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3. A multicentre observational study to investigate feasibility of a direct oral penicillin challenge in de-labelling ‘low risk’ patients with penicillin allergy by non-allergy healthcare professionals (SPACE study): Implications for healthcare systems

Author

Krishna, Mamidipudi Thirumala, Bhogal, Rashmeet, Ng, Bee Yean, Kildonaviciute, Kornelija, Jani, Yogini H., Williams, Iestyn, Sandoe, Jonathan A.T., Pollard, Rachel, Jones, Nicola, Dunsmure, Louise, Powell, Neil, Hullur, Chidanand, Balaji, Ariyur, Moriarty, Catherine, Jackson, Beverley, Warner, Amena, Daniels, Ron, West, Robert, Thomas, Caroline, Misbah, Siraj A., and Savic, Louise

Published
2024
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4. The innate ability of pet dogs to spontaneously anticipate epileptic seizures

Author

Powell, Neil, Ruffell, Alastair, and Arnott, Gareth

Subjects
636.7
Abstract

The main aim of this Study was to investigate anecdotal claims of spontaneous seizure alerting behaviour by pet dogs and then to attempt to elucidate the sensory mechanism they used for doing so. Little was known about this topic when I started my research in 2014, when, to the best of my knowledge, only four limited studies had been published. Chapter one defines epilepsy as a serious neurological condition which is often associated with injury and comorbidities like anxiety, depression, suicidal intention, limited employment prospects, social isolation and prejudice. In global terms, thirty per cent of people with epilepsy, (20 million), are unable to control their seizures by medication. For them, the only intervention available is targeted brain surgery to excise the seizure source, but waiting lists are long and the procedure expensive. Anecdotally, dogs appear to be capable of anticipating seizures although no empirical evidence has been offered to support this claim. Many accounts in the literature, attest to the role dogs have played in assisting humanity since they were first domesticated some 30,000 years ago. They have shown an astonishing ability to detect concealed contraband in support of law enforcement, or to find people trapped in hostile terrain or under collapsed buildings. Dogs have also begun to assist with medical diagnosis of life-threatening conditions like cancer and in the prediction of hypo and hyper glycaemic events albeit with questionable reliability. Chapter two recounts the outcome of an international survey of people with epilepsy, 70% of whom attested their pet dogs had demonstrated spontaneous seizure-alerting. It appears this is a widespread phenomenon, not restricted by nationality or social strata and with a commonality of behavioural responses resembling attention-seeking strategies. These seizure-related behavioural changes were found to be independent of breed, gender or length of ownership, but were predicted by the absence of children and by the relationship between owners and dogs. Furthermore, alerting responses appeared to be consistent and reliable for most or in some cases, all seizure events, with predictive times ranging from minutes to hours prior to an episode. Chapter three explored the viability and reliability of a bespoke piece of apparatus called a remote odour delivery mechanism, (RODM), for transferring odours from A to B. This was tested by delivering target odours to six specialist search dogs to compare their trained target-response behaviours with their reaction to the RODM delivered target odours. Chapter Four describes how the RODM facilitated the controlled observation of responses made by nineteen untrained dogs to seizure odours, delivered to the vicinity of their owners. The subsequent reactions of the dogs strongly reflected those reported as being of an attention-seeking nature, described for spontaneous seizure alerting in Chapter Two. These findings provided compelling evidence for the existence of a seizure-related olfactory bio-marker. To attempt to understand why 30% of the dogs sampled in Chapter Two did not respond to seizure onset, Chapter five explored whether this could be a factor of the dogs’ relationships with their owners. This relationship and some traits of the dogs, were assessed using two validated owner-dog assessment mechanisms, the findings of which indicated that three characteristics were key predictors for seizure alerting behaviour: (1) an enhanced relationship occasioned by an active owner-dog association, (2) low scores on separation anxiety and (3) low scores on trainability.

Published
2020

7. Antibiotic review kit for hospitals (ARK-Hospital): a stepped-wedge cluster-randomised controlled trial

Author

Llewelyn, Martin J, Budgell, Eric P, Laskawiec-Szkonter, Magda, Cross, Elizabeth L A, Alexander, Rebecca, Bond, Stuart, Coles, Phil, Conlon-Bingham, Geraldine, Dymond, Samantha, Evans, Morgan, Fok, Rosemary, Frost, Kevin J, Garcia-Arias, Veronica, Glass, Stephen, Gormley, Cairine, Gray, Katherine, Hamson, Clare, Harvey, David, Hills, Tim, Iyer, Shabnam, Johnson, Alison, Jones, Nicola, Kang, Parmjit, Kiapi, Gloria, Mack, Damien, Makanga, Charlotte, Mawer, Damian, McCullagh, Bernie, Mirfenderesky, Mariyam, McEwen, Ruth, Nag, Sath, Nagar, Aaron, Northfield, John, O'Driscoll, Jean, Pegden, Amanda, Porter, Robert, Powell, Neil, Price, David, Sheridan, Elizabeth, Slatter, Mandy, Stewart, Bruce, Watson, Cassandra, Weichert, Immo, Sivyer, Katy, Wordsworth, Sarah, Quaddy, Jack, Santillo, Marta, Krusche, Adele, Roope, Laurence S J, Mowbray, Fiona, Hand, Kieran S, Dobson, Melissa, Crook, Derrick W, Vaughan, Louella, Hopkins, Susan, Yardley, Lucy, Peto, Timothy E A, and Walker, Ann Sarah

Published
2023
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9. The cost-effectiveness of procalcitonin for guiding antibiotic prescribing in individuals hospitalized with COVID-19: part of the PEACH study.

Author

Webb, Edward J D, Howdon, Daniel, Bestwick, Rebecca, King, Natalie, Sandoe, Jonathan A T, Euden, Joanne, Grozeva, Detelina, West, Robert, Howard, Philip, Powell, Neil, Albur, Mahableshwar, Bond, Stuart, Brookes-Howell, Lucy, Dark, Paul, Hellyer, Thomas, Llewelyn, Martin, McCullagh, Iain J, Ogden, Margaret, Pallmann, Philip, and Parsons, Helena

Subjects
COVID-19 pandemic, COVID-19, QUALITY-adjusted life years, COST estimates, HEALTH boards
Abstract

Background Many hospitals introduced procalcitonin (PCT) testing to help diagnose bacterial coinfection in individuals with COVID-19, and guide antibiotic decision-making during the COVID-19 pandemic in the UK. Objectives Evaluating cost-effectiveness of using PCT to guide antibiotic decisions in individuals hospitalized with COVID-19, as part of a wider research programme. Methods Retrospective individual-level data on patients hospitalized with COVID-19 were collected from 11 NHS acute hospital Trusts and Health Boards from England and Wales, which varied in their use of baseline PCT testing during the first COVID-19 pandemic wave. A matched analysis (part of a wider analysis reported elsewhere) created groups of patients whose PCT was/was not tested at baseline. A model was created with combined decision tree/Markov phases, parameterized with quality-of-life/unit cost estimates from the literature, and used to estimate costs and quality-adjusted life years (QALYs). Cost-effectiveness was judged at a £20 000/QALY threshold. Uncertainty was characterized using bootstrapping. Results People who had baseline PCT testing had shorter general ward/ICU stays and spent less time on antibiotics, though with overlap between the groups' 95% CIs. Those with baseline PCT testing accrued more QALYs (8.76 versus 8.62) and lower costs (£9830 versus £10 700). The point estimate was baseline PCT testing being dominant over no baseline testing, though with uncertainty: the probability of cost-effectiveness was 0.579 with a 1 year horizon and 0.872 with a lifetime horizon. Conclusions Using PCT to guide antibiotic therapy in individuals hospitalized with COVID-19 is more likely to be cost-effective than not, albeit with uncertainty. [ABSTRACT FROM AUTHOR]

Published
2024
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10. Exploring co-creation labs: creative convergence at work.

Author

Bussey, Marcus, Friman, Eva, Do, Thao, Barrineau, Sanna, and Powell, Neil

Subjects
TRANSFORMATIVE learning, SOCIAL learning, RESEARCH personnel, SPACE, CLINICAL pathology, TECHNOLOGY convergence
Abstract

This paper reports on research into co-creation labs as a tool for exploring environmental communication. Co-creation labs are novel spaces for experimentation, social learning, and trans-disciplinary as well as cross-sectoral collaboration for sustainability transformations. This paper examines the approach taken by researchers to theorising, via a repurposing of the 2×2 scenario matrix, a series of "labs" that represent diverse spaces in which to explore co-creative convergence through transformative learning processes. In addition, examples from work done to date are offered to illustrate progress in implementing these labs and testing the strengths and weaknesses of these co-creative spaces. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Forensic geoscience on, and in, water.

Author

Ruffell, Alastair, Pringle, Jamie K., Powell, Neil, O'Keefe, Amy, Wisniewski, Kristopher D., and Hobson, Luke

Subjects
CRIMINAL investigation, BODIES of water, EARTH sciences, EARTH scientists, LAW enforcement
Abstract

Geoscientists are being increasingly asked by law enforcement, environmental agencies and even wildlife trusts to investigate suspected illegal activities in and around water bodies for criminal or civil investigations. Searches and surveys in aquatic environments can be challenging, depending on the item(s) of interest that is being looked for, the available search teams and equipment and the search area. This article will briefly detail the current work of geoscientists in assisting these aquatic investigations, provide some relevant case studies and discuss future developments. [ABSTRACT FROM AUTHOR]

Published
2024
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18. Developing a model for decision-making around antibiotic prescribing for patients with COVID-19 pneumonia in acute NHS hospitals during the first wave of the COVID-19 pandemic: qualitative results from the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH Study)

Author

Henley, Josie, primary, Brookes-Howell, Lucy, additional, Euden, Joanne, additional, Pallmann, Philip, additional, Llewelyn, Martin, additional, Howard, Philip, additional, Powell, Neil, additional, Dark, Paul, additional, Szakmany, Tamas, additional, Hellyer, Thomas P, additional, Albur, Mahableshwar, additional, Hamilton, Ryan, additional, Prestwich, Graham, additional, Ogden, Margaret, additional, Maboshe, Wakunyambo, additional, Sandoe, Jonathan, additional, Thomas-Jones, Emma, additional, and Carrol, Enitan, additional

Published
2023
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21. Removal of incorrect penicillin allergy labels in a UK hospital

Author

Hearsey, Daniel, primary, Elkhalifa, Shuayb, additional, Sandoe, Jonathan, additional, Wilcock, Michael, additional, Owens, Rhys, additional, Gay, Bethan, additional, Wildblood, Charlotte, additional, Mendonca, Jane, additional, Leigh, Nicola, additional, and Powell, Neil, additional

Published
2023
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26. Assessment of the appropriateness of antibiotic prescribing in an acute UK hospital using a national audit tool: a single centre retrospective survey

Author

Owens, Rhys, primary, Bamford, Kathy, additional, Pinion, Sophie, additional, Garry, Emma, additional, Cranmer, Emily, additional, Pearce, Catharine, additional, Wint, Htet htet, additional, Gill, Simon, additional, Philips, Ryan, additional, Khan, Adnan, additional, Roy Bentley, Selina, additional, Roberts, Neil, additional, Keating, Bernadette, additional, Askaroff, Natasha, additional, Morphew, Megan, additional, Orr, Charles, additional, Mouket, Tarek, additional, Pope, Katherine, additional, and Powell, Neil, additional

Published
2023
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28. First, do no harm: time for a systems approach to address the problem of health-care-derived pharmaceutical pollution

Author

Thornber, Kelly, primary, Adshead, Fiona, additional, Balayannis, Angeliki, additional, Brazier, Richard, additional, Brown, Ross, additional, Comber, Sean, additional, Court, Caroline, additional, Davidson, Iain, additional, Depledge, Michael, additional, Farmer, Caroline, additional, Gibb, Stuart, additional, Hixson, Richard, additional, Kirchhelle, Claas, additional, Moore, Keith, additional, Motta, Marco, additional, Niemi, Lydia, additional, Owen, Stewart, additional, Pencheon, David, additional, Pfleger, Sharon, additional, Pitchforth, Emma, additional, Powell, Neil, additional, Schmidt, Wiebke, additional, Smith, Richard, additional, Sowman, Georgina, additional, Tyler-Batt, Wendy, additional, Wilkinson, Helen, additional, Wilson, Edward CF, additional, Fleming, Lora, additional, Gaze, William, additional, and Tyler, Charles, additional

Published
2022
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29. Procalcitonin Evaluation of Antibiotic Use in COVID-19 Hospitalised Patients (PEACH): Protocol for a Retrospective Observational Study

Author

Euden, Joanne, primary, Pallmann, Philip, additional, Grozeva, Detelina, additional, Albur, Mahableshwar, additional, Bond, Stuart E., additional, Brookes-Howell, Lucy, additional, Dark, Paul, additional, Hellyer, Thomas, additional, Hopkins, Susan, additional, Howard, Philip, additional, Llewelyn, Martin J., additional, Maboshe, Wakunyambo, additional, McCullagh, Iain J., additional, Ogden, Margaret, additional, Parsons, Helena, additional, Partridge, David, additional, Powell, Neil, additional, Shaw, Dominick, additional, Shinkins, Bethany, additional, Szakmany, Tamas, additional, Todd, Stacy, additional, Thomas-Jones, Emma, additional, West, Robert M., additional, Carrol, Enitan D., additional, and Sandoe, Jonathan A. T., additional

Published
2022
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30. Identification of Intervention Opportunities through Assessment of the Appropriateness of Antibiotic Prescribing in Surgical Patients in a UK Hospital Using a National Audit Tool: A Single Centre Retrospective Audit

Author

Hearsey, Daniel John, primary, Bamford, Kathleen B., additional, Hutton, Michael, additional, Wade, Liam, additional, Coates, Henry, additional, Ramsay, Elizabeth, additional, Alberts, Barbara, additional, and Powell, Neil, additional

Published
2022
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33. The effectiveness of interventions that support penicillin allergy assessment and de-labelling of adult and paediatric patients by non-allergy specialists: A systematic review and meta-analysis

Author

Powell, Neil, primary, Stephens, Jennie, additional, Kohl, Declan, additional, Owens, Rhys, additional, Ahmed, Shadia, additional, Musicha, Crispin, additional, Upton, Mathew, additional, Kent, Bridie, additional, Tonkin-Crine, Sarah, additional, and Sandoe, Jonathan, additional

Published
2022
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36. Integrated Water Resource Management: A Platform for Higher Education Institutions to Meet Complex Sustainability Challenges

Author

Powell, Neil and Larsen, Rasmus Kløcker

Abstract

Higher education institutions in Sweden are increasingly exposed to international market conditions and rising competition from a more mobile student body. This increases the need for universities to adapt to their social and economic environment and to their clients, including the political trends and financial opportunities in Sweden and EU, if they are to successfully implement sustainability reforms. In this regard, we examine the barriers faced by a "post-normal" education for sustainable development (ESD) inherent within the structures of a "normal" University. We pose the question whether Integrated Water Resource Management (IWRM) as a post-normal process can contribute to increased capacity of normal higher education institutions to address complex sustainability problems? IWRM is conceptualised as an interactionist process of social learning and adaptive management to reflect on the experiences from one particular case, namely the Master Programme in IWRM at the Swedish University of Agricultural Sciences. We illustrate how IWRM can contribute to address conflicts of interests in education arising from competing claims of stakeholders in real life management situations, but also to reconcile the conflicts associated with institutional adaptation under conditions characterised by a new international educational regime and rapidly changing market conditions. The paper brings together the discourse on ESD with lessons from IWRM and contends that the interactionist approach might offer a useful alternative to realist conceptions of ESD in learner-centred and institutional systemic approaches. Contrary to other reports on IWRM education, this paper reflects on this role of IWRM within higher education "per se."

Published
2013
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37. Impact of introducing procalcitonin testing on antibiotic usage in acute NHS hospitals during the first wave of COVID-19 in the UK: a controlled interrupted time series analysis of organization-level data

Author

Llewelyn, Martin J., Grozeva, Detelina, Howard, Philip, Euden, Joanne, Gerver, Sarah M., Hope, Russell, Heginbothom, Margaret, Powell, Neil, Richman, Colin, Shaw, Dominick, Thomas-Jones, Emma, West, Robert M., Carrol, Enitan D., Pallmann, Philip, Sandoe, Jonathan A. T., Albur, Mahableswhar, Berry, Claire, Bond, Stuart E., Brookes-Howell, Lucy, Dark, Paul, Hellyer, Thomas P., Henley, Josie, Hopkins, Susan, McCullagh, Iain J., Ogden, Margaret, Parsons, Helena, Partridge, David G., Sandoe, Jonathan A.T., Shinkins, Bethany, Szakmany, Tamas, and Todd, Stacy

Subjects
Pharmacology, Microbiology (medical), COVID-19/diagnosis, COVID-19, Interrupted Time Series Analysis, Hospitals, State Medicine, United Kingdom, Anti-Bacterial Agents, COVID-19 Drug Treatment, Anti-Bacterial Agents/therapeutic use, Infectious Diseases, Humans, Pharmacology (medical), Pandemics, Procalcitonin, Retrospective Studies
Abstract

Background Blood biomarkers have the potential to help identify COVID-19 patients with bacterial coinfection in whom antibiotics are indicated. During the COVID-19 pandemic, procalcitonin testing was widely introduced at hospitals in the UK to guide antibiotic prescribing. We have determined the impact of this on hospital-level antibiotic consumption. Methods We conducted a retrospective, controlled interrupted time series analysis of organization-level data describing antibiotic dispensing, hospital activity and procalcitonin testing for acute hospitals/hospital trusts in England and Wales during the first wave of COVID-19 (24 February to 5 July 2020). Results In the main analysis of 105 hospitals in England, introduction of procalcitonin testing in emergency departments/acute medical admission units was associated with a statistically significant decrease in total antibiotic use of −1.08 (95% CI: −1.81 to −0.36) DDDs of antibiotic per admission per week per trust. This effect was then lost at a rate of 0.05 (95% CI: 0.02–0.08) DDDs per admission per week. Similar results were found specifically for first-line antibiotics for community-acquired pneumonia and for COVID-19 admissions rather than all admissions. Introduction of procalcitonin in the ICU setting was not associated with any significant change in antibiotic use. Conclusions At hospitals where procalcitonin testing was introduced in emergency departments/acute medical units this was associated with an initial, but unsustained, reduction in antibiotic use. Further research should establish the patient-level impact of procalcitonin testing in this population and understand its potential for clinical effectiveness.

Published
2022

38. Antibiotic Review Kit for Hospitals (ARK-Hospital): a stepped wedge cluster randomised controlled trial

Author

Llewelyn, Martin J, primary, Budgell, Eric P, additional, Laskawiec-Szkonter, Magda, additional, Cross, Elizabeth LA, additional, Alexander, Rebecca, additional, Bond, Stuart, additional, Coles, Phil, additional, Conlon-Bingham, Geraldine, additional, Dymond, Samantha, additional, Evans, Morgan, additional, Fok, Rosemary, additional, Frost, Kevin J, additional, Garcia-Arias, Veronica, additional, Glass, Stephen, additional, Gormley, Cairine, additional, Gray, Katherine, additional, Hamson, Clare, additional, Harvey, David, additional, Hills, Tim, additional, Iyer, Shabnam, additional, Johnson, Alison, additional, Jones, Nicola, additional, Kang, Parmjit, additional, Kiapi, Gloria, additional, Mack, Damien, additional, Makanga, Charlotte, additional, Mawer, Damian, additional, McCullagh, Bernie, additional, Mirfenderesky, Mariyam, additional, McEwen, Ruth, additional, Nag, Sath, additional, Nagar, Aaron, additional, Northfield, John, additional, O’Driscoll, Jean, additional, Pegden, Amanda, additional, Porter, Robert, additional, Powell, Neil, additional, Price, David, additional, Sheridan, Elizabeth, additional, Slatter, Mandy, additional, Stewart, Bruce, additional, Watson, Cassandra, additional, Weichert, Immo, additional, Sivyer, Katy, additional, Wordsworth, Sarah, additional, Quaddy, Jack, additional, Santillo, Marta, additional, Krusche, Adele, additional, Roope, Laurence SJ, additional, Mowbray, Fiona, additional, Hand, Kieran S, additional, Dobson, Melissa, additional, Crook, Derrick, additional, Vaughan, Louella, additional, Hopkins, Susan, additional, Yardley, Lucy, additional, Peto, Timothy EA, additional, and Walker, Ann Sarah, additional

Published
2022
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44. P14 Procalcitonin evaluation of antibiotic use in COVID-19 hospitalized patients during the first wave of COVID-19: the PEACH study

Author

Euden, Joanne, primary, Howard, Philip, additional, Powell, Neil, additional, Llewelyn, Martin J., additional, Szakmany, Tamas, additional, Albur, Mahableswhar, additional, Bond, Stuart E., additional, Brookes-Howell, Lucy, additional, Dark, Paul, additional, Hellyer, Thomas P., additional, Hopkins, Susan, additional, McCullagh, Iain J., additional, Ogden, Margaret, additional, Pallmann, Philip, additional, Parsons, Helena, additional, Partridge, David G., additional, Shaw, Dominick E., additional, Shinkins, Bethany, additional, Todd, Stacy, additional, Thomas-Jones, Emma, additional, West, Robert, additional, Carrol, Enitan D., additional, and Sandoe, Jonathan A. T., additional

Published
2022
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46. Potential impact of national recommendations to use short course antibiotic therapy on antibiotic use in the emergency department of a UK hospital: retrospective observational study

Author

Powell, Neil, primary, Wade, Liam, additional, Iqbal-elahi, Rumaysah, additional, McDonald, Caitlin, additional, Philips, Ryan, additional, Owens, Rhys, additional, Amir, Amani, additional, Cho, Steven, additional, Nampa, Tracy, additional, Lim, Deborah, additional, Tai, Kevin, additional, and Jadav, Mark, additional

Published
2021
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50. P30 Can non-allergy health workers safely delabel reported penicillin allergies using an antibiotic allergy assessment tool? - A multicentre study

Author

Owens, Rhys, Sandoe, Jonathan, Whyte, Andrew, West, Robert, Slatter, Mandy, Stonell, Rebecca, and Powell, Neil

Subjects
Penicillin, Antibiotic allergy, medicine.medical_specialty, Allergy, business.industry, Poster Presentation, medicine, General Medicine, business, medicine.disease, Dermatology, medicine.drug
Abstract

Background False penicillin allergy labels can be potentially hazardous to patients. Most penicillin allergy labels can be safely removed following risk stratification and formal drug challenge. These de-labelling strategies have been limited to specialist allergy and infectious disease services. Aims To determine whether non-allergy specialist health-care workers can use an antibiotic allergy assessment tool (AAAT) to correctly phenotype and manage reported penicillin allergy. Method Non-allergy health-care workers in three UK hospital were emailed online questionnaires and asked to assign the allergy phenotype and management recommendation for eight vignettes of real cases reporting a penicillin allergy using the AAAT. In one hospital participants were randomised into two groups: one group was directed to use the AAAT whilst the second group had no decision tool. Participants were assigned an average score for correct allergy phenotype, management and a major error rate. Results Use of the AAAT across the eight vignettes significantly improved the average score for assigning correct phenotype (6.7 vs 5.2 p Conclusion The AAAT significantly improved health worker performance in phenotyping and choosing correct management for reported penicillin. However, even with the AAAT, there remains a risk of potentially hazardous management choices highlighting the need for formal allergy training to expand penicillin allergy assessment services.

Published
2021

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