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1. Patient-Oriented Unsupervised Learning to Unlock Patterns of Multimorbidity Associated with Stroke using Primary Care Electronic Health Records

Author

Delord, Marc, Sun, Xiaohui, Learoyd, Annastazia, Curcin, Vasa, Marshall, Iain, Wolfe, Charles, Ashworth, Mark, and Douiri, Abdel

Subjects
Statistics - Applications, 62P10
Abstract

Background: Identifying and characterising the longitudinal patterns of multimorbidity associated with stroke is needed to better understand patients' needs and inform new models of care. Methods: We used an unsupervised patient-oriented clustering approach to analyse primary care electronic health records (EHR) of 30 common long-term conditions (LTC), in patients with stroke aged over 18, registered in 41 general practices in south London between 2005 and 2021. Results: Of 849,968 registered patients, 9,847 (1.16%) had a record of stroke, 46.5% were female and median age at record was 65.0 year (IQR: 51.5 to 77.0). The median number of LTCs in addition to stroke was 3 (IQR: from 2 to 5). Patients were stratified in eight clusters. These clusters revealed contrasted patterns of multimorbidity, socio-demographic characteristics (age, gender and ethnicity) and risk factors. Beside a core of 3 clusters associated with conventional stroke risk-factors, minor clusters exhibited less common but recurrent combinations of LTCs including mental health conditions, asthma, osteoarthritis and sickle cell anaemia. Importantly, complex profiles combining mental health conditions, infectious diseases and substance dependency emerged. Conclusion: This patient-oriented approach to EHRs uncovers the heterogeneity of profiles of multimorbidity and socio-demographic characteristics associated with stroke. It highlights the importance of conventional stroke risk factors as well as the association of mental health conditions in complex profiles of multimorbidity displayed in a significant proportion of patients. These results address the need for a better understanding of stroke-associated multimorbidity and complexity to inform more efficient and patient-oriented healthcare models.

Published
2024

3. Machine learning-based multiscale constitutive modelling: Development and application to dual-porosity mass transfer

Author

Ashworth, Mark, Elsheikh, Ahmed, and Doster, Florian

Subjects
Physics - Geophysics, Physics - Computational Physics
Abstract

In multiscale modelling, multiple models are used simultaneously to describe scale-dependent phenomena in a system of interest. Here we introduce a machine learning (ML)-based multiscale modelling framework for modelling hierarchical multiscale problems. In these problems, closure relations are required for the macroscopic problem in the form of constitutive relations. However, forming explicit closures for nonlinear and hysteretic processes remains challenging. Instead, we provide a framework for learning constitutive mappings given microscale data generated according to micro and macro transitions governed by two-scale homogenisation rules. The resulting data-driven model is then coupled to a macroscale simulator leading to a hybrid ML-physics-based modelling approach. Accordingly, we apply the multiscale framework within the context of transient phenomena in dual-porosity geomaterials. In these materials, the inter-porosity flow is a complex time-dependent function making its adoption within flow simulators challenging. We explore nonlinear feedforward autoregressive ML strategies for the constitutive modelling of this sequential problem. We demonstrate how to inject the resulting surrogate constitutive model into a simulator. We then compare the resulting hybrid approach to traditional dual-porosity and microscale models on a variety of tests. We show the hybrid approach to give high-quality results with respect to explicit microscale simulations without the computational burden of the latter. Lastly, the steps provided by the multiscale framework herein are sufficiently general to be applied to a variety of multiscale settings, using different data generation and learning techniques accordingly.

Published
2021
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8. The impact of the COVID-19 pandemic on cardiovascular disease prevention and management

Author

Dale, Caroline E., Takhar, Rohan, Carragher, Raymond, Katsoulis, Michail, Torabi, Fatemeh, Duffield, Stephen, Kent, Seamus, Mueller, Tanja, Kurdi, Amanj, Le Anh, Thu Nguyen, McTaggart, Stuart, Abbasizanjani, Hoda, Hollings, Sam, Scourfield, Andrew, Lyons, Ronan A., Griffiths, Rowena, Lyons, Jane, Davies, Gareth, Harris, Daniel, Handy, Alex, Mizani, Mehrdad A., Tomlinson, Christopher, Thygesen, Johan H., Ashworth, Mark, Denaxas, Spiros, Banerjee, Amitava, Sterne, Jonathan A. C., Brown, Paul, Bullard, Ian, Priedon, Rouven, Mamas, Mamas A., Slee, Ann, Lorgelly, Paula, Pirmohamed, Munir, Khunti, Kamlesh, Morris, Andrew D., Sudlow, Cathie, Akbari, Ashley, Bennie, Marion, Sattar, Naveed, and Sofat, Reecha

Published
2023
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10. Anisotropic dual-continuum representations for multiscale poroelastic materials: Development and numerical modelling

Author

Ashworth, Mark and Doster, Florian

Subjects
Physics - Geophysics, Computer Science - Computational Engineering, Finance, and Science
Abstract

Dual-continuum (DC) models can be tractable alternatives to explicit approaches for the numerical modelling of multiscale materials with multiphysics behaviours. This work concerns the conceptual and numerical modelling of poroelastically coupled dual-scale materials such as naturally fractured rock. Apart from a few exceptions, previous poroelastic DC models have assumed isotropy of the constituents and the dual-material. Additionally, it is common to assume that only one continuum has intrinsic stiffness properties. Finally, little has been done into validating whether the DC paradigm can capture the global poroelastic behaviours of explicit numerical representations at the DC modelling scale. We address the aforementioned knowledge gaps in two steps. First, we utilise a homogenisation approach based on Levin's theorem to develop a previously derived anisotropic poroelastic constitutive model. Our development incorporates anisotropic intrinsic stiffness properties of both continua. This addition is in analogy to anisotropic fractured rock masses with stiff fractures. Second, we perform numerical modelling to test the dual-continuum model against fine-scale explicit equivalents. In doing, we present our hybrid numerical framework, as well as the conditions required for interpretation of the numerical results. The tests themselves progress from materials with isotropic to anisotropic mechanical and flow properties. The fine-scale simulations show anisotropy can have noticeable effects on deformation and flow behaviour. However, our numerical experiments show the DC approach can capture the global poroelastic behaviours of both isotropic and anisotropic fine-scale representations.

Published
2020
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11. Multiscale dual-continuum modelling of deformable porous media

Author

Ashworth, Mark and Doster, Florian

Abstract

Within the geosciences, we are often challenged by how to model the coupling of physical phenomena across varying space and time scales, as well as between different phenomena themselves. As a result, we forgo accuracy and physical consistency/understanding, in favour of efficiency and practicality. To address these tradeoffs we can use multiscale and multiphysics modelling. In this work, we are concerned with multiscale behaviours owing to the coupling between a microscale model and a (macroscopic) dual-continuum model. For the multiphysics component, we consider the coupling between linear deformation and flow, referred to as poroelasticity. Accordingly, the goal of this thesis is to apply multiscale and multiphysics modelling concepts to the study of strongly heterogeneous (deformable) porous media, to better understand and represent the links between various scales of interest. We split this work into three main parts. Part one investigates the relations between microscopic and dual-continuum poroelastic constitutive models, including previously introduced phenomenological models. To do so, we use micromechanical approaches. Subsequently, starting from the microscale, we derive a fully anisotropic dual-continuum poroelastic constitutive model using homogenisation. We then show how the resulting model is related to constitutive models available in literature. For these previously introduced models, we use micromechanical considerations and analytical solutions to compare and contrast the various modelling concepts used in their derivation. We also investigate various simplifying assumptions made by past users of these models. On the basis of our studies we provide recommendations for how and when to use the various dual-continuum poroelastic constitutive modelling concepts and simplifications. Part two introduces a numerical framework for poroelastic dual-continuum modelling. We subsequently use this framework to further study the links between microscale and macroscale poroelastic materials. Our numerical framework considers anisotropy and uses a hybrid discretisation suited for the flow and deformation subproblems accordingly. We benchmark the resulting framework against analytical solutions and demonstrate its use on a complex geological grid. With the framework in-hand we compare and study dual-continuum behaviours against microscale representations given various modelling and material assumptions on the latter. We present a number of tests starting from isotropic cases, progressing to more complex anisotropic cases. Our results show that anisotropy can have measurable effects on coupled behaviours. However, for the tests considered, we show the dual-continuum approach is capable of capturing the global poroelastic behaviours of microscopic representations. Finally, part three establishes a computational multiscale approach based on machine learning to improve the accuracy of macroscopic approaches in subsurface modelling. Here the idea is to use data-driven modelling as a surrogate constitutive model within a hierarchical multiscale setting. Accordingly, we detail the framework, describing the key components and considerations therein. We then apply the framework to the problem of inter-continuum mass transfer, whilst considering an uncoupled (flow only) dual-continuum representation. We couple the resulting data-driven model to a physics-based model leading to a hybrid machine learning-physics-based approach. We show the resulting hybrid method to give high quality results with respect to a microscale model, without the computational expense of the latter.

Published
2021

12. A New Web-Based Personalized Learning System Improves Student Learning Outcomes

Author

Sancenon, Vicente, Wijaya, Kharisma, Wen, Xavier Yue Shu, Utama, Diaz Adi, Ashworth, Mark, Ng, Kelvin Hongrui, Cheong, Alicia, and Neo, Zhizhong

Abstract

Although there is increasing acceptance that personalization improves learning outcomes, there is still limited experimental evidence supporting this claim. The aim of this study was to implement and evaluate the effectiveness of an adaptive recommendation system for Singapore primary and secondary education. The system leverages users trace data and learning analytics to generate assessment worksheets customized to individual learner's proficiency. Analysis of online data is used to measure students' skill levels in specific knowledge domains and monitor their progress. Notably, online measurements correlate positively with offline academic outcomes. A randomized controlled trial conducted on forty-three primary school students revealed statistically significant improvement on academic performance of a group of students receiving personalized content over a control group using non-adaptive material. The authors conclude that the reported recommender system successfully helps students improve their academic achievements.

Published
2022
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13. Foundations and their practical implications for the constitutive coefficients of poromechanical dual-continuum models

Author

Ashworth, Mark and Doster, Florian

Subjects
Physics - Geophysics
Abstract

A dual-continuum model can offer a practical approach to understanding first-order behaviours of poromechanically coupled multiscale systems. To close the governing equations, constitutive equations with models to calculate effective constitutive coefficients are required. Several coefficient models have been proposed within the literature. However, a holistic overview of the different modelling concepts is still missing. To address this we first compare and contrast the dominant models existing within the literature. In terms of the constitutive relations themselves, early relations were indirectly postulated that implicitly neglected the effect of the mechanical interaction arising between continuum pressures. Further, recent users of complete constitutive systems that include inter-continuum pressure coupling have explicitly neglected these couplings as a means of providing direct relations between composite and constituent properties, and to simplify coefficient models. Within the framework of micromechanics, we show heuristically that these explicit decouplings are in fact coincident with bounds on the effective parameters themselves. Depending on the formulation, these bounds correspond to end-member states of isostress or isostrain. We show the impacts of using constitutive coefficient models, decoupling assumptions and parameter bounds on poromechanical behaviours using analytical solutions for a 2D model problem. Based on the findings herein, we offer recommendations for how and when to use different coefficient modelling concepts., Comment: Transport in Porous Media (2019)

Published
2019
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21. COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records

Author

Abbasizanjani, Hoda, Ahmed, Nida, Ahmed, Badar, Akbari, Ashley, Akinoso-Imran, Abdul Qadr, Allara, Elias, Allery, Freya, Angelantonio, Emanuele Di, Ashworth, Mark, Ayyar-Gupta, Vandana, Babu-Narayan, Sonya, Bacon, Seb, Ball, Steve, Banerjee, Ami, Barber, Mark, Barrett, Jessica, Bennie, Marion, Berry, Colin, Beveridge, Jennifer, Birney, Ewan, Bojanić, Lana, Bolton, Thomas, Bone, Anna, Boyle, Jon, Braithwaite, Tasanee, Bray, Ben, Briffa, Norman, Brind, David, Brown, Katherine, Buch, Maya, Canoy, Dexter, Caputo, Massimo, Carragher, Raymond, Carson, Alan, Cezard, Genevieve, Chang, Jen-Yu Amy, Cheema, Kate, Chin, Richard, Chudasama, Yogini, Cooper, Jennifer, Copland, Emma, Crallan, Rebecca, Cripps, Rachel, Cromwell, David, Curcin, Vasa, Curry, Gwenetta, Dale, Caroline, Danesh, John, Das-Munshi, Jayati, Dashtban, Ashkan, Davies, Alun, Davies, Joanna, Davies, Gareth, Davies, Neil, Day, Joshua, Delmestri, Antonella, Denaxas, Spiros, Denholm, Rachel, Dennis, John, Denniston, Alastair, Deo, Salil, Dhillon, Baljean, Docherty, Annemarie, Dong, Tim, Douiri, Abdel, Downs, Johnny, Dregan, Alexandru, Ellins, Elizabeth A, Elwenspoek, Martha, Falck, Fabian, Falter, Florian, Fan, Yat Yi, Firth, Joseph, Fraser, Lorna, Friebel, Rocco, Gavrieli, Amir, Gerstung, Moritz, Gilbert, Ruth, Gillies, Clare, Glickman, Myer, Goldacre, Ben, Goldacre, Raph, Greaves, Felix, Green, Mark, Grieco, Luca, Griffiths, Rowena, Gurdasani, Deepti, Halcox, Julian, Hall, Nick, Hama, Tuankasfee, Handy, Alex, Hansell, Anna, Hardelid, Pia, Hardy, Flavien, Harris, Daniel, Harrison, Camille, Harron, Katie, Hassaine, Abdelaali, Hassan, Lamiece, Healey, Russell, Hemingway, Harry, Henderson, Angela, Herz, Naomi, Heyl, Johannes, Hidajat, Mira, Higginson, Irene, Hinchliffe, Rosie, Hippisley-Cox, Julia, Ho, Frederick, Hocaoglu, Mevhibe, Hollings, Sam, Horne, Elsie, Hughes, David, Humberstone, Ben, Inouye, Mike, Ip, Samantha, Islam, Nazrul, Jackson, Caroline, Jenkins, David, Jiang, Xiyun, Johnson, Shane, Kadam, Umesh, Kallis, Costas, Karim, Zainab, Kasan, Jake, Katsoulis, Michalis, Kavanagh, Kim, Kee, Frank, Keene, Spencer, Kent, Seamus, Khalid, Sara, Khawaja, Anthony, Khunti, Kamlesh, Killick, Richard, Kinnear, Deborah, Knight, Rochelle, Kolamunnage-Dona, Ruwanthi, Kontopantelis, Evan, Kurdi, Amanj, Lacey, Ben, Lai, Alvina, Lambarth, Andrew, Larzjan, Milad Nazarzadeh, Lawler, Deborah, Lawrence, Thomas, Lawson, Claire, Li, Qiuju, Li, Ken, Llinares, Miguel Bernabeu, Lorgelly, Paula, Lowe, Deborah, Lyons, Jane, Lyons, Ronan, Machado, Pedro, Macleod, Mary Joan, Macleod, John, Malgapo, Evaleen, Mamas, Mamas, Mamouei, Mohammad, Manohar, Sinduja, Mapeta, Rutendo, Martelli, Javiera Leniz, Martos, David Moreno, Mateen, Bilal, McCarthy, Aoife, Melville, Craig, Milton, Rebecca, Mizani, Mehrdad, Moncusi, Marta Pineda, Morales, Daniel, Mordi, Ify, Morrice, Lynn, Morris, Carole, Morris, Eva, Mu, Yi, Mueller, Tanja, Murdock, Lars, Nafilyan, Vahé, Nicholson, George, Nikiphorou, Elena, Nolan, John, Norris, Tom, Norris, Ruth, North, Laura, North, Teri-Louise, O'Connell, Dan, Oliver, Dominic, Oluyase, Adejoke, Olvera-Barrios, Abraham, Omigie, Efosa, Onida, Sarah, Padmanabhan, Sandosh, Palmer, Tom, Pasea, Laura, Patel, Riyaz, Payne, Rupert, Pell, Jill, Petitjean, Carmen, Pherwani, Arun, Pickrell, Owen, Pierotti, Livia, Pirmohamed, Munir, Priedon, Rouven, Prieto-Alhambra, Dani, Proudfoot, Alastair, Quinn, Terry, Quint, Jennifer, Raffetti, Elena, Rahimi, Kazem, Rao, Shishir, Razieh, Cameron, Roberts, Brian, Rogers, Caroline, Rossdale, Jennifer, Salim, Safa, Samani, Nilesh, Sattar, Naveed, Schnier, Christian, Schwartz, Roy, Selby, David, Seminog, Olena, Shabnam, Sharmin, Shah, Ajay, Shelton, Jon, Sheppard, James, Sinha, Shubhra, Skrypak, Mirek, Slapkova, Martina, Sleeman, Katherine, Smith, Craig, Sofat, Reecha, Sosenko, Filip, Sperrin, Matthew, Steeg, Sarah, Sterne, Jonathan, Stoica, Serban, Sudell, Maria, Sudlow, Cathie, Sun, Luanluan, Suseeladevi, Arun Karthikeyan, Sweeting, Michael, Sydes, Matt, Takhar, Rohan, Tang, Howard, Thygesen, Johan, Tilston, George, Tochel, Claire, Toit, Clea du, Tomlinson, Christopher, Toms, Renin, Torabi, Fatemeh, Torralbo, Ana, Townson, Julia, Tufail, Adnan, Tungamirai, Tapiwa, Varma, Susheel, Vollmer, Sebastian, Walker, Venexia, Wang, Tianxiao, Wang, Huan, Warwick, Alasdair, Watkinson, Ruth, Watson, Harry, Whiteley, William, Whittaker, Hannah, Wilde, Harry, Wilkinson, Tim, Williams, Gareth, Williams, Michelle, Williams, Richard, Withnell, Eloise, Wolfe, Charles, Wood, Angela, Wright, Lucy, Wu, Honghan, Wu, Jinge, Wu, Jianhua, Yates, Tom, Zaccardi, Francesco, Zhang, Haoting, Zhang, Huayu, Zuccolo, Luisa, Thygesen, Johan H, Mizani, Mehrdad A, Banerjee, Amitava, Lai, Alvina G, Li, Kezhi, Mateen, Bilal A, Sterne, Jonathan A C, Pagel, Christina, and Whiteley, William N

Published
2022
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25. Structure-based engineering of CYP105AS1 for the production of high-value molecules

Author

Ashworth, Mark, Munro, Andrew, and Leys, David

Subjects
540, Statins, Pravastatin, Biocatalysis, CYP105AS1, Cytochrome P450, Biotechnology, Enzyme engineering, Computational enzyme design, Protein engineering, Synthetic biology, Enantioselectivity
Abstract

Biocatalysis represents an attractive route to the production of various compounds which are difficult or impossible to synthesise and isolate using traditional chemical synthesis. In particular, the production of chiral molecules is a function ideally suited to biocatalysis, due to the natural stereospecificity of enzymes. The synthesis of such chiral molecules is essential in the production of pharmaceuticals, additives for the food and drinks industry and the creation of specialist polymers. CYP105AS1, isolated from Amycolatopsis orientalis, is a cytochrome P450 enzyme which produces the inactive 6-epi-pravastatin of the blockbuster anti-cholesterol drug pravastatin. Previous directed evolution efforts have engineered this enzyme to produce a five-point mutant, known as P450prava, which partially reversed the stereospecificity of the enzyme to produce a majority pravastatin product mixture. This thesis details work to use structure-led engineering approaches to redesign the active site of P450prava to introduce stringent stereospecificity. A combinatorial approach of manual and computational rational design was pursued, leading to the creation of a novel T95F/V180M double mutant of P450prava. This double mutant was found to have successfully eliminated the unwanted 6-epi-pravastatin enantiomer from the product mix, leaving a pure pravastatin product. P450prava was also shown to bind and hydroxylate other statin substrate molecules, demonstrating its versatility in the production of drug metabolites and other high-value oxyfunctionalised molecules. This property, along with its proven tolerance of significant active site engineering efforts, demonstrates the viability of the P450prava as a platform for the creation of novel biocatalysts for the production of various hydroxylated products from diverse substrate molecules.

Published
2018

27. Risk of fibromyalgia following antibiotic prescriptions: A population‐based case–control study.

Author

Armstrong, David, Dregan, Alex, Ashworth, Mark, and White, Patrick

Abstract

Background: The health of the gut microbiome is now recognized to be an important component of the gut–brain axis which itself appears to be implicated in pain perception. Antibiotics are known to create dysbiosis in the microbiome, so whether fibromyalgia is more commonly diagnosed after antibiotic prescriptions provides a means of exploring the role of the microbiome in the experience of chronic pain. Methods: A case–control study was carried out using electronic health records collected in the UK's Clinical Practice Research Datalink (CPRD), a comprehensive database of primary care consultations. For each case of diagnosed fibromyalgia, three controls were identified and matched by age, gender and GP practice. The exposure variable was the number and timing of antibiotic prescriptions over previous years. The analysis involved adjusting for a wide range of co‐variates that might be possible confounders. Results: A total of 44,674 cases of fibromyalgia were identified together with 133,513 controls. After adjusting for co‐variates, it was found that both the total number of prescriptions and their timing was associated with an FM diagnosis. For example, the quartile with the highest number of prescriptions and that with the longest exposure had a greater than three‐fold increase in FM diagnoses (number of prescriptions: odds ratio 3.92; 95% CIs: 3.71–4.13; exposure odds ratio 3.28; CIs: 3.13–3.43). Some antibiotics (such as tetracyclines and metronidazole) seemed to confer greater risk than others. Conclusions: The results lend support for prior antibiotics being an important risk factor for a diagnosis of FM. Significance: This study shows an association between the volume as well as timing of prior antibiotic prescriptions and of a subsequent diagnosis of fibromyalgia in primary care. [ABSTRACT FROM AUTHOR]

Published
2024
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32. Exploring the Experiences of Living With the Post‐COVID Syndrome: A Qualitative Study.

Author

Kalfas, Michail, Jolley, Caroline, Hart, Nicholas, Rafferty, Gerrard F., Duncan, Emma L., Nicholson, Timothy, Ashworth, Mark, Brewin, Debbie, Barrett, Barbara, Witard, Oliver C., Ridge, Damien, and Chalder, Trudie

Subjects
HEALTH services accessibility, HEALTH status indicators, QUALITATIVE research, SELF-management (Psychology), POST-acute COVID-19 syndrome, INTERVIEWING, SEX distribution, HEALTH, REFLECTION (Philosophy), INFORMATION resources, FUNCTIONAL status, PSYCHOLOGICAL adaptation, EXPERIENCE, THEMATIC analysis, QUALITY of life, RESEARCH methodology, ATTITUDES of medical personnel, SOCIAL support, PATIENTS' attitudes, ACTIVITIES of daily living, PSYCHOSOCIAL functioning
Abstract

Introduction: Many people experience persistent symptoms for more than 12 weeks following SARS‐CoV‐2 infection, which is known as post‐COVID‐19 condition (PCS) or Long COVID (LC). PCS can impair people's quality of life and daily functioning. However, there is a lack of in‐depth research exploring the PCS patient journey, as well as gendered aspects of patients' experiences. Methods: Nineteen semi‐structured qualitative interviews were conducted with people living with PCS in the United Kingdom (13 women, 6 men). Interviews were transcribed verbatim and analysed inductively using reflexive thematic analysis. Results: Five main themes were identified: 'Symptom dismissal', 'Lack of information and support', 'Life before and after Long COVID', 'Psychological impact' and 'Acceptance'. A shift overtime to self‐management of symptoms was evident. These themes represent different stages of patients' PCS journey. Narratives indicated that women highlighted dismissal by healthcare professionals (HCPs), which was not as prominent in men's narratives. In addition, women went into more detail about the psychological impact of PCS compared to men. Conclusion: Women with PCS reported symptom dismissal by HCPs, which may have delayed their diagnosis and negatively affected their well‐being. We were not able to explore the experiences of people from non‐conforming gender groups. Raising awareness of these issues among HCPs, particularly general practitioners, could improve patient care in PCS. Patient or Public Contribution: Patient and public involvement consisted of people who took part in the interviews and commented on the themes' interpretation and study conclusions. [ABSTRACT FROM AUTHOR]

Published
2024
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33. IT Evaluation of Foundation Healthcare Group Vanguard Project

Author

Tapuria, Archana, primary, Kordowicz, Maria, additional, Ashworth, Mark, additional, Ferlie, Ewan, additional, Curcin, Vasa, additional, Koleva-Kolarova, Rositsa, additional, Fox-Rushby, Julia, additional, Edwards, Sylvia, additional, Crilly, Tessa, additional, and Wolfe, Charles, additional

Published
2021
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36. Peritonsillar Abscess and Antibiotic Prescribing for Respiratory Infection in Primary Care: A Population-Based Cohort Study and Decision-Analytic Model

Author

Winter, Joanne R., Charlton, Judith, Ashworth, Mark, Bunce, Catey, and Gulliford, Martin C.

Subjects
Respiratory tract diseases -- Drug therapy, Antibacterial agents -- Usage, Peritonsillar abscess -- Drug therapy, Primary health care -- Methods, Health, Science and technology
Abstract

PURPOSE To quantify the risk of peritonsillar abscess (PTA) following consultation for respiratory tract infection (RTI) in primary care. METHOD A cohort study was conducted in the UK Clinical Practice Research Datalink including 718 general practices with 65,681,293 patient years of follow-up and 11,007 patients with a first episode of PTA. From a decision tree, Bayes theorem was employed to estimate both the probability of PTA following an RTI consultation if antibiotics were prescribed or not, and the number of patients needed to be treated with antibiotics to prevent 1 PTA. RESULTS There were 11,007 patients with PTA with age-standardized incidence of new episodes of PTA of 17.2 per 100,000 patient years for men and 16.1 for women; 6,996 (64%) consulted their practitioner in the 30 days preceding PTA diagnosis, including 4,243 (39%) consulting for RTI. The probability of PTA following an RTI consultation was greatest in men aged 15 to 24 years with 1 PTA in 565 (95% uncertainty interval 527 to 605) RTI consultations without antibiotics prescribed but 1 in 1,139 consultations (1,044 to 1,242) if antibiotics were prescribed. One PTA might be avoided for every 1,121 (975 to 1,310) additional antibiotic prescriptions for men aged 15 to 24 years and 926 (814 to 1,063) for men aged 25 to 34 years. The risk of PTA following RTI consultation was smaller and the number needed to treat higher at other ages and risks were lower in women than men. CONCLUSIONS The risk of PTA may be lower if antibiotics are prescribed for RTI but even in young men nearly 1,000 antibiotic prescriptions may be required to prevent 1 PTA case. We caution that lack of randomization and data standardization may bias estimates. Key words: antibacterial agents; antibiotics; primary health care; respiratory tract infections; peritonsillar abscess; decision support, INTRODUCTION Widespread unnecessary use of antibiotics is contributing to the development of antimicrobial drug resistance with increased risk of infections from difficult-to-treat antibiotic-resistant organisms. (1,2) Strategies designed to limit antimicrobial [...]

Published
2020
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42. Disease patterns in high-cost individuals with multimorbidity: a retrospective cross-sectional study in primary care.

Author

Soley-Bori, Marina, Ashworth, Mark, McGreevy, Alice, Wang, Yanzhong, Durbaba, Stevo, Dodhia, Hiten, and Fox-Rushby, Julia

Subjects
MENTAL health services, MEDICAL quality control, COMORBIDITY, PRIMARY care, CROSS-sectional method
Abstract

Background: 'High-cost' individuals with multimorbidity account for a disproportionately large share of healthcare costs and are at most risk of poor quality of care and health outcomes. Aim: To compare high-cost with lower-cost individuals with multimorbidity and assess whether these populations can be clustered based on similar disease patterns. Design and setting: A cross-sectional study based on 2019/2020 electronic medical records from adults registered to primary care practices (n = 41) in a London borough. Method: Multimorbidity is defined as having ≥2 long-term conditions (LTCs). Primary care costs reflected consultations, which were costed based on provider and consultation types. High cost was defined as the top 20% of individuals in the cost distribution. Descriptive analyses identified combinations of 32 LTCs and their contribution to costs. Latent class analysis explored clustering patterns. Results: Of 386 238 individuals, 101 498 (26%) had multimorbidity. The high-cost group (n = 20 304) incurred 53% of total costs and had 6833 unique disease combinations, about three times the diversity of the lower-cost group (n = 81 194). The trio of anxiety, chronic pain, and depression represented the highest share of costs (5%). High-cost individuals were best grouped into five clusters, but no cluster was dominated by a single LTC combination. In three of five clusters, mental health conditions were the most prevalent. Conclusion: High-cost individuals with multimorbidity have extensive heterogeneity in LTCs, with no single LTC combination dominating their primary care costs. The frequent presence of mental health conditions in this population supports the need to enhance coordination of mental and physical health care to improve outcomes and reduce costs. [ABSTRACT FROM AUTHOR]

Published
2024
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45. Multidisciplinary ecosystem to study lifecourse determinants and prevention of early-onset burdensome multimorbidity (MELD-B) – protocol for a research collaboration

Author

Fraser, Simon DS, primary, Stannard, Sebastian, additional, Holland, Emilia, additional, Boniface, Michael, additional, Hoyle, Rebecca B, additional, Wilkinson, Rebecca, additional, Akbari, Ashley, additional, Ashworth, Mark, additional, Berrington, Ann, additional, Chiovoloni, Roberta, additional, Enright, Jessica, additional, Francis, Nick A, additional, Giles, Gareth, additional, Gulliford, Martin, additional, Macdonald, Sara, additional, Mair, Frances S, additional, Owen, Rhiannon K, additional, Paranjothy, Shantini, additional, Parsons, Heather, additional, Sanchez-Garcia, Ruben J, additional, Shiranirad, Mozhdeh, additional, Zlatev, Zlatko, additional, and Alwan, Nisreen, additional

Published
2023
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47. Mechanisms for Integrating Real Data into Search Game Simulations: An Application to Winter Health Service Pressures and Preventative Policies

Author

Chapman, Martin, primary, G-Medhin, Abigail, additional, Daneshi, Kian, additional, Bramwell, Tom, additional, Durbaba, Stevo, additional, Curcin, Vasa, additional, Parmar, Divya, additional, Boulding, Harriet, additional, Becares, Laia, additional, Morgan, Craig, additional, Molokhia, Mariam, additional, McBurney, Peter, additional, Harding, Seeromanie, additional, Wolfe, Ingrid, additional, Ashworth, Mark, additional, and Poston, Lucilla, additional

Published
2023
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48. A conceptual framework for characterising lifecourse determinants of multiple long-term condition multimorbidity

Author

Stannard, Sebastian, primary, Berrington, Ann, additional, Paranjothy, Shantini, additional, Owen, Rhiannon, additional, Fraser, Simon, additional, Hoyle, Rebecca, additional, Boniface, Michael, additional, Wilkinson, Becky, additional, Akbari, Ashley, additional, Batchelor, Sophia, additional, Jones, William, additional, Ashworth, Mark, additional, Welch, Jack, additional, Mair, Frances S, additional, and Alwan, Nisreen A, additional

Published
2023
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