causal effects of substance use treatment programs for adolescents
    Springer Science and Business Media LLC ; 2023
    In:  Health Services and Outcomes Research Methodology Vol. 23, No. 2 ( 2023-06), p. 115-148
    Details
    In: Health Services and Outcomes Research Methodology, Springer Science and Business Media LLC, Vol. 23, No. 2 ( 2023-06), p. 115-148
    Abstract: Randomized controlled trials are the gold standard for measuring causal effects. However, they are often not always feasible, and causal treatment effects must be estimated from observational data. Observational studies do not allow robust conclusions about causal relationships unless statistical techniques account for the imbalance of pretreatment confounders across groups and key assumptions hold. Propensity score and balance weighting (PSBW) are useful techniques that aim to reduce the observed imbalances between treatment groups by weighting the groups to look alike on the observed confounders. Notably, there are many methods available to estimate PSBW. However, it is unclear a priori which will achieve the best trade-off between covariate balance and effective sample size for a given application. Moreover, it is critical to assess the validity of key assumptions required for robust estimation of the needed treatment effects, including the overlap and no unmeasured confounding assumptions. We present a step-by-step guide to the use of PSBW for estimation of causal treatment effects that includes steps on how to evaluate overlap before the analysis, obtain estimates of PSBW using multiple methods and select the optimal one, check for covariate balance on multiple metrics, and assess sensitivity of findings (both the estimated treatment effect and statistical significance) to unobserved confounding. We illustrate the key steps using a case study examining the relative effectiveness of substance use treatment programs and provide a user-friendly Shiny application that can implement the proposed steps for any application with binary treatments.
    Type of Medium: Online Resource
    ISSN: 1387-3741 , 1572-9400
    URL: Article
    DOI: 10.1007/s10742-022-00280-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2005197-9
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  • 5
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    Cohort profile: The UK COVID-19 Public Experiences (COPE) prospective longitudinal mixed-methods study of health and well-being during the SARSCoV2 coronavirus pandemic
    Public Library of Science (PLoS) ; 2021
    In:  PLOS ONE Vol. 16, No. 10 ( 2021-10-13), p. e0258484-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 10 ( 2021-10-13), p. e0258484-
    Abstract: Public perceptions of pandemic viral threats and government policies can influence adherence to containment, delay, and mitigation policies such as physical distancing, hygienic practices, use of physical barriers, uptake of testing, contact tracing, and vaccination programs. The UK COVID-19 Public Experiences (COPE) study aims to identify determinants of health behaviour using the Capability, Opportunity, Motivation (COM-B) model using a longitudinal mixed-methods approach. Here, we provide a detailed description of the demographic and self-reported health characteristics of the COPE cohort at baseline assessment, an overview of data collected, and plans for follow-up of the cohort. The COPE baseline survey was completed by 11,113 UK adult residents (18+ years of age). Baseline data collection started on the 13 th of March 2020 (10-days before the introduction of the first national COVID-19 lockdown in the UK) and finished on the 13 th of April 2020. Participants were recruited via the HealthWise Wales (HWW) research registry and through social media snowballing and advertising (Facebook ® , Twitter ® , Instagram ® ). Participants were predominantly female (69%), over 50 years of age (68%), identified as white (98%), and were living with their partner (68%). A large proportion (67%) had a college/university level education, and half reported a pre-existing health condition (50%). Initial follow-up plans for the cohort included in-depth surveys at 3-months and 12-months after the first UK national lockdown to assess short and medium-term effects of the pandemic on health behaviour and subjective health and well-being. Additional consent will be sought from participants at follow-up for data linkage and surveys at 18 and 24-months after the initial UK national lockdown. A large non-random sample was recruited to the COPE cohort during the early stages of the COVID-19 pandemic, which will enable longitudinal analysis of the determinants of health behaviour and changes in subjective health and well-being over the course of the pandemic.
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
    URL: Article
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    DOI: 10.1371/journal.pone.0258484
    DOI: 10.1371/journal.pone.0258484.g001
    DOI: 10.1371/journal.pone.0258484.t001
    DOI: 10.1371/journal.pone.0258484.t002
    DOI: 10.1371/journal.pone.0258484.s001
    DOI: 10.1371/journal.pone.0258484.s002
    DOI: 10.1371/journal.pone.0258484.s003
    DOI: 10.1371/journal.pone.0258484.s004
    DOI: 10.1371/journal.pone.0258484.r001
    DOI: 10.1371/journal.pone.0258484.r002
    DOI: 10.1371/journal.pone.0258484.r003
    DOI: 10.1371/journal.pone.0258484.r004
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2021
    detail.hit.zdb_id: 2267670-3
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  • 6
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    Neonatal sepsis and mortality in low-income and middle-income countries from a facility-based birth cohort: an international multisite prospective observational study
    Elsevier BV ; 2022
    In:  The Lancet Global Health Vol. 10, No. 5 ( 2022-05), p. e661-e672
    Details
    In: The Lancet Global Health, Elsevier BV, Vol. 10, No. 5 ( 2022-05), p. e661-e672
    Type of Medium: Online Resource
    ISSN: 2214-109X
    URL: Article
    DOI: 10.1016/S2214-109X(22)00043-2
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2723488-5
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  • 7
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    Characterization of antimicrobial-resistant Gram-negative bacteria that cause neonatal sepsis in seven low- and middle-income countries
    Springer Science and Business Media LLC ; 2021
    In:  Nature Microbiology Vol. 6, No. 4 ( 2021-03-29), p. 512-523
    Details
    In: Nature Microbiology, Springer Science and Business Media LLC, Vol. 6, No. 4 ( 2021-03-29), p. 512-523
    Abstract: Antimicrobial resistance in neonatal sepsis is rising, yet mechanisms of resistance that often spread between species via mobile genetic elements, ultimately limiting treatments in low- and middle-income countries (LMICs), are poorly characterized. The Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS) network was initiated to characterize the cause and burden of antimicrobial resistance in neonatal sepsis for seven LMICs in Africa and South Asia. A total of 36,285 neonates were enrolled in the BARNARDS study between November 2015 and December 2017, of whom 2,483 were diagnosed with culture-confirmed sepsis. Klebsiella pneumoniae ( n  = 258) was the main cause of neonatal sepsis, with Serratia marcescens ( n  = 151), Klebsiella michiganensis ( n  = 117), Escherichia coli ( n  = 75) and Enterobacter cloacae complex ( n  = 57) also detected. We present whole-genome sequencing, antimicrobial susceptibility and clinical data for 916 out of 1,038 neonatal sepsis isolates (97 isolates were not recovered from initial isolation at local sites). Enterobacterales ( K. pneumoniae, E. coli and E. cloacae ) harboured multiple cephalosporin and carbapenem resistance genes. All isolated pathogens were resistant to multiple antibiotic classes, including those used to treat neonatal sepsis. Intraspecies diversity of K. pneumoniae and E. coli indicated that multiple antibiotic-resistant lineages cause neonatal sepsis. Our results will underpin research towards better treatments for neonatal sepsis in LMICs.
    Type of Medium: Online Resource
    ISSN: 2058-5276
    URL: Article
    DOI: 10.1038/s41564-021-00870-7
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2845610-5
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  • 8
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    Perceived threat of COVID ‐19, attitudes towards vaccination, and vaccine hesitancy: A prospective longitudinal study in the UK
    Wiley ; 2022
    In:  British Journal of Health Psychology Vol. 27, No. 4 ( 2022-11), p. 1354-1381
    Details
    In: British Journal of Health Psychology, Wiley, Vol. 27, No. 4 ( 2022-11), p. 1354-1381
    Abstract: Using the Health Belief Model as a conceptual framework, we investigated the association between attitudes towards COVID‐19, COVID‐19 vaccinations, and vaccine hesitancy and change in these variables over a 9‐month period in a UK cohort. Methods The COPE study cohort ( n  = 11,113) was recruited via an online survey at enrolment in March/April 2020. The study was advertised via the HealthWise Wales research registry and social media. Follow‐up data were available for 6942 people at 3 months (June/July 2020) and 5037 at 12 months (March/April 2021) post‐enrolment. Measures included demographics, perceived threat of COVID‐19, perceived control, intention to accept or decline a COVID‐19 vaccination, and attitudes towards vaccination. Logistic regression models were fitted cross‐sectionally at 3 and 12 months to assess the association between motivational factors and vaccine hesitancy. Longitudinal changes in motivational variables for vaccine‐hesitant and non‐hesitant groups were examined using mixed‐effect analysis of variance models. Results Fear of COVID‐19, perceived susceptibility to COVID‐19, and perceived personal control over COVID‐19 infection transmission decreased between the 3‐ and 12‐month surveys. Vaccine hesitancy at 12 months was independently associated with low fear of the disease and more negative attitudes towards COVID‐19 vaccination. Specific barriers to COVID‐19 vaccine uptake included concerns about safety and efficacy in light of its rapid development, mistrust of government and pharmaceutical companies, dislike of coercive policies, and perceived lack of relaxation in COVID‐19‐related restrictions as the vaccination programme progressed. Conclusions Decreasing fear of COVID‐19, perceived susceptibility to the disease, and perceptions of personal control over reducing infection‐transmission may impact future COVID‐19 vaccination uptake.
    Type of Medium: Online Resource
    ISSN: 1359-107X , 2044-8287
    URL: Issue
    URL: Article
    DOI: 10.1111/bjhp.v27.4
    DOI: 10.1111/bjhp.12606
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2026500-1
    SSG: 5,2
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  • 9
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    In-depth phenotyping for clinical stratification of Gaucher disease
    Springer Science and Business Media LLC ; 2021
    In:  Orphanet Journal of Rare Diseases Vol. 16, No. 1 ( 2021-12)
    Details
    In: Orphanet Journal of Rare Diseases, Springer Science and Business Media LLC, Vol. 16, No. 1 ( 2021-12)
    Abstract: The Gaucher Investigative Therapy Evaluation is a national clinical cohort of 250 patients aged 5–87 years with Gaucher disease in the United Kingdom—an ultra-rare genetic disorder. To inform clinical decision-making and improve pathophysiological understanding, we characterized the course of Gaucher disease and explored the influence of costly innovative medication and other interventions. Retrospective and prospective clinical, laboratory and radiological information including molecular analysis of the GBA 1 gene and comprising  〉  2500 variables were collected systematically into a relational database with banking of collated biological samples in a central bioresource. Data for deep phenotyping and life-quality evaluation, including skeletal, visceral, haematological and neurological manifestations were recorded for a median of 17.3 years; the skeletal and neurological manifestations are the main focus of this study. Results At baseline, 223 of the 250 patients were classified as type 1 Gaucher disease. Skeletal manifestations occurred in most patients in the cohort (131 of 201 specifically reported bone pain). Symptomatic osteonecrosis and fragility fractures occurred respectively in 76 and 37 of all 250 patients and the first osseous events occurred significantly earlier in those with neuronopathic disease. Intensive phenotyping in a subgroup of 40 patients originally considered to have only systemic features, revealed neurological involvement in 18: two had Parkinson disease and 16 had clinical signs compatible with neuronopathic Gaucher disease—indicating a greater than expected prevalence of neurological features. Analysis of longitudinal real-world data enabled Gaucher disease to be stratified with respect to advanced therapies and splenectomy. Splenectomy was associated with an increased hazard of fragility fractures, in addition to osteonecrosis and orthopaedic surgery; there were marked gender differences in fracture risk over time since splenectomy. Skeletal disease was a heavy burden of illness, especially where access to specific therapy was delayed and in patients requiring orthopaedic surgery. Conclusion Gaucher disease has been explored using real-world data obtained in an era of therapeutic transformation. Introduction of advanced therapies and repeated longitudinal measures enabled this heterogeneous condition to be stratified into obvious clinical endotypes. The study reveals diverse and changing phenotypic manifestations with systemic, skeletal and neurological disease as inter-related sources of disability.
    Type of Medium: Online Resource
    ISSN: 1750-1172
    URL: Article
    DOI: 10.1186/s13023-021-02034-6
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2225857-7
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