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Health Professional Co-Design of an Asthma Clinical Decision Support Tool

We are conducting a study which aims to identify potential pathways for computer aided decision support in asthma care by consulting with health professionals – GPs, practice nurses, practice pharmacists, and secondary care respiratory specialists.

  • Where in current routine practice do healthcare professionals envision their care for asthma patients could most benefit from computer aided decision support?
  • What are the primary concerns and barriers that healthcare providers foresee hindering the benefit from computer aided decision support?
  • How do healthcare professionals prefer risk estimation be presented, both for their own assessment, and for health promotion purposes.

More information about the study is available on our study website.

If you are a healthcare professional interested in taking part in this study, please contact Dr. Holly Tibble (holly.tibble@ed.ac.uk).  The inclusion criteria for the study are as follows:

  • Willing and able to give informed consent for participation in the study.
  • A practising UK health professional for at least one year (at least 60% FTE).
  • Consulted with at least one patient with confirmed or suspected asthma in the past six months.

Interview participants will be remunerated £35 each, through a Love2Shop voucher issued by the University of Edinburgh.

For our other readers, we would be grateful if you could share our tweet, or put us in touch with contacts who might be interested in joining.

If you would like to discuss this study anonymously with someone independent of the study please contact Dr. Ian Sinha, Consultant respiratory paediatrician at Alder Hey Children’s Hospital, Liverpool (Ian.Sinha@alderhey.nhs.uk).

Publication: Cause of death coding in asthma

We’ve recently published a paper in BMC Medical Research Methodology on how cause of death is ICD10 coded in people with asthma.  This was a collaboration between myself, Dr. Alexandria Chung (an NHS Lothian Clinical Research Fellow), and George Addo Opoku-Pare, who I was lucky enough to be paired with for the HDRUK Black Internship Program last year.  You can read more about that here, and read about George’s experience here.

Our study investigated 91,022 deaths recorded in a Scottish longitudinal linked electronic health record dataset between 2000 and 2017. Asthma-related deaths were identified by the presence of any of ICD-10 codes J45 or J46, in any position. These codes were categorized either as relating to asthma attacks specifically (status asthmatic; J46) or generally to asthma diagnosis (J45).

We found that less than 1% of asthma-related mortality records used both J45 and J46 ICD-10 codes as causes. Infection (predominantly pneumonia) was more commonly reported as a contributing cause of death when J45 was the primary coded cause, compared to J46, which specifically denotes asthma attacks.

Further inspection of patient history can be essential to validate deaths recorded as caused by asthma, and to identify potentially mis-recorded non-asthma deaths, particularly in those with complex comorbidities.

HDR UK Funding for Queen’s University and University of Edinburgh Collaboration

Congratulations to the team from QUB and UoE on their recent funding success, as part of the HDR UK Inflammation and Immunity Driver Program.

“Our team of clinicians, statisticians and epidemiologists from Queen’s University and the University of Edinburgh have received HDR UK funding to develop prognostic models to help inform treatment decisions for individuals with severe asthma. First line rescue treatment for a severe asthma attack is systemic corticosteroids, which carry a risk of toxicities. Biologic therapies are effective in reducing asthma attacks and have a substantially better safety profile but are more expensive. Currently, Payer Access in the UK advise that individuals with severe asthma will only become eligible for biological therapy after multiple attacks. Identifying individuals at risk of multiple asthma attacks could potentially allow treatment decisions to be brought forward and avoid toxicities due to corticosteroid exposure. Our work aims to develop and validate prognostic models to estimate risk and prospectively identify individuals who will have multiple asthma attacks. This may allow a better understanding of the consequences of delayed intervention with effective therapies to reduce asthma attacks and allow Healthcare Payers and Providers to make more informed treatment decisions for individuals living with severe asthma.” – Andrew Kunzmann, QUB

The Asthma UK Centre for Applied Research’s 10 Year Impact Review

This year, the Asthma UK Centre for Applied Research is celebrating 10 years of generating evidence and impact in the applied asthma research community, in working with patients and the public, and driving change, all with the overall aim of improving the lives of people with asthma.

“Reflecting on the Centre’s work, we are proud to announce the launch of the Centre’s 10-Year Impact Report (2014 – 2024).

We believe this report shows what can be achieved in collaborative research networks involving researchers, people with asthma, clinicians, data safe havens and other data custodians. We are an excellent source of evidence from data-enabled trials.  It also shows an excellent return on investment with a 20-fold increase in funding through partnerships and additional grant funding.

Learn more about the Centre’s work and impact over the past 10 years on our website: www.aukcar.ac.uk.

Find out how you can join the Centre as we move forward with our mission to transform the respiratory research environment by emailing us at aukcar.admin@ed.ac.uk.”

 

The AUKCAR members smiling on a sunny doorstep, in front of a beautiful stained glass door.

NIHR Funding for Nottingham’s Matt Martin

Matt Martin and Ralph Akyea (University of Nottingham, Primary Care Stratified Medicine Research Group) have recently received £50k NIHR School for Primary Care Research funding for Development and external validation of a risk prediction model for asthma attacks in primary care: a retrospective cohort study.  Matt is a Consultant Respiratory Physician at Nottingham University Hospitals NHS Trust with research interests in the phenotyping of asthma, asthma attacks and cough, particularly in developing personalised medicine approaches for prevention and treatment of asthma attacks.

“I will be working on this grant with my Co-PI Ralph who is a Senior Research Fellow with the Centre for Academic Primary Care, University of Nottingham and early career epidemiologist with a postgraduate master’s degree in public health and research doctorate in Primary Care. Ralph’s interests include the use of coded data in electronic health records to stratify and improve care in primary care. We will collaborate with experts from other centres including Holly (!) and Prof Kontopantelis from the University of Manchester. We aim to develop and validate (internally and externally) an asthma attack prediction model to estimate the 12-month risk of an asthma attack (using CPRD GOLD and Aurum and HES data) using supervised machine learning approaches guided by expert and patient knowledge.  We will obviously be very keen to hear about the results of Holly’s work in this area and to discuss further with anyone else working in a similar area once we get underway!”  – Matt Martin

Derivation and validation of an asthma diagnosis prediction model for children and young people in primary care

Dr. Luke Daines (Edinburgh University) has recently published in Wellcome Open Research on an asthma diagnosis prediction model for children and young people in primary care.  The logistic regression based prediction model was derived using the Avon Longitudinal Study of Parents and Children (ALSPAC) data linked to electronic health records, and validated in the Optimum Patient Care Research Database (OPCRD).   Predictors included in the final model were wheeze, cough, breathlessness, hay-fever, eczema, food allergy, social class, maternal asthma, childhood exposure to cigarette smoke, prescription of a short acting beta agonist and the past recording of lung function/reversibility testing. In the external validation dataset the C-statistic was 0.85, 95% CI 0.83–0.88.  Following further evaluation of clinical effectiveness, the prediction model could be implemented as a decision support software.

Investing in breath

Asthma +  Lung UK recently published their report ‘Investing in breath’, illustrating the huge financial cost of lung conditions to the UK economy. The report highlights how increased investment in lung research has the potential to drive growth, create jobs, and reduce the burden of ill health at a time when we need to support UK economic growth and keep the NHS fit for the future.  The hope is that this work will influence increased funding into respiratory disease research, but it is also a great reference when describing the potential impact of ongoing respiratory research in the  UK.

The eCRUSADers Community

Those of you working in Scottish, or four nation, data, might be interested in linking up with the Early Career  Researchers Using Scottish Administrative Data community, the eCRUSADers.  eCRUSADers provides a space to share information and experiences, to encourage discussion and improve the use of Scottish administrative data in research, and is  managed by Dr Elizabeth Lemmon, Research Fellow in Health Economics at the University of Edinburgh.  They have many interesting blog posts, including this recent piece on PPI involvement in administrative data research.   Visit the website to find out more, or contact them at ecrusad@ed.ac.uk.

Spotlight: Ryan Orr

Ryan Orr is our Innovation Project Manager; he joined the NHS in July 2021 working within e-health delivering a large-scale IT upgrade of windows 7 devices to windows 10 devices as part the of the Scottish Government mandate. Leading additional projects in TrakCare Theatres he implemented additional large-scale screen and multiple devices to hep with the change over from ORSOS to TrakCare across all Lothian sites. With a master’s in computing Ryan was looking for something a little more and came across to HISES on a seconded post and soon took a variety of large projects on such as Asthma, COPD and Microsoft ICU. Recently he became a permanent member of the HISES team and is continuing to manage and grow the projects in his portfolio. Ryan has a passion for machine learning and AI, looking at transforming the NHS with new innovate ideas and opportunities.

If he’s not working hard on his projects then he’ll be out with dog Roxy, rolling around the grass and throwing a ball around. He’s always looking to meet new people so please free to reach out and say hi!

See further:

Meet the NHS Lothian Team

LinkedIn

Spotlight: Samantha Smith-Garrett

Samantha Smith-Garrett

Samantha joined NHS Lothian in October 2019 as Innovation Project Team Manager and was responsible for setting up the South East Regional Innovation Test Bed office team, Health Innovation South East Scotland (HISES). The HISES team provide a key support function for the delivery of transformational innovative change within the three NHS Boards (Borders, Fife, and Lothian), whilst also contributing to the spread of healthcare innovation across NHS Scotland.

Taking up the post of Senior Innovation Programme Manager in March 2023, Samantha provides leadership in developing a large complex and diverse portfolio of innovation projects and programmes, working with clinicians, academics, service managers, third sector, and industry partners. This includes defining innovation challenges, developing partners and consortiums to address these challenges. Her portfolio includes COPD and Long-Term Conditions Management, Paediatric Asthma, Cancer, Hip Fracture, and a proposed drone delivery network which connects hospitals, pathology laboratories, distribution centres and GP surgeries across Scotland.

Samantha is passionate about leading service redesign and mapping clinical pathways to identify innovative opportunities for system wide change across health & social care to support the delivery of frontline services and improve outcomes for families and the care they receive.

Recently Samantha has just gotten married at Orocco Pier in South Queensferry, all her hard work and late nights paid off with an incredible wedding. If you ever need a wedding planner Samantha is the person.

See further:

@SamanthaNHSL on  Twitter

Meet the NHS Lothian Team

LinkedIn

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