Appropriately identifying and representing stakeholders' interests and viewpoints in evaluati... more Appropriately identifying and representing stakeholders' interests and viewpoints in evaluations of health information technology (health IT) is a critical part of ensuring continued progress and innovation in eHealth. This contribution therefore seeks to clarify the principles of stakeholder analysis in an eHealth context. We describe this with reference to a mixed methods national evaluation of ePrescribing systems in English hospitals. We use this evaluation to exemplify the engagement and analytical tools required to ensure a detailed understanding of the issues, challenges and lessons learnt across stakeholder groups. We conclude that this type of approach may support the robustness of evaluations of health IT as well as their longer term impact on innovation in the field.
... that increasing age curtails an individual's ability to adapt to change, adaptability be... more ... that increasing age curtails an individual's ability to adapt to change, adaptability being the hallmark of youth. ... 319: 123. 15 Francome C (1994) The Great Leap 2: a study of Muslim students ... 310: 1590-2. 19 Razzaq AB (1998) Circumcision in Islam, pp 30-6. Dar Al-Taqwa, London ...
SummaryTo develop a classification system to improve the reporting of observational studies of th... more SummaryTo develop a classification system to improve the reporting of observational studies of the use of information technology (IT) in clinical consultations.Literature review, workshops, and development of a position statement. We grouped the important aspects for consistent reporting into a “faceted classification”; the components relevant to a particular study to be used independently.The eightfacetsof ourclassification are: (1) Theoretical and methodological approach: e.g. dramaturgical, cognitive; (2) Data collection: Type and method of observation; (3) Room layout and environment: How this affects interaction between clinician, patient and computer. (4) Initiation and Interaction: Who starts the consultation, and how the participants interact; (5) Information and knowledge utilisation: What sources of information or decision support are used or provided; (6) Timing and type of consultation variables: Standard descriptors that can be used to allow comparison of duration and d...
Exposure to environmental tobacco smoke (ETS) from combustible tobacco products causes various di... more Exposure to environmental tobacco smoke (ETS) from combustible tobacco products causes various diseases and makes quitting smoking more difficult. However, little is known about exposure of e-cigarette users to ETS from combustible tobacco products. This study aimed to investigate e-cigarette users' exposure to ETS from tobacco smokers. The association between ETS exposure frequency and different types of smokers including e-cigarette users was examined using ordered logistic regression analysis and nationally representative survey data on 28,765 individuals who were interviewed in the Canadian Tobacco, Alcohol and Drugs Surveys conducted during 2013 and 2015. Survey respondents were classified into one of five smoker types: smokers of tobacco only, dual users of tobacco and e-cigarettes, users of e-cigarette only, former smokers and never smokers. The analyses were conducted using the entire sample and by age group. Young to mid-age (15-54) dual users of both regular cigarettes...
Despite effective treatments and long-standing management guidelines, there are approximately 140... more Despite effective treatments and long-standing management guidelines, there are approximately 1400 hospital admissions for asthma weekly in the United Kingdom (UK), many of which could be avoided. In our previous research, a secondary analysis of the intervention (ARRISA) suggested an improvement in the management of at-risk asthma patients in primary care. ARRISA involved identifying individuals at risk of adverse asthma events, flagging their electronic health records, training practice staff to develop and implement practice-wide processes of care when alerted by the flag, plus motivational reminders. We now seek to determine the effectiveness and cost-effectiveness of ARRISA in reducing asthma-related crisis events. We are undertaking a pragmatic, two-arm, multicentre, cluster randomised controlled trial, plus health economic and process evaluation. We will randomise 270 primary care practices from throughout the UK covering over 10,000 registered patients with 'at-risk asth...
International archives of allergy and immunology, 2018
Google Trends (GT) searches trends of specific queries in Google, which potentially reflect the r... more Google Trends (GT) searches trends of specific queries in Google, which potentially reflect the real-life epidemiology of allergic rhinitis. We compared GT terms related to ragweed pollen allergy in American and European Union countries with a known ragweed pollen season. Our aim was to assess seasonality and the terms needed to perform the GT searches and to compare these during the spring and summer pollen seasons. We examined GT queries from January 1, 2011, to January 4, 2017. We included 15 countries with a known ragweed pollen season and used the standard 5-year GT graphs. We used the GT translation for all countries and the untranslated native terms for each country. The results of "pollen," "ragweed," and "allergy" searches differed between countries, but "ragweed" was clearly identified in 12 of the 15 countries. There was considerable heterogeneity of findings when the GT translation was used. For Croatia, Hungary, Romania, Serbia, a...
Asthma has a considerable, but potentially, avoidable burden on many populations globally. Scotla... more Asthma has a considerable, but potentially, avoidable burden on many populations globally. Scotland has some of the poorest health outcomes from asthma. Although ambient pollution, weather changes and sociodemographic factors have been associated with asthma attacks, it remains unclear whether modelled environment data and geospatial information can improve population-based asthma predictive algorithms. We aim to create the afferent loop of a national learning health system for asthma in Scotland. We will investigate the associations between ambient pollution, meteorological, geospatial and sociodemographic factors and asthma attacks. We will develop and implement a secured data governance and linkage framework to incorporate primary care health data, modelled environment data, geospatial population and sociodemographic data. Data from 75 recruited primary care practices (n=500 000 patients) in Scotland will be used. Modelled environment data on key air pollutants at a horizontal re...
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, Jan 16, 2018
Children exposed to second-hand smoke (SHS) are at increased risk of respiratory illnesses. We pi... more Children exposed to second-hand smoke (SHS) are at increased risk of respiratory illnesses. We piloted a Smoke Free Intervention (SFI) and trial methods before investigating its effectiveness and cost-effectiveness in primary school children. In a pilot cluster randomised controlled-trial in Bangladesh, primary schools were allocated to usual education (control) or SFI, using minimisation. Year-5 children were recruited. Masking treatment allocation was not possible. Delivered by schoolteachers, SFI consisted of two 45-minute and four 15-minute educational sessions. Our primary outcome was SHS exposure at two months post-randomisation, verified by children's salivary cotinine. The trial is registered at ISRCTN.com; ISRCTN68690577. Between 1st April and 30th June 2015, we recruited 12 schools. Of the 484 children present in year-5, 481 consented. Six schools were allocated to both SFI (n=245) and to usual education only (n=236). 450 children (SFI = 229; control = 221) who had cot...
In this UK study, we investigated the impact of computerised physician order entry (CPOE) and cli... more In this UK study, we investigated the impact of computerised physician order entry (CPOE) and clinical decision support (CDS) implementation on the rate of 78 high-risk prescribing errors amenable to CDS. We conducted a preintervention/postintervention study in three acute hospitals in England. A predefined list of prescribing errors was incorporated into an audit tool. At each site, approximately 4000 prescriptions were reviewed both pre-CPOE and 6 months post-CPOE implementation. The number of opportunities for error and the number of errors that occurred were collated. Error rates were then calculated and compared between periods, as well as by the level of CDS. The prescriptions of 1244 patients were audited pre-CPOE and 1178 post-CPOE implementation. A total of 28 526 prescriptions were reviewed, with 21 138 opportunities for error identified based on 78 defined errors. Across the three sites, for those prescriptions where opportunities for error were identified, the error rate...
Ethnic minorities often experience barriers to health care. We studied six established quality in... more Ethnic minorities often experience barriers to health care. We studied six established quality indicators of health-system performance across ethnic groups in Scotland. In this population-based cohort study, we linked ethnicity from Scotland's Census 2001 (April 29, 2001) to hospital admissions and mortality records, with follow-up until April 30, 2013. Indicators of health-system performance included amenable deaths (ie, deaths avertable by effective treatment), preventable deaths (ie, deaths avertable by public health policy), avoidable deaths (combined amenable and preventable deaths), avoidable hospital admissions, unplanned readmissions, and length of stay. We calculated rate ratios and odds ratios (with 95% CIs) using Poisson and logistic regression, which we multiplied by 100, adjusting first for age-related covariates and then for socioeconomic-related and birthplace-related covariates. The white Scottish population was the reference (rate ratio [RR] 100). The results ar...
Appropriately identifying and representing stakeholders' interests and viewpoints in evaluati... more Appropriately identifying and representing stakeholders' interests and viewpoints in evaluations of health information technology (health IT) is a critical part of ensuring continued progress and innovation in eHealth. This contribution therefore seeks to clarify the principles of stakeholder analysis in an eHealth context. We describe this with reference to a mixed methods national evaluation of ePrescribing systems in English hospitals. We use this evaluation to exemplify the engagement and analytical tools required to ensure a detailed understanding of the issues, challenges and lessons learnt across stakeholder groups. We conclude that this type of approach may support the robustness of evaluations of health IT as well as their longer term impact on innovation in the field.
... that increasing age curtails an individual's ability to adapt to change, adaptability be... more ... that increasing age curtails an individual's ability to adapt to change, adaptability being the hallmark of youth. ... 319: 123. 15 Francome C (1994) The Great Leap 2: a study of Muslim students ... 310: 1590-2. 19 Razzaq AB (1998) Circumcision in Islam, pp 30-6. Dar Al-Taqwa, London ...
SummaryTo develop a classification system to improve the reporting of observational studies of th... more SummaryTo develop a classification system to improve the reporting of observational studies of the use of information technology (IT) in clinical consultations.Literature review, workshops, and development of a position statement. We grouped the important aspects for consistent reporting into a “faceted classification”; the components relevant to a particular study to be used independently.The eightfacetsof ourclassification are: (1) Theoretical and methodological approach: e.g. dramaturgical, cognitive; (2) Data collection: Type and method of observation; (3) Room layout and environment: How this affects interaction between clinician, patient and computer. (4) Initiation and Interaction: Who starts the consultation, and how the participants interact; (5) Information and knowledge utilisation: What sources of information or decision support are used or provided; (6) Timing and type of consultation variables: Standard descriptors that can be used to allow comparison of duration and d...
Exposure to environmental tobacco smoke (ETS) from combustible tobacco products causes various di... more Exposure to environmental tobacco smoke (ETS) from combustible tobacco products causes various diseases and makes quitting smoking more difficult. However, little is known about exposure of e-cigarette users to ETS from combustible tobacco products. This study aimed to investigate e-cigarette users' exposure to ETS from tobacco smokers. The association between ETS exposure frequency and different types of smokers including e-cigarette users was examined using ordered logistic regression analysis and nationally representative survey data on 28,765 individuals who were interviewed in the Canadian Tobacco, Alcohol and Drugs Surveys conducted during 2013 and 2015. Survey respondents were classified into one of five smoker types: smokers of tobacco only, dual users of tobacco and e-cigarettes, users of e-cigarette only, former smokers and never smokers. The analyses were conducted using the entire sample and by age group. Young to mid-age (15-54) dual users of both regular cigarettes...
Despite effective treatments and long-standing management guidelines, there are approximately 140... more Despite effective treatments and long-standing management guidelines, there are approximately 1400 hospital admissions for asthma weekly in the United Kingdom (UK), many of which could be avoided. In our previous research, a secondary analysis of the intervention (ARRISA) suggested an improvement in the management of at-risk asthma patients in primary care. ARRISA involved identifying individuals at risk of adverse asthma events, flagging their electronic health records, training practice staff to develop and implement practice-wide processes of care when alerted by the flag, plus motivational reminders. We now seek to determine the effectiveness and cost-effectiveness of ARRISA in reducing asthma-related crisis events. We are undertaking a pragmatic, two-arm, multicentre, cluster randomised controlled trial, plus health economic and process evaluation. We will randomise 270 primary care practices from throughout the UK covering over 10,000 registered patients with 'at-risk asth...
International archives of allergy and immunology, 2018
Google Trends (GT) searches trends of specific queries in Google, which potentially reflect the r... more Google Trends (GT) searches trends of specific queries in Google, which potentially reflect the real-life epidemiology of allergic rhinitis. We compared GT terms related to ragweed pollen allergy in American and European Union countries with a known ragweed pollen season. Our aim was to assess seasonality and the terms needed to perform the GT searches and to compare these during the spring and summer pollen seasons. We examined GT queries from January 1, 2011, to January 4, 2017. We included 15 countries with a known ragweed pollen season and used the standard 5-year GT graphs. We used the GT translation for all countries and the untranslated native terms for each country. The results of "pollen," "ragweed," and "allergy" searches differed between countries, but "ragweed" was clearly identified in 12 of the 15 countries. There was considerable heterogeneity of findings when the GT translation was used. For Croatia, Hungary, Romania, Serbia, a...
Asthma has a considerable, but potentially, avoidable burden on many populations globally. Scotla... more Asthma has a considerable, but potentially, avoidable burden on many populations globally. Scotland has some of the poorest health outcomes from asthma. Although ambient pollution, weather changes and sociodemographic factors have been associated with asthma attacks, it remains unclear whether modelled environment data and geospatial information can improve population-based asthma predictive algorithms. We aim to create the afferent loop of a national learning health system for asthma in Scotland. We will investigate the associations between ambient pollution, meteorological, geospatial and sociodemographic factors and asthma attacks. We will develop and implement a secured data governance and linkage framework to incorporate primary care health data, modelled environment data, geospatial population and sociodemographic data. Data from 75 recruited primary care practices (n=500 000 patients) in Scotland will be used. Modelled environment data on key air pollutants at a horizontal re...
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, Jan 16, 2018
Children exposed to second-hand smoke (SHS) are at increased risk of respiratory illnesses. We pi... more Children exposed to second-hand smoke (SHS) are at increased risk of respiratory illnesses. We piloted a Smoke Free Intervention (SFI) and trial methods before investigating its effectiveness and cost-effectiveness in primary school children. In a pilot cluster randomised controlled-trial in Bangladesh, primary schools were allocated to usual education (control) or SFI, using minimisation. Year-5 children were recruited. Masking treatment allocation was not possible. Delivered by schoolteachers, SFI consisted of two 45-minute and four 15-minute educational sessions. Our primary outcome was SHS exposure at two months post-randomisation, verified by children's salivary cotinine. The trial is registered at ISRCTN.com; ISRCTN68690577. Between 1st April and 30th June 2015, we recruited 12 schools. Of the 484 children present in year-5, 481 consented. Six schools were allocated to both SFI (n=245) and to usual education only (n=236). 450 children (SFI = 229; control = 221) who had cot...
In this UK study, we investigated the impact of computerised physician order entry (CPOE) and cli... more In this UK study, we investigated the impact of computerised physician order entry (CPOE) and clinical decision support (CDS) implementation on the rate of 78 high-risk prescribing errors amenable to CDS. We conducted a preintervention/postintervention study in three acute hospitals in England. A predefined list of prescribing errors was incorporated into an audit tool. At each site, approximately 4000 prescriptions were reviewed both pre-CPOE and 6 months post-CPOE implementation. The number of opportunities for error and the number of errors that occurred were collated. Error rates were then calculated and compared between periods, as well as by the level of CDS. The prescriptions of 1244 patients were audited pre-CPOE and 1178 post-CPOE implementation. A total of 28 526 prescriptions were reviewed, with 21 138 opportunities for error identified based on 78 defined errors. Across the three sites, for those prescriptions where opportunities for error were identified, the error rate...
Ethnic minorities often experience barriers to health care. We studied six established quality in... more Ethnic minorities often experience barriers to health care. We studied six established quality indicators of health-system performance across ethnic groups in Scotland. In this population-based cohort study, we linked ethnicity from Scotland's Census 2001 (April 29, 2001) to hospital admissions and mortality records, with follow-up until April 30, 2013. Indicators of health-system performance included amenable deaths (ie, deaths avertable by effective treatment), preventable deaths (ie, deaths avertable by public health policy), avoidable deaths (combined amenable and preventable deaths), avoidable hospital admissions, unplanned readmissions, and length of stay. We calculated rate ratios and odds ratios (with 95% CIs) using Poisson and logistic regression, which we multiplied by 100, adjusting first for age-related covariates and then for socioeconomic-related and birthplace-related covariates. The white Scottish population was the reference (rate ratio [RR] 100). The results ar...
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