231 results on '"Matthew Broadbent"'
Search Results
2. Developing a validated methodology for identifying clozapine treatment periods in electronic health records
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Aviv Segev, Risha Govind, Ebenezer Oloyede, Hamilton Morrin, Amelia Jewell, Rowena Jones, Laura Mangiaterra, Stefano Bonora, Ehtesham Iqbal, Robert Stewart, Matthew Broadbent, and James H. MacCabe
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Clozapine ,Schizophrenia ,Psychosis ,Databases ,Algorithm ,CRIS ,Psychiatry ,RC435-571 - Abstract
Abstract Background Clozapine is the only recommended antipsychotic medication for individuals diagnosed with treatment-resistant schizophrenia. Unfortunately, its wider use is hindered by several possible adverse effects, some of which are rare but potentially life threatening. As such, there is a growing interest in studying clozapine use and safety in routinely collected healthcare data. However, previous attempts to characterise clozapine treatment have had low accuracy. Aim To develop a methodology for identifying clozapine treatment dates by combining several data sources and implement this on a large clinical database. Methods Non-identifiable electronic health records from a large mental health provider in London and a linked database from a national clozapine blood monitoring service were used to obtain information regarding patients' clozapine treatment status, blood tests and pharmacy dispensing records. A rule-based algorithm was developed to determine the dates of starting and stopping treatment based on these data, and more than 10% of the outcomes were validated by manual review of de-identified case note text. Results A total of 3,212 possible clozapine treatment periods were identified, of which 425 (13.2%) were excluded due to insufficient data to verify clozapine administration. Of the 2,787 treatments remaining, 1,902 (68.2%) had an identified start-date. On evaluation, the algorithm identified treatments with 96.4% accuracy; start dates were 96.2% accurate within 15 days, and end dates were 85.1% accurate within 30 days. Conclusions The algorithm produced a reliable database of clozapine treatment periods. Beyond underpinning future observational clozapine studies, we envisage it will facilitate similar implementations on additional large clinical databases worldwide. more...
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- 2024
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3. Physical health challenges faced by elders with severe mental illness: population-based retrospective cohort study
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Chin-Kuo Chang, Richard D. Hayes, Matthew Broadbent, Hitesh Shetty, Yu-Ping Su, Paul D. Meesters, and Robert Stewart
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Severe mental illness ,hospital admission ,schizophrenia ,bipolar disorder ,schizoaffective disorder ,Psychiatry ,RC435-571 - Abstract
Background Severe mental illness (SMI), which includes schizophrenia, schizoaffective disorder and bipolar disorder, has profound health impacts, even in the elderly. Aims To evaluate relative risk of hospital admission and length of hospital stay for physical illness in elders with SMI. Method To construct a population-based retrospective cohort observed from April 2007 to March 2016, data from a case registry with full but de-identified electronic health records were retrieved for patients of the South London and Maudsley NHS Foundation Trust, the single secondary mental healthcare service provider in south-east London. We compared participants with SMI aged >60 years old with the general population of the same age and residing in the same areas through data linkage by age-, sex- and fiscal-year-standardised admission ratios (SARs) for primary diagnoses at hospital discharge. Furthermore, we compared the duration of hospital stay with an age-, sex- and cause-of-admission-matched random group by linear regression for major causes of admission. Results In total, records for 4175 older people with SMI were obtained, relating to 10 342 admission episodes, showing an overall SAR for all physical illnesses of 5.15 (95% CI: 5.05, 5.25). Among the top causes of admission, SARs ranged from 3.87 for circulatory system disorders (ICD-10 codes: I00–I99) to 6.99 for genitourinary system or urinary conditions (N00–N39). Specifically, the diagnostic group of ‘symptoms, signs and findings, not elsewhere classified’ (R00–R99) had an elevated SAR of 6.56 (95% CI: 6.22, 6.90). Elders with SMI also had significantly longer hospital stays than their counterparts in the general population, especially for digestive system illnesses (K00–K93), after adjusting for confounding. Conclusions Poorer overall physical health and specific patterns were identified in elders with SMI. more...
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- 2024
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4. Cohort profile: working age adults accessing secondary mental health services in South London (UK) and benefits – a data linkage of electronic mental health records and benefits data.
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Ava Phillips, Ray Leal, Amelia Jewell, Ira Madan, Johnny Downs, Matthew Broadbent, Matthew Hotopf, Sarah Dorrington, Nicola Fear, and Sharon Stevelink
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linked data ,benefits ,administrative data ,mental health records ,secondary care ,UK ,Demography. Population. Vital events ,HB848-3697 - Abstract
Introduction In the UK, mental disorders are one of the most common reasons for claiming a benefit relating to unemployment, income, sickness and disability. Limited information exists regarding the demographic characteristics and psychiatric profiles of working age individuals claiming benefits in London. Until recently, detailed data on both mental disorders and benefit receipt were unavailable. Objectives To establish and describe a cohort of working age adults accessing secondary mental health services and benefits related to unemployment, income, sickness, and disability. Methods Using a novel data linkage containing electronic secondary mental health records from the South London and Maudsley (SLaM) NHS Foundation Trust and benefits data from the Department for Work and Pensions (DWP), we present descriptive statistics on sociodemographics, psychiatric diagnoses, and benefits received among a cohort of working age adults. The DWP benefits data window covers the period January 2007-June 2020, the SLaM data window covers the period January 2007-June 2019. Results We identified n = 150,348 patients (18-65 years), who had attended SLaM secondary mental health services, 78.3% of which had received a benefit relating to unemployment, income, sickness and disability. Of this group, 68% had a recorded primary psychiatric diagnosis. We found that a much higher percentage of those with a primary psychiatric diagnosis received more than one benefit (69.4%) compared to those who had not received a primary psychiatric diagnosis (30.6%). Almost 70% of claimants who obtained more than one benefit were identified as living within the two quintiles representing the highest levels of deprivation in the South-east London boroughs served by SLaM. Conclusions We showed types of benefits received among working age adults accessing secondary mental health services. This cohort will be further examined to explore trajectories of mental health care and benefit receipt and provide evidence that will help to inform both DWP policies and mental health care delivery. more...
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- 2024
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5. Associations between air pollution and mental health service use in dementia: a retrospective cohort study
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Robert Stewart, Christoph Mueller, Matthew Broadbent, Matthew Hotopf, Jayati Das-Munshi, Ioannis Bakolis, Sean Beevers, Ian S Mudway, Stephani L Hatch, David Dajnak, Amy Ronaldson, Joanne B Newbury, and Helen L Fisher more...
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Psychiatry ,RC435-571 - Abstract
Background Little is known about the role of air pollution in how people with dementia use mental health services.Objective We examined longitudinal associations between air pollution exposure and mental health service use in people with dementia.Methods In 5024 people aged 65 years or older with dementia in South London, high resolution estimates of nitrogen dioxide (NO2) and particulate matter (PM2.5 and PM10) levels in ambient air were linked to residential addresses. Associations between air pollution and Community Mental Health Team (CMHT) events (recorded over 9 years) were examined using negative binomial regression models. Cognitive function was measured using the Mini Mental State Examination (MMSE) and health and social functioning was measured using the Health of the Nation Outcomes Scale (HoNOS65+). Associations between air pollution and both MMSE and HoNOS65+ scores were assessed using linear regression models.Findings In the first year of follow-up, increased exposure to all air pollutants was associated with an increase in the use of CMHTs in a dose-response manner. These associations were strongest when we compared the highest air pollution quartile (quartile 4: Q4) with the lowest quartile (Q1) (eg, NO2: adjusted incidence rate ratio (aIRR) 1.27, 95% CI 1.11 to 1.45, p more...
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- 2023
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6. Cohort profile: Working age adults accessing secondary mental healthcare services in South London (UK) and benefits – A data linkage of electronic mental healthcare records and benefits data
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Ava Phillips, Ray Leal, Sarah Dorrington, Matthew Hotopf, Matthew Broadbent, Amelia Jewell, Johnny Downs, and Sharon Stevelink
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Demography. Population. Vital events ,HB848-3697 - Abstract
Objectives To present an overview of a cohort of working age adults accessing secondary mental healthcare services and benefits related to unemployment, sickness, disability, or income support and describe the different benefit types received across diagnostic and sociodemographic groups. Methods Using a novel data linkage containing electronic secondary mental health care records from the South London and Maudsley (SLaM) NHS Foundation Trust and benefits data from the Department for Work and Pensions (DWP), we present descriptive statistics on a cohort of working age adults. The data window covers the period January 2007-June 2020. Results We identified n=150,348 patients of working age (18-65 years), who had attended SLaM secondary mental health care services, 78.3% of which had received a benefit relating to unemployment, sickness, disability, or income support. Of this group, 68% had a recorded primary psychiatric diagnosis. We found that a much higher percentage of those with a primary psychiatric diagnosis received more than one benefit (69.4%) compared to those who had not received a primary psychiatric diagnosis (30.6%). Conclusions We showed types of benefits received among working age adults accessing secondary mental health care services. This cohort will be further examined to explore trajectories of mental health care and benefit receipt and provide evidence that will help to inform both DWP policies and mental health care delivery. more...
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- 2023
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7. Recording of intellectual disability in general hospitals in England 2006-2019: Cohort study using linked datasets.
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Rory Sheehan, Hassan Mansour, Matthew Broadbent, Angela Hassiotis, Christoph Mueller, Robert Stewart, Andre Strydom, and Andrew Sommerlad
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Medicine - Abstract
BackgroundAccurate recognition and recording of intellectual disability in those who are admitted to general hospitals is necessary for making reasonable adjustments, ensuring equitable access, and monitoring quality of care. In this study, we determined the rate of recording of intellectual disability in those with the condition who were admitted to hospital and factors associated with the condition being unrecorded.Methods and findingsRetrospective cohort study using 2 linked datasets of routinely collected clinical data in England. We identified adults with diagnosed intellectual disability in a large secondary mental healthcare database and used general hospital records to investigate recording of intellectual disability when people were admitted to general hospitals between 2006 and 2019. Trends over time and factors associated with intellectual disability being unrecorded were investigated. We obtained data on 2,477 adults with intellectual disability who were admitted to a general hospital in England at least once during the study period (total number of admissions = 27,314; median number of admissions = 5). People with intellectual disability were accurately recorded as having the condition during 2.9% (95% CI 2.7% to 3.1%) of their admissions. Broadening the criteria to include a nonspecific code of learning difficulty increased recording to 27.7% (95% CI 27.2% to 28.3%) of all admissions. In analyses adjusted for age, sex, ethnicity, and socioeconomic deprivation, having a mild intellectual disability and being married were associated with increased odds of the intellectual disability being unrecorded in hospital records. We had no measure of quality of hospital care received and could not relate this to the presence or absence of a record of intellectual disability in the patient record.ConclusionsRecognition and recording of intellectual disability in adults admitted to English general hospitals needs to be improved. Staff awareness training, screening at the point of admission, and data sharing between health and social care services could improve care for people with intellectual disability. more...
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- 2023
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8. Linking electronic mental healthcare and benefits records in South London: design, procedure and descriptive outcomes
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Johnny Downs, Amelia Jewell, Matthew Broadbent, Matthew Hotopf, Nicola T Fear, Ioannis Bakolis, Sharon A M Stevelink, Ira Madan, Andy Boyd, Sarah Dorrington, Ava Phillips, and Ray Leal
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Medicine - Abstract
Objectives To describe the process and outcomes of a data linkage between electronic secondary mental healthcare records from the South London and Maudsley (SLaM) NHS Foundation Trust with benefits records from the Department for Work and Pensions (DWP). We also describe the mental health and benefit profile of patients who were successfully linked.Design A deterministic linkage of routine records from health and welfare government service providers within a secure environment.Setting and participants Adults aged≥18 years who were referred to or accessed treatment at SLaM services between January 2007 and June 2019, including those who were treated as part of Improving Access to Psychological Therapies (IAPT) services between January 2008 and June 2019 (n=448 404). Benefits data from the DWP from January 2005 to June 2020.Outcome measures The linkage rate and associated sociodemographic, diagnostic and treatment factors. Recorded primary psychiatric diagnosis based on International Classification of Diseases (ICD)-10 codes and type of benefit receipt.Results A linkage rate of 92.3% was achieved. Women, younger patients and those from ethnic minority groups were less likely to be successfully linked. Patients who had subsequently died, had a recorded primary psychiatric diagnosis, had also engaged with IAPT and had a higher number of historical postcodes available were more likely to be linked. Overall, 83% of patients received benefits at some point between 2005 and 2020. Benefit receipt across the psychiatric diagnosis spectrum was high, over 80% across most ICD-10 codes.Conclusions This data linkage is the first of its kind in the UK demonstrating the use of routinely collected mental health and benefits data. Benefit receipt was high among patients accessing SLaM services and varied by psychiatric diagnosis. Future areas of research are discussed, including exploring the effectiveness of interventions for helping people into work and the impact of benefit reforms. more...
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- 2023
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9. Body mass index and mortality in patients with schizophrenia spectrum disorders: a cohort study in a South London catchment area
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Robert Stewart, Hitesh Shetty, Matthew Broadbent, Jianhua Chen, Yifeng Xu, and Gayan Perera
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Psychiatry ,RC435-571 - Abstract
Background People with schizophrenia have a high premature mortality risk. Obesity is a key potential underlying risk factor that is relatively unevaluated to date.Aims In this study, we investigated the associations of routinely recorded body size with all-cause mortality and deaths from common causes in a large cohort of people with schizophrenia spectrum disorders.Methods We assembled a retrospective observational cohort using data from a large mental health service in South London. We followed all patients over the age of 18 years with a clinical diagnosis of schizophrenia spectrum disorders from the date of their first recorded body mass index (BMI) between 1 January 2007 and 31 March 2018.Results Of 11 900 patients with a BMI recording, 1566 died. The Cox proportional hazards regression models, after adjusting for sociodemographic, socioeconomic variables and comorbidities, indicated that all-cause mortality was only associated with underweight status compared with healthy weight status (hazard ratio (HR): 1.33, 95% confidence interval (CI): 1.01 to 1.76). Obesity (HR: 1.24, 95% CI: 1.01 to 1.52) and morbid obesity (HR: 1.54, 95% CI: 1.03 to 2.42) were associated with all-cause mortality in the 18–45 years age range, and obesity was associated with lower risk (HR: 0.66, 95% CI: 0.50 to 0.87) in those aged 65+ years. Cancer mortality was raised in underweight individuals (HR: 1.93, 95% CI: 1.03 to 4.10) and respiratory disease mortality raised in those with morbid obesity (HR: 2.17, 95% CI: 1.02 to 5.22).Conclusions Overall, being underweight was associated with higher mortality in this disorder group; however, this was potentially accounted for by frailty in older age groups, and obesity was a risk factor for premature mortality in younger ages. The impact of obesity on life expectancy for people with schizophrenia spectrum disorders is clear from our findings. A deeper biological understanding of the relationship between these diseases and schizophrenia will help improve clinical practice. more...
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- 2022
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10. Ethnic inequalities in mental and physical multimorbidity in women of reproductive age: a data linkage cohort study
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Amelia Jewell, Matthew Broadbent, Stephani Hatch, Mark Ashworth, Megan Pritchard, Sarah Dorrington, Louise Howard, and Raquel Catalao
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Medicine - Abstract
Objectives Explore inequalities in risk factors, mental and physical health morbidity in non-pregnant women of reproductive age in contact with mental health services and how these vary per ethnicity.Design Retrospective cohort study.Setting Data from Lambeth DataNet, anonymised primary care records of this ethnically diverse London borough, linked to anonymised electronic mental health records (‘CRIS secondary care database’).Participants Women aged 15–40 years with an episode of secondary mental health care between January 2008 and December 2018 and no antenatal or postnatal Read codes (n=3817) and a 4:1 age-matched comparison cohort (n=14 532).Main outcome measures Preconception risk factors including low/high body mass index, smoking, alcohol, substance misuse, micronutrient deficiencies and physical diagnoses.Results Women in contact with mental health services (whether with or without severe mental illness (SMI)) had a higher prevalence of all risk factors and physical health diagnoses studied. Women from minority ethnic groups were less likely to be diagnosed with depression in primary care compared with white British women (adjusted OR 0.66 (0.55–0.79) p more...
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- 2022
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11. Mental healthcare utilisation by patients before and after receiving paliperidone palmitate treatment: mirror image analyses
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David Taylor, Robert Stewart, Hitesh Shetty, Matthew Broadbent, Richard Hayes, Megan Pritchard, Chin-Kuo Chang, Giouliana Kadra-Scalzo, Deborah Ahn, and Alex Bird
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Medicine - Abstract
Objectives To compare mental healthcare use and healthcare professional (HCP) contacts for patients before and after initiation of paliperidone palmitate.Setting The South London and Maudsley NHS Foundation Trust (SLAM) Biomedical Research Centre Clinical Record Interactive Search.Participants We identified all adults with a diagnosis of schizophrenia (International Classification of Diseases 10th Revision: F20.x), who had received paliperidone palmitate prescription for at least 365 days and had at least 1 year of recorded treatment from SLAM, prior to the first recorded receipt of paliperidone palmitate.Primary and secondary outcome measures Inpatient and community mental healthcare service use, such as inpatient bed days, number of active days in the service, face-to-face and telephone HCP use in the 12 months before and after paliperidone palmitate initiation.Results We identified 664 patients initiated on paliperidone palmitate. Following initiation, inpatient bed days were lower, although patients remained active on the service case load longer for both mirror approach 1 (mean difference of inpatient bed days −10.48 (95% CI −15.75 to −5.22); days active 40.67 (95% CI 33.39 to 47.95)) and mirror approach 2 (mean difference of inpatient bed days −23.96 (95% CI −30.01 to −17.92); mean difference of days active 40.69 (95% CI 33.39 to 47.94)). The postinitiation period was further characterised by fewer face-to-face and telephone contacts with medical and social work HCPs, and an increased contact with clinical psychologists.Conclusions Our findings indicate a change in the profile of HCP use, consistent with a transition from treatment to possible rehabilitation. more...
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- 2022
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12. All-cause and cause-specific mortality in people with mental disorders and intellectual disabilities, before and during the COVID-19 pandemic: cohort study
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Jayati Das-Munshi, Chin Kuo Chang, Ioannis Bakolis, Matthew Broadbent, Alex Dregan, Matthew Hotopf, Craig Morgan, and Robert Stewart
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Public aspects of medicine ,RA1-1270 - Abstract
ABSTRACT: BACKGROUND: People with mental disorders and intellectual disabilities experience excess mortality compared with the general population. The impact of COVID-19 on exacerbating this, and in widening ethnic inequalities, is unclear. METHODS: Prospective data (N=167,122) from a large mental healthcare provider in London, UK, with deaths from 2019 to 2020, used to assess age- and gender-standardised mortality ratios (SMRs) across nine psychiatric conditions (schizophrenia-spectrum disorders, affective disorders, somatoform/ neurotic disorders, personality disorders, learning disabilities, eating disorders, substance use disorders, pervasive developmental disorders, dementia) and by ethnicity. FINDINGS: Prior to the World Health Organization (WHO) declaring COVID-19 a public health emergency on 30th January 2020, all-cause SMRs across all psychiatric cohorts were more than double the general population. By the second quarter of 2020, when the UK experienced substantial peaks in COVID-19 deaths, all-cause SMRs increased further, with COVID-19 SMRs elevated across all conditions (notably: learning disabilities: SMR: 9.24 (95% CI: 5.98-13.64), pervasive developmental disorders: 5.01 (95% CI: 2.40-9.20), eating disorders: 4.81 (95% CI: 1.56-11.22), schizophrenia-spectrum disorders: 3.26 (95% CI: 2.55-4.10), dementia: 3.82 (95% CI: 3.42, 4.25) personality disorders 4.58 (95% CI: 3.09-6.53)). Deaths from other causes remained at least double the population average over the whole year. Increased SMRs were similar across ethnic groups. INTERPRETATION: People with mental disorders and intellectual disabilities were at a greater risk of deaths relative to the general population before, during and after the first peak of COVID-19 deaths, with similar risks by ethnicity. Mortality from non-COVID-19/ other causes was elevated before/ during the pandemic, with higher COVID-19 mortality during the pandemic. FUNDING: ESRC (JD, CM), NIHR (JD, RS, MH), Health Foundation (JD), GSK, Janssen, Takeda (RS). more...
- Published
- 2021
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13. Access to mental healthcare in the year after first fit note: a longitudinal study of linked clinical records
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Matthew Broadbent, Matthew Hotopf, Sharon Stevelink, Stephani Hatch, Mark Ashworth, Ira Madan, Ewan Carr, and Sarah Dorrington
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Medicine - Abstract
Objectives Sickness absence is strongly associated with poor mental health, and mental disorders often go untreated. In this population-based cohort study, we identified people receiving fit notes from their general practitioner (GP) and determined access to mental health treatment stratified by health complaint and demographic variables.Design Longitudinal study of health records.Setting Primary care and secondary mental health care in the borough of Lambeth, South London. Forty-five GP practices in Lambeth and the local secondary mental healthcare trust.Participants The analytical sample included 293 933 working age adults (16–60 years) registered at a Lambeth GP practice between 1 January 2014 and 30 April 2016.Primary and secondary outcome measures Three indicators of mental healthcare in the year after first fit note were antidepressant prescription, contact with Improving Access to Psychological Therapy (IAPT) services and contact with secondary mental health services.Results 75% of people with an identified mental health condition at first fit note had an indicator of mental healthcare in the following year. Black Caribbean and Black African groups presenting with mental disorders were less likely to have a mental healthcare indicator compared with White British groups.Conclusions The majority of those with an identified mental health need receive some treatment in the year following a fit note; however, our results suggest Black African and Black Caribbean groups with an identified mental healthcare need have less complete access compared to the White British group. more...
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- 2021
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14. Continuity of care and mortality in people with schizophrenia
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Alastair Macdonald, Dimitrios Adamis, Matthew Broadbent, Tom Craig, Rob Stewart, and Robin M. Murray
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Mortality ,schizophrenia ,deliberate self-harm ,outcome studies ,suicide ,Psychiatry ,RC435-571 - Abstract
Background People with schizophrenia have shortened lives. This excess mortality seems to be related to physical health conditions that may be amenable to better primary and secondary prevention. Better continuity of care may enhance such interventions as well as help prevent death by self-injury. Aims We set out to examine the relationship between the continuity of care of patients with schizophrenia, their mortality and cause of death. Method Pseudoanonymised community data from 5551 people with schizophrenia presenting over 11 years were examined for changes in continuity of care using the numbers of community teams caring for them and the Modified Modified Continuity Index. These and demographic variables were related to death certifications of physical illness from the Office of National Statistics and mortal self-injury from clinical data. Data were analysed using generalised estimating equations. Results We found no independent relationship between levels of continuity of care and overall mortality. However, lower levels of relationship continuity were significantly and independently related to death by self-injury. Conclusions We found no evidence that continuity of care is important in the prevention of physical causes of death in schizophrenia. However, there is evidence that declining relationship continuity of care has an independent effect on deaths as a result of self-injury. We suggest that there should be more attention focused on the improvement of continuity of care for these patients. more...
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- 2021
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15. Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 ‘lockdown’ policy in 10 UK sites: a regression discontinuity in time design
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David Baldwin, Andrea Cipriani, Robert Stewart, Ann John, Neil Nixon, Matthew Broadbent, Shanaya Rathod, David Osborn, Rob Waller, Sabine Landau, Peter Phiri, Ioannis Bakolis, Shanquan Chen, Rachel Sokal, Andrew McIntosh, Dan W Joyce, Jonathan Lewis, Caroline A Jackson, Jane Beenstock, Paul Bibby, Rudolf Cardinal, Karthik Chinnasamy, Simon Douglas, Philip Horner, Sze Chim Lee, and Tanya Smith more...
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Medicine - Abstract
Objectives To investigate changes in daily mental health (MH) service use and mortality in response to the introduction and the lifting of the COVID-19 ‘lockdown’ policy in Spring 2020.Design A regression discontinuity in time (RDiT) analysis of daily service-level activity.Setting and participants Mental healthcare data were extracted from 10 UK providers.Outcome measures Daily (weekly for one site) deaths from all causes, referrals and discharges, inpatient care (admissions, discharges, caseloads) and community services (face-to-face (f2f)/non-f2f contacts, caseloads): Adult, older adult and child/adolescent mental health; early intervention in psychosis; home treatment teams and liaison/Accident and Emergency (A&E). Data were extracted from 1 Jan 2019 to 31 May 2020 for all sites, supplemented to 31 July 2020 for four sites. Changes around the commencement and lifting of COVID-19 ‘lockdown’ policy (23 March and 10 May, respectively) were estimated using a RDiT design with a difference-in-difference approach generating incidence rate ratios (IRRs), meta-analysed across sites.Results Pooled estimates for the lockdown transition showed increased daily deaths (IRR 2.31, 95% CI 1.86 to 2.87), reduced referrals (IRR 0.62, 95% CI 0.55 to 0.70) and reduced inpatient admissions (IRR 0.75, 95% CI 0.67 to 0.83) and caseloads (IRR 0.85, 95% CI 0.79 to 0.91) compared with the pre lockdown period. All community services saw shifts from f2f to non-f2f contacts, but varied in caseload changes. Lift of lockdown was associated with reduced deaths (IRR 0.42, 95% CI 0.27 to 0.66), increased referrals (IRR 1.36, 95% CI 1.15 to 1.60) and increased inpatient admissions (IRR 1.21, 95% CI 1.04 to 1.42) and caseloads (IRR 1.06, 95% CI 1.00 to 1.12) compared with the lockdown period. Site-wide activity, inpatient care and community services did not return to pre lockdown levels after lift of lockdown, while number of deaths did. Between-site heterogeneity most often indicated variation in size rather than direction of effect.Conclusions MH service delivery underwent sizeable changes during the first national lockdown, with as-yet unknown and unevaluated consequences. more...
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- 2021
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16. Health condition at first fit note and number of fit notes: a longitudinal study of primary care records in south London
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Emmert Roberts, Matthew Broadbent, Matthew Hotopf, Sharon Stevelink, Stephani Hatch, Mark Ashworth, Ira Madan, Ewan Carr, C Polling, and Sarah Dorrington
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Medicine - Abstract
Objectives The fit note replaced the sick note in the UK in 2010, with the aim of improving support for patients requiring sickness absence, yet there has been very little research into fit note use. This study aims to describe number of fit notes by condition, to improve our understanding of patterns of fit note use in primary care. Previous fit note research has relied on extracting diagnoses directly from fit notes, rather than extracting information from clinical records. In this paper, we extract information from clinical records to explore demographic factors and conditions associated with number of fit notes issued.Design This is a longitudinal study of clinical data. We analysed individual-level anonymised data from general practitioner consultations, including demographic information and condition recorded at first fit note. The latter encompassed diagnoses, individual symptoms and psychosocial issues.Setting A database called Lambeth DataNet, containing electronic clinical records on 326 415 adults (ages 16–60) from all 45 general practices within the London Borough of Lambeth from 1 January 2014 to 30 April 2017.Participants Our analytical sample contained 40 698 people with a condition recorded at first fit note.Primary outcome measure Predicted number of fit notes in the period January 2014–April 2017Results Of all studied diagnostic groups, mental illness had the highest predicted number of fit notes (n=3.3; 95% CI: 3.1 to 3.4) after controlling for demographic factors and long-term conditions. The highest predicted number of fit notes for any condition subgroup was among patients presenting for drug and/or alcohol misuse (n=4.5; 95% CI: 4.1 to 4.8).Conclusions For the first time, we show drug and/or alcohol misuse at first fit note are associated with the highest number of fit notes. Research is needed to understand the trajectories of individuals at highest risk of long-term sickness absence, in particular, people presenting with drug and/or alcohol misuse. more...
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- 2021
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17. Impact of the COVID-19 pandemic on remote mental healthcare and prescribing in psychiatry: an electronic health record study
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Johnny Downs, Robert Stewart, Hitesh Shetty, Matthew Broadbent, Rashmi Patel, Megan Pritchard, Philip McGuire, Aimee Brinn, Jessica Irving, and Robert Harland
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Medicine - Abstract
Objectives The recent COVID-19 pandemic has disrupted mental healthcare delivery, with many services shifting from in-person to remote patient contact. We investigated the impact of the pandemic on the use of remote consultation and on the prescribing of psychiatric medications.Design and setting The Clinical Record Interactive Search tool was used to examine deidentified electronic health records of people receiving mental healthcare from the South London and Maudsley (SLaM) NHS Foundation Trust. Data from the period before and after the onset of the pandemic were analysed using linear regression, and visualised using locally estimated scatterplot smoothing.Participants All patients receiving care from SLaM between 7 January 2019 and 20 September 2020 (around 37 500 patients per week).Outcome measures (i) The number of clinical contacts (in-person, remote or non-attended) with mental healthcare professionals per week.(ii) Prescribing of antipsychotic and mood stabiliser medications per week.Results Following the onset of the pandemic, the frequency of in-person contacts was significantly reduced compared with that in the previous year (β coefficient: −5829.6 contacts, 95% CI −6919.5 to −4739.6, p more...
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- 2021
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18. Cohort profile: the eLIXIR Partnership—a maternity–child data linkage for life course research in South London, UK
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Robert Stewart, Amelia Jewell, Matthew Broadbent, Lucilla Poston, Lauren E Carson, Borscha Azmi, Clare L Taylor, Angela Flynn, Carolyn Gill, and Louise Howard
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Medicine - Abstract
Purpose Linked maternity, neonatal and maternal mental health records were created to support research into the early life origins of physical and mental health, in mothers and children. The Early Life Cross Linkage in Research (eLIXIR) Partnership was developed in 2018, generating a repository of real-time, pseudonymised, structured data derived from the electronic health record systems of two acute and one Mental Health Care National Health Service (NHS) Provider in South London. We present early descriptive data for the linkage database and the robust data security and governance structures, and describe the intended expansion of the database from its original development. Additionally, we report details of the accompanying eLIXIR Research Tissue Bank of maternal and neonatal blood samples.Participants Descriptive data were generated from the eLIXIR database from 1 October 2018 to 30 June 2019. Over 17 000 electronic patient records were included.Findings to date 10 207 women accessed antenatal care from the 2 NHS maternity services, with 8405 deliveries (8772 infants). This diverse, inner-city maternity service population was born in over 170 countries with an ethnic profile of 46.1% white, 19.1% black, 7.0% Asian, 4.1% mixed and 4.1% other. Of the 10 207 women, 11.6% had a clinical record in mental health services with 3.0% being treated during their pregnancy. This first data extract included 947 infants treated in the neonatal intensive care unit, of whom 19.1% were postnatal transfers from external healthcare providers.Future plans Electronic health records provide potentially transformative information for life course research, integrating physical and mental health disorders and outcomes in routine clinical care. The eLIXIR database will grow by ~14 000 new maternity cases annually, in addition to providing child follow-up data. Additional datasets will supplement the current linkage from other local and national resources, including primary care and hospital inpatient data for mothers and their children. more...
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- 2020
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19. Impact of matching error on linked mortality outcome in a data linkage of secondary mental health data with Hospital Episode Statistics (HES) and mortality records in South East London: a cross-sectional study
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Ruth Gilbert, Johnny Downs, Robert Stewart, Amelia Jewell, Matthew Broadbent, and Richard D Hayes
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Medicine - Abstract
Objectives Linkage of electronic health records (EHRs) to Hospital Episode Statistics (HES)-Office for National Statistics (ONS) mortality data has provided compelling evidence for lower life expectancy in people with severe mental illness. However, linkage error may underestimate these estimates. Using a clinical sample (n=265 300) of individuals accessing mental health services, we examined potential biases introduced through missed matching and examined the impact on the association between clinical disorders and mortality.Setting The South London and Maudsley NHS Foundation Trust (SLaM) is a secondary mental healthcare provider in London. A deidentified version of SLaM’s EHR was available via the Clinical Record Interactive Search system linked to HES-ONS mortality records.Participants Records from SLaM for patients active between January 2006 and December 2016.Outcome measures Two sources of death data were available for SLaM participants: accurate and contemporaneous date of death via local batch tracing (gold standard) and date of death via linked HES-ONS mortality data. The effect of linkage error on mortality estimates was evaluated by comparing sociodemographic and clinical risk factor analyses using gold standard death data against HES-ONS mortality records.Results Of the total sample, 93.74% were successfully matched to HES-ONS records. We found a number of statistically significant administrative, sociodemographic and clinical differences between matched and unmatched records. Of note, schizophrenia diagnosis showed a significant association with higher mortality using gold standard data (OR 1.08; 95% CI 1.01 to 1.15; p=0.02) but not in HES-ONS data (OR 1.05; 95% CI 0.98 to 1.13; p=0.16). Otherwise, little change was found in the strength of associated risk factors and mortality after accounting for missed matching bias.Conclusions Despite significant clinical and sociodemographic differences between matched and unmatched records, changes in mortality estimates were minimal. However, researchers and policy analysts using HES-ONS linked resources should be aware that administrative linkage processes can introduce error. more...
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- 2020
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20. The side effect profile of Clozapine in real world data of three large mental health hospitals.
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Ehtesham Iqbal, Risha Govind, Alvin Romero, Olubanke Dzahini, Matthew Broadbent, Robert Stewart, Tanya Smith, Chi-Hun Kim, Nomi Werbeloff, James H MacCabe, Richard J B Dobson, and Zina M Ibrahim
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Medicine ,Science - Abstract
ObjectiveMining the data contained within Electronic Health Records (EHRs) can potentially generate a greater understanding of medication effects in the real world, complementing what we know from Randomised control trials (RCTs). We Propose a text mining approach to detect adverse events and medication episodes from the clinical text to enhance our understanding of adverse effects related to Clozapine, the most effective antipsychotic drug for the management of treatment-resistant schizophrenia, but underutilised due to concerns over its side effects.Material and methodsWe used data from de-identified EHRs of three mental health trusts in the UK (>50 million documents, over 500,000 patients, 2835 of which were prescribed Clozapine). We explored the prevalence of 33 adverse effects by age, gender, ethnicity, smoking status and admission type three months before and after the patients started Clozapine treatment. Where possible, we compared the prevalence of adverse effects with those reported in the Side Effects Resource (SIDER).ResultsSedation, fatigue, agitation, dizziness, hypersalivation, weight gain, tachycardia, headache, constipation and confusion were amongst the highest recorded Clozapine adverse effect in the three months following the start of treatment. Higher percentages of all adverse effects were found in the first month of Clozapine therapy. Using a significance level of (p< 0.05) our chi-square tests show a significant association between most of the ADRs and smoking status and hospital admission, and some in gender, ethnicity and age groups in all trusts hospitals. Later we combined the data from the three trusts hospitals to estimate the average effect of ADRs in each monthly interval. In gender and ethnicity, the results show significant association in 7 out of 33 ADRs, smoking status shows significant association in 21 out of 33 ADRs and hospital admission shows the significant association in 30 out of 33 ADRs.ConclusionA better understanding of how drugs work in the real world can complement clinical trials. more...
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- 2020
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21. Predicting high-cost care in a mental health setting
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Craig Colling, Mizanur Khondoker, Rashmi Patel, Marcella Fok, Robert Harland, Matthew Broadbent, Paul McCrone, and Robert Stewart
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Digital health records ,mental health service ,prediction ,natural language processing ,Psychiatry ,RC435-571 - Abstract
BackgroundThe density of information in digital health records offers new potential opportunities for automated prediction of cost-relevant outcomes.AimsWe investigated the extent to which routinely recorded data held in the electronic health record (EHR) predict priority service outcomes and whether natural language processing tools enhance the predictions. We evaluated three high priority outcomes: in-patient duration, readmission following in-patient care and high service cost after first presentation.MethodWe used data obtained from a clinical database derived from the EHR of a large mental healthcare provider within the UK. We combined structured data with text-derived data relating to diagnosis statements, medication and psychiatric symptomatology. Predictors of the three different clinical outcomes were modelled using logistic regression with performance evaluated against a validation set to derive areas under receiver operating characteristic curves.ResultsIn validation samples, the full models (using all available data) achieved areas under receiver operating characteristic curves between 0.59 and 0.85 (in-patient duration 0.63, readmission 0.59, high service use 0.85). Adding natural language processing-derived data to the models increased the variance explained across all clinical scenarios (observed increase in r2 = 12–46%).ConclusionsEHR data offer the potential to improve routine clinical predictions by utilising previously inaccessible data. Of our scenarios, prediction of high service use after initial presentation achieved the highest performance. more...
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- 2020
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22. Prevalence and incidence of clinical outcomes in patients presenting to secondary mental health care with mood instability and sleep disturbance
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Keltie McDonald, Tanya Smith, Matthew Broadbent, Rashmi Patel, John R. Geddes, and Kate E. A. Saunders
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Electronic health records ,epidemiology ,mood ,psychiatry ,sleep ,Psychiatry ,RC435-571 - Abstract
AbstractBackground.Mood instability and sleep disturbance are common symptoms in people with mental illness. Both features are clinically important and associated with poorer illness trajectories. We compared clinical outcomes in people presenting to secondary mental health care with mood instability and/or sleep disturbance with outcomes in people without either mood instability or sleep disturbance.Methods.Data were from electronic health records of 31,391 patients ages 16–65 years presenting to secondary mental health services between 2008 and 2016. Mood instability and sleep disturbance were identified using natural language processing. Prevalence of mood instability and sleep disturbance were estimated at baseline. Incidence rate ratios were estimates for clinical outcomes including psychiatric diagnoses, prescribed medication, and hospitalization within 2-years of presentation in persons with mood instability and/or sleep disturbance compared to individuals without either symptom.Results.Mood instability was present in 9.58%, and sleep disturbance in 26.26% of patients within 1-month of presenting to secondary mental health services. Compared with individuals without either symptom, those with mood instability and sleep disturbance showed significantly increased incidence of prescription of any psychotropic medication (incidence rate ratios [IRR] = 7.04, 95% confidence intervals [CI] 6.53–7.59), and hospitalization (IRR = 5.32, 95% CI 5.32, 4.67–6.07) within 2-years of presentation. Incidence rates of most clinical outcomes were considerably increased among persons with both mood instability and sleep disturbance, relative to persons with only one symptom.Conclusions.Mood instability and sleep disturbance are present in a wide range of mental disorders, beyond those in which they are conventionally considered to be symptoms. They are associated with poor outcomes, particularly when they occur together. The poor prognosis associated with mood instability and sleep disorder may be, in part, because they are often treated as secondary symptoms. Mood instability and sleep disturbance need better recognition as clinical targets for treatment in their own right. more...
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- 2020
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23. ‘He left me a message on Facebook’: comparing the risk profiles of self-harming patients who leave paper suicide notes with those who leave messages on new media
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Jessica R. Barrett, William Lee, Hitesh Shetty, Matthew Broadbent, Sean Cross, Matthew Hotopf, and Robert Stewart
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Psychiatry ,RC435-571 - Abstract
Background In cases of non-fatal self-harm, suicide notes are a major risk factor for repeated self-harm and suicide. Suicide notes can now be left on new media services, emails or text messages, as well as on paper. Aims In a group of people who had harmed themselves, we aimed to compare new media note-leavers with paper note-leavers and characterise these groups demographically and by risk factors. Method Clinical notes of patients who presented with non-fatal self-harm to two London emergency departments were anonymously searched for mentions of new media use. These were categorised and risk factors were compared for those who had left a new media note, a paper note, or no note to establish differences in risk of note-leaving. Results New media note-leaving was associated with younger age and substance use; both risk factors for repeated self-harm. However, suicidal intent remained highest in paper note-leavers. Conclusions Paper note-leavers remain at greatest risk, however new media note leaving is still correlated with risk factors related to repeated self-harm and suicide. Clinicians should enquire about new media use during emergency department assessments of self-harm. more...
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- 2016
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24. The Camden & Islington Research Database: Using electronic mental health records for research.
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Nomi Werbeloff, David P J Osborn, Rashmi Patel, Matthew Taylor, Robert Stewart, Matthew Broadbent, and Joseph F Hayes
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Medicine ,Science - Abstract
BackgroundElectronic health records (EHRs) are widely used in mental health services. Case registers using EHRs from secondary mental healthcare have the potential to deliver large-scale projects evaluating mental health outcomes in real-world clinical populations.MethodsWe describe the Camden and Islington NHS Foundation Trust (C&I) Research Database which uses the Clinical Record Interactive Search (CRIS) tool to extract and de-identify routinely collected clinical information from a large UK provider of secondary mental healthcare, and demonstrate its capabilities to answer a clinical research question regarding time to diagnosis and treatment of bipolar disorder.ResultsThe C&I Research Database contains records from 108,168 mental health patients, of which 23,538 were receiving active care. The characteristics of the patient population are compared to those of the catchment area, of London, and of England as a whole. The median time to diagnosis of bipolar disorder was 76 days (interquartile range: 17-391) and median time to treatment was 37 days (interquartile range: 5-194). Compulsory admission under the UK Mental Health Act was associated with shorter intervals to diagnosis and treatment. Prior diagnoses of other psychiatric disorders were associated with longer intervals to diagnosis, though prior diagnoses of schizophrenia and related disorders were associated with decreased time to treatment.ConclusionsThe CRIS tool, developed by the South London and Maudsley NHS Foundation Trust (SLaM) Biomedical Research Centre (BRC), functioned very well at C&I. It is reassuring that data from different organizations deliver similar results, and that applications developed in one Trust can then be successfully deployed in another. The information can be retrieved in a quicker and more efficient fashion than more traditional methods of health research. The findings support the secondary use of EHRs for large-scale mental health research in naturalistic samples and settings investigated across large, diverse geographical areas. more...
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- 2018
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25. Analysis of diagnoses extracted from electronic health records in a large mental health case register.
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Yevgeniya Kovalchuk, Robert Stewart, Matthew Broadbent, Tim J P Hubbard, and Richard J B Dobson
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Medicine ,Science - Abstract
The UK government has recently recognised the need to improve mental health services in the country. Electronic health records provide a rich source of patient data which could help policymakers to better understand needs of the service users. The main objective of this study is to unveil statistics of diagnoses recorded in the Case Register of the South London and Maudsley NHS Foundation Trust, one of the largest mental health providers in the UK and Europe serving a source population of over 1.2 million people residing in south London. Based on over 500,000 diagnoses recorded in ICD10 codes for a cohort of approximately 200,000 mental health patients, we established frequency rate of each diagnosis (the ratio of the number of patients for whom a diagnosis has ever been recorded to the number of patients in the entire population who have made contact with mental disorders). We also investigated differences in diagnoses prevalence between subgroups of patients stratified by gender and ethnicity. The most common diagnoses in the considered population were (recurrent) depression (ICD10 codes F32-33; 16.4% of patients), reaction to severe stress and adjustment disorders (F43; 7.1%), mental/behavioural disorders due to use of alcohol (F10; 6.9%), and schizophrenia (F20; 5.6%). We also found many diagnoses which were more likely to be recorded in patients of a certain gender or ethnicity. For example, mood (affective) disorders (F31-F39); neurotic, stress-related and somatoform disorders (F40-F48, except F42); and eating disorders (F50) were more likely to be found in records of female patients, while males were more likely to be diagnosed with mental/behavioural disorders due to psychoactive substance use (F10-F19). Furthermore, mental/behavioural disorders due to use of alcohol and opioids were more likely to be recorded in patients of white ethnicity, and disorders due to use of cannabinoids in those of black ethnicity. more...
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- 2017
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26. Trajectories of dementia-related cognitive decline in a large mental health records derived patient cohort.
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Elizabeth Baker, Ehtesham Iqbal, Caroline Johnston, Matthew Broadbent, Hitesh Shetty, Robert Stewart, Robert Howard, Stephen Newhouse, Mizanur Khondoker, and Richard J B Dobson
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Medicine ,Science - Abstract
BACKGROUND:Modeling trajectories of decline can help describe the variability in progression of cognitive impairment in dementia. Better characterisation of these trajectories has significant implications for understanding disease progression, trial design and care planning. METHODS:Patients with at least three Mini-mental State Examination (MMSE) scores recorded in the South London and Maudsley NHS Foundation Trust Electronic Health Records, UK were selected (N = 3441) to form a retrospective cohort. Trajectories of cognitive decline were identified through latent class growth analysis of longitudinal MMSE scores. Demographics, Health of Nation Outcome Scales and medications were compared across trajectories identified. RESULTS:Four of the six trajectories showed increased rate of decline with lower baseline MMSE. Two trajectories had similar initial MMSE scores but different rates of decline. In the faster declining trajectory of the two, a higher incidence of both behavioral problems and sertraline prescription were present. CONCLUSIONS:We find suggestive evidence for association of behavioral problems and sertraline prescription with rate of decline. Further work is needed to determine whether trajectories replicate in other datasets. more...
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- 2017
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27. ADEPt, a semantically-enriched pipeline for extracting adverse drug events from free-text electronic health records.
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Ehtesham Iqbal, Robbie Mallah, Daniel Rhodes, Honghan Wu, Alvin Romero, Nynn Chang, Olubanke Dzahini, Chandra Pandey, Matthew Broadbent, Robert Stewart, Richard J B Dobson, and Zina M Ibrahim
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Medicine ,Science - Abstract
Adverse drug events (ADEs) are unintended responses to medical treatment. They can greatly affect a patient's quality of life and present a substantial burden on healthcare. Although Electronic health records (EHRs) document a wealth of information relating to ADEs, they are frequently stored in the unstructured or semi-structured free-text narrative requiring Natural Language Processing (NLP) techniques to mine the relevant information. Here we present a rule-based ADE detection and classification pipeline built and tested on a large Psychiatric corpus comprising 264k patients using the de-identified EHRs of four UK-based psychiatric hospitals. The pipeline uses characteristics specific to Psychiatric EHRs to guide the annotation process, and distinguishes: a) the temporal value associated with the ADE mention (whether it is historical or present), b) the categorical value of the ADE (whether it is assertive, hypothetical, retrospective or a general discussion) and c) the implicit contextual value where the status of the ADE is deduced from surrounding indicators, rather than explicitly stated. We manually created the rulebase in collaboration with clinicians and pharmacists by studying ADE mentions in various types of clinical notes. We evaluated the open-source Adverse Drug Event annotation Pipeline (ADEPt) using 19 ADEs specific to antipsychotics and antidepressants medication. The ADEs chosen vary in severity, regularity and persistence. The average F-measure and accuracy achieved by our tool across all tested ADEs were 0.83 and 0.83 respectively. In addition to annotation power, the ADEPT pipeline presents an improvement to the state of the art context-discerning algorithm, ConText. more...
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- 2017
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28. Identification of Adverse Drug Events from Free Text Electronic Patient Records and Information in a Large Mental Health Case Register.
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Ehtesham Iqbal, Robbie Mallah, Richard George Jackson, Michael Ball, Zina M Ibrahim, Matthew Broadbent, Olubanke Dzahini, Robert Stewart, Caroline Johnston, and Richard J B Dobson
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Medicine ,Science - Abstract
Electronic healthcare records (EHRs) are a rich source of information, with huge potential for secondary research use. The aim of this study was to develop an application to identify instances of Adverse Drug Events (ADEs) from free text psychiatric EHRs.We used the GATE Natural Language Processing (NLP) software to mine instances of ADEs from free text content within the Clinical Record Interactive Search (CRIS) system, a de-identified psychiatric case register developed at the South London and Maudsley NHS Foundation Trust, UK. The tool was built around a set of four movement disorders (extrapyramidal side effects [EPSEs]) related to antipsychotic therapy and rules were then generalised such that the tool could be applied to additional ADEs. We report the frequencies of recorded EPSEs in patients diagnosed with a Severe Mental Illness (SMI) and then report performance in identifying eight other unrelated ADEs.The tool identified EPSEs with >0.85 precision and >0.86 recall during testing. Akathisia was found to be the most prevalent EPSE overall and occurred in the Asian ethnic group with a frequency of 8.13%. The tool performed well when applied to most of the non-EPSEs but least well when applied to rare conditions such as myocarditis, a condition that appears frequently in the text as a side effect warning to patients.The developed tool allows us to accurately identify instances of a potential ADE from psychiatric EHRs. As such, we were able to study the prevalence of ADEs within subgroups of patients stratified by SMI diagnosis, gender, age and ethnicity. In addition we demonstrated the generalisability of the application to other ADE types by producing a high precision rate on a non-EPSE related set of ADE containing documents.The application can be found at http://git.brc.iop.kcl.ac.uk/rmallah/dystoniaml. more...
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- 2015
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29. Delays before Diagnosis and Initiation of Treatment in Patients Presenting to Mental Health Services with Bipolar Disorder.
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Rashmi Patel, Hitesh Shetty, Richard Jackson, Matthew Broadbent, Robert Stewart, Jane Boydell, Philip McGuire, and Matthew Taylor
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Medicine ,Science - Abstract
Bipolar disorder is a significant cause of morbidity and mortality. Although existing treatments are effective, there is often a substantial delay before diagnosis and treatment initiation. We sought to investigate factors associated with the delay before diagnosis of bipolar disorder and the onset of treatment in secondary mental healthcare.Retrospective cohort study using anonymised electronic mental health record data from the South London and Maudsley NHS Foundation Trust (SLaM) Biomedical Research Centre (BRC) Case Register on 1364 adults diagnosed with bipolar disorder between 2007 and 2012. The following predictor variables were analysed in a multivariable Cox regression analysis: age, gender, ethnicity, compulsory admission to hospital under the UK Mental Health Act, marital status and other diagnoses prior to bipolar disorder. The outcomes were time to recorded diagnosis from first presentation to specialist mental health services (the diagnostic delay), and time to the start of appropriate therapy (treatment delay).The median diagnostic delay was 62 days (interquartile range: 17-243) and median treatment delay was 31 days (4-122). Compulsory hospital admission was associated with a significant reduction in both diagnostic delay (hazard ratio 2.58, 95% CI 2.18-3.06) and treatment delay (4.40, 3.63-5.62). Prior diagnoses of other psychiatric disorders were associated with increased diagnostic delay, particularly alcohol (0.48, 0.33-0.41) and substance misuse disorders (0.44, 0.31-0.61). Prior diagnosis of schizophrenia and psychotic depression were associated with reduced treatment delay.Some individuals experience a significant delay in diagnosis and treatment of bipolar disorder after initiation of specialist mental healthcare, particularly those who have prior diagnoses of alcohol and substance misuse disorders. These findings highlight a need for further study on strategies to better identify underlying symptoms and offer appropriate treatment sooner in order to facilitate improved clinical outcomes, such as developing specialist early intervention services to identify and treat people with bipolar disorder. more...
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- 2015
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30. Examining the Strength of Three Word Passwords.
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William Fraser, Matthew Broadbent, Nikolaos Pitropakis, and Christos Chrysoulas
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- 2024
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31. AI in Energy Digital Twining: A Reinforcement Learning-Based Adaptive Digital Twin Model for Green Cities.
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Lal Verda çakir, Kübra Duran, Craig Thomson, Matthew Broadbent, and Berk Canberk
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- 2024
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32. Playing Catch-Up: Evaluating Playback Speed Control in Low-Latency Live Streaming.
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Yu Liang, Tomasz Lyko, Mike Nilsson, Paul Farrow, Steve Appleby, Matthew Broadbent, and Nicholas J. P. Race
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- 2024
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33. Factors associated with response to acetylcholinesterase inhibition in dementia: a cohort study from a secondary mental health care case register in london.
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Gayan Perera, Mizanur Khondoker, Matthew Broadbent, Gerome Breen, and Robert Stewart
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Medicine ,Science - Abstract
BackgroundAcetylcholinesterase inhibitors (AChEIs) are widely used to delay cognitive decline in Alzheimer's disease. Observational studies in routine clinical practice have shown cognitive improvement in some groups of patients receiving these agents but longitudinal trajectories before and after AChEI initiation have not previously been considered.ObjectivesTo compare trajectories of cognitive function before and after AChEI initiation and investigate predictors of these differences.MethodA retrospective longitudinal study was constructed using data from 2460 patients who received AChEIs and who had routine data on cognitive function (Mini-Mental State Examination; MMSE) before and after AChEI initiation. Longitudinal MMSE change was modelled using three-piece linear mixed models with the following segments: 0-12 months prior to AChEI initiation, 0-6 months and 6-36 months after initiation.ResultsMMSE decline was reversed (in that the slope was improved by an average 4.2 units per year, 95% CI 3.5-4.8) during the 6-month period following AChEI initiation compared with the slope in the one year period before AChEI initiation. The slope in the period from 6-36 months following AChEI initiation returned to the pre-initiation downward trajectory. The differences in slopes in the 1 year period prior to AChEI initiation and in the 6 months after initiation were smaller among those with higher MMSE scores at the time of AChEI initiation, among those who received a vascular dementia diagnosis at any point, and among those receiving antipsychotic agents.ConclusionIn this naturalistic observational study, changes in cognitive trajectories around AChEI initiation were similar to those reported in randomised controlled trials. The magnitude of the difference in slopes between the 1 year period prior to AChEI initiation and the 6 month period after AChEI initiation was related to level of cognitive function at treatment initiation, vascular comorbidity and antipsychotic use. more...
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- 2014
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34. Mini-mental state examination as a predictor of mortality among older people referred to secondary mental healthcare.
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Yu-Ping Su, Chin-Kuo Chang, Richard D Hayes, Gayan Perera, Matthew Broadbent, David To, Matthew Hotopf, and Robert Stewart
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Medicine ,Science - Abstract
Lower levels of cognitive function have been found to be associated with higher mortality in older people, particularly in dementia, but the association in people with other mental disorders is still inconclusive.Data were analysed from a large mental health case register serving a geographic catchment of 1.23 million residents, and associations were investigated between cognitive function measured by the Mini-Mental State Examination (MMSE) and survival in patients aged 65 years old and over. Cox regressions were carried out, adjusting for age, gender, psychiatric diagnosis, ethnicity, marital status, and area-level socioeconomic index. A total of 6,704 subjects were involved, including 3,368 of them having a dementia diagnosis and 3,336 of them with depression or other diagnoses. Descriptive outcomes by Kaplan-Meier curves showed significant differences between those with normal and impaired cognitive function (MMSE score more...
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- 2014
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35. Harnessing clinical psychiatric data with an electronic assessment tool (OPCRIT+): the utility of symptom dimensions.
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Philip James Brittain, Sarah Elizabeth Margaret Lobo, James Rucker, Myanthi Amarasinghe, Anantha Padmanabha Pillai Anilkumar, Martin Baggaley, Pallavi Banerjee, Jenny Bearn, Matthew Broadbent, Matthew Butler, Colin Donald Campbell, Anthony James Cleare, Luiz Dratcu, Sophia Frangou, Fiona Gaughran, Matthew Goldin, Annika Henke, Nikola Kern, Abdallah Krayem, Faiza Mufti, Ronan McIvor, Humphrey Needham-Bennett, Stuart Newman, Dele Olajide, David O'Flynn, Ranga Rao, Ijaz Ur Rehman, Gertrude Seneviratne, Daniel Stahl, Sajid Suleman, Janet Treasure, John Tully, David Veale, Robert Stewart, Peter McGuffin, Simon Lovestone, Matthew Hotopf, and Gunter Schumann more...
- Subjects
Medicine ,Science - Abstract
Progress in personalised psychiatry is dependent on researchers having access to systematic and accurately acquired symptom data across clinical diagnoses. We have developed a structured psychiatric assessment tool, OPCRIT+, that is being introduced into the electronic medical records system of the South London and Maudsley NHS Foundation Trust which can help to achieve this. In this report we examine the utility of the symptom data being collected with the tool. Cross-sectional mental state data from a mixed-diagnostic cohort of 876 inpatients was subjected to a principal components analysis (PCA). Six components, explaining 46% of the variance in recorded symptoms, were extracted. The components represented dimensions of mania, depression, positive symptoms, anxiety, negative symptoms and disorganization. As indicated by component scores, different clinical diagnoses demonstrated distinct symptom profiles characterized by wide-ranging levels of severity. When comparing the predictive value of symptoms against diagnosis for a variety of clinical outcome measures (e.g. 'Overactive, aggressive behaviour'), symptoms proved superior in five instances (R(2) range: 0.06-0.28) whereas diagnosis was best just once (R(2):0.25). This report demonstrates that symptom data being routinely gathered in an NHS trust, when documented on the appropriate tool, have considerable potential for onward use in a variety of clinical and research applications via representation as dimensions of psychopathology. more...
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- 2013
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36. Correction: Harnessing Clinical Psychiatric Data with an Electronic Assessment Tool (OPCRIT+): The Utility of Symptom Dimensions.
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Philip James Brittain, Sarah Elizabeth Margaret Lobo, James Rucker, Myanthi Amarasinghe, Anantha Padmanabha Pillai Anilkumar, Martin Baggaley, Pallavi Banerjee, Jenny Bearn, Matthew Broadbent, Matthew Butler, Colin Donald Campbell, Anthony James Cleare, Luiz Dratcu, Sophia Frangou, Fiona Gaughran, Matthew Goldin, Annika Henke, Nikola Kern, Abdallah Krayem, Faiza Mufti, Ronan McIvor, Humphrey Needham-Bennett, Stuart Newman, Dele Olajide, David O’Flynn, Ranga Rao, Ijaz Ur Rehman, Gertrude Seneviratne, Daniel Stahl, Sajid Suleman, Janet Treasure, John Tully, David Veale, Robert Stewart, Peter McGuffin, Simon Lovestone, Matthew Hotopf, and Gunter Schumann more...
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Medicine ,Science - Published
- 2013
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37. Functional status and all-cause mortality in serious mental illness.
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Richard D Hayes, Chin-Kuo Chang, Andrea C Fernandes, Aysha Begum, David To, Matthew Broadbent, Matthew Hotopf, and Robert Stewart
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Medicine ,Science - Abstract
Serious mental illness can affect many aspects of an individual's ability to function in daily life. The aim of this investigation was to determine if the environmental and functional status of people with serious mental illness contribute to the high mortality risk observed in this patient group.We identified cases of schizophrenia, schizoaffective and bipolar disorder aged ≥ 15 years in a large secondary mental healthcare case register linked to national mortality tracing. We modelled the effect of activities of daily living (ADLs), living conditions, occupational and recreational activities and relationship factors (Health of the Nation Outcome Scale [HoNOS] subscales) on all-cause mortality over a 4-year observation period (2007-10) using Cox regression.We identified 6,880 SMI cases (242 deaths) in the observation period. ADL impairment was associated with an increased risk of all-cause mortality (adjusted HR 1.9; 95% CI 1.3-2.8; p = 0.001, p for trend across ADL categories = 0.001) after controlling for a broad range of covariates (including demographic factors, physical health, mental health symptoms and behaviours, socio-economic status and mental health service contact). No associations were found for the other three exposures. Stratification by age indicated that ADLs were most strongly associated with mortality in the youngest (15 to more...
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- 2012
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38. Improving quality of experience in adaptive low latency live streaming.
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Tomasz Lyko, Matthew Broadbent, Nicholas J. P. Race, Mike Nilsson, Paul Farrow, and Steve Appleby
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- 2024
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39. How to synchronize Digital Twins? A Communication Performance Analysis.
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Lal Verda çakir, Sarah Al-Shareeda, Sema F. Oktug, Mehmet özdem, Matthew Broadbent, and Berk Canberk
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- 2023
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40. Contactless Human Activity Recognition using Deep Learning with Flexible and Scalable Software Define Radio.
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Muhammad Zakir Khan, Jawad Ahmad 0001, Wadii Boulila, Matthew Broadbent, Syed Aziz Shah, Anis Koubaa, and Qammer H. Abbasi
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- 2023
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41. A Security Evaluation Framework for Software-Defined Network Architectures in Data Center Environments.
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Igor Ivkic, Dominik Thiede, Nicholas J. P. Race, Matthew Broadbent, and Antonios Gouglidis
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- 2023
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42. Digital Twin-Native AI-Driven Service Architecture for Industrial Networks.
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Kübra Duran, Matthew Broadbent, Gökhan Yurdakul, and Berk Canberk
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- 2023
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43. Security Evaluation in Software-Defined Networks.
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Igor Ivkic, Dominik Thiede, Nicholas J. P. Race, Matthew Broadbent, and Antonios Gouglidis
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- 2024
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44. How to synchronize Digital Twins? A Communication Performance Analysis.
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Lal Verda çakir, Sarah Al-Shareeda, Sema F. Oktug, Mehmet özdem, Matthew Broadbent, and Berk Canberk
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- 2024
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45. 5G in the Wild: Performance of C-Band 5G-NR in Rural Low-Power Fixed Wireless Access.
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Eleanor Davies, Antony Chung, Matthew Broadbent, Alasdair Macleod, and Nicholas J. P. Race
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- 2022
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46. Practical Intrusion Detection of Emerging Threats.
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Ryan Mills, Angelos K. Marnerides, Matthew Broadbent, and Nicholas J. P. Race
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- 2022
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47. Effectiveness of Vicinity-based Content Finding in Mobile NDN Environments.
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Atthapol Suwannasa, Matthew Broadbent, and Andreas Mauthe
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- 2021
- Full Text
- View/download PDF
48. From One Edge to the Other: Exploring Gaming's Rising Presence on the Network.
- Author
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Matthew Marsden, Mike Hazas, and Matthew Broadbent
- Published
- 2020
- Full Text
- View/download PDF
49. Safe and Secure Software-Defined Networks for Smart Electricity Substations.
- Author
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Filip Holík, Matthew Broadbent, Mislav Findrik, Paul Smith 0001, and Nicholas J. P. Race
- Published
- 2020
- Full Text
- View/download PDF
50. Citrus: Orchestrating Security Mechanisms via Adversarial Deception.
- Author
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Ryan Mills, Nicholas J. P. Race, and Matthew Broadbent
- Published
- 2020
- Full Text
- View/download PDF
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