Medical Centre

A recent article by Helen Atherton , Christopher Huckvale and Josip Car in the Journal of Telemedicine and Telecare discussed the use of email in healthcare . The use of email as a method of transferring information between clinicians and patients is increasing. For example, email is now commonly used for the management of appointments and to provide test results. The widespread availability and use of email by the public creates opportunities for people to participate more actively in their own health care. One common use of email to support this is its use by primary care physicians to provide patients with additional information about disease prevention and health promotion, and thus reinforce the messages given during the consultation. The article confirmed that the use of email in healthcare developing rapidly, but also found that the evidence base to support the use of email is not well established, and that better research was needed if we are to maximise the benefits of th...

A recent article in the journal Primary Health Care Research & Development  By Edgar Samarasundera and colleagues discusses the use of socio-demographic data sources for monitoring local health profiles and for use in the geographical planning of primary health care in England. The article updates an older paper published in the BMJ in 1995. There is an increasing range of resources available for geographical analyses in health. The 2001 census introduced important changes to what routine data are available, as will the 2011 census. These changes have been paralleled by developments in the availability of socio-demographic indicators and the increasing popularity of geographic information systems. Health data can now be combined with those from socio-demographic more efficiently to produce value-added datasets. Recent and planned developments in the availability of both socio-demographic datasets in tandem with parallel developments in spatial technologies have provid...

A scientific workflow  is a method in computer science for formulating abstract descriptions of analytical processes. This allows automation and reuse of many of the tasks in analysing large, complex data sets. A recent article in the journal Statistical Methods in Medical Research discussed the use of these scientific workflows for the analysis of data from large primary care databases . Routinely collected primary care data in electronic repositories are a promising source of data for audits, quality improvement, health service planning, epidemiological studies and research. However, a number of challenges have been noted about working with these data sets. In the paper, we discuss these issues and describe how we used scientific workflows to analyse data from one large primary care database (GPRD). Some of the steps in the analysis of data from the GPRD our shown in the figure below.

In a recent BMJ editorial , Nicholas Moore and Bernard Begaud outline initiatives to improve pharmacovigilance in Europe. Such initiatives are essential to improving the safety of healthcare because current approaches to detection of serious adverse drug reactions (ADRs) have major limitations. Serious adverse drug reactions are often too rare to be detected in early clinical trials, and may not be detected through post-marketing surveillance for many years. This delay in identifying adverse drug reactions leaves clinicians unaware about the potential risks of the drugs they are prescribing, puts patients at risk of iatrogenic harm, and increases both healthcare costs and the costs of drug development. The development of databases derived from electronic patient records and hospital administration systems could help to improve the detection of adverse drug reactions. In England, these databases include the General Practice Research Database (GPRD), The Health Improvement Network (THI...

I am sometimes asked where a list of my academic publications can be found? Details of my publications can be found on my Imperial College Publications Page . This is updated automatically - at regular intervals, a search of the PubMed and other bibliographic databases is carried out and any publications with an author matching my details are flagged for me to decide whether they are included on the page. The advantage of using this page to view my list of publications - rather than a PubMed search - is that there are other authors with similar details to me. Hence, a PubMed search will include publications from other authors and not just those which are mine.

The incorrect classification, diagnosis and coding of the type of diabetes can affect the quality of health care that people with diabetes receive. A study published recently in the journal Diabetic Medicine examined the accuracy of diagnostic data on diabetes. The study found that errors in the coding and classification of diabetes were common. The study included some useful algorithms to help doctors identify which patients may not have their diabetes recorded correctly.

An opportunity has arisen for either a Research Assistant or Research Associate to join an international/cross-discipline team creating a rapid learning healthcare system to improve patient safety and volume of clinical research in Europe. This is an exciting opportunity for an individual with a keen interest in data mining and/or data provenance who is looking to gain experience in medical informatics. The aim of the research is to design and develop an extensible provenance framework to be integrated into the decision support and data mining engines to ensure auditability and accountability. This position will be responsible for investigating existing provenance models and their applicability to data mining tasks and contributing to the development of novel data mining models for translational data. See the Imperial College Recruitment Page for further details.

I attended a conference today hosted jointly by the Imperial College’s Institute for Global Health and the Lancet which discussed public financing of health in developing countries. The centre-piece of the conference was a presentation by Professor Christopher Murray of the paper published by him and his colleagues in the Lancet . The main conclusion of Professor Murray’s study was that development assistance for health from donor countries can lead to a reduction in direct government spending on health in developing countries. In contrast, when development assistance for health was given to non-governmental organisations, this effect was not present. The study was a very impressive achievement, particularly given the limitations of the data that Professor Murray’s team had to use. The study raises some important questions for both donor countries and recipients of development assistance for health.

A recent article in Primary Care Diabetes examines the question of whether pay for performance has improved the management of diabetes in the United Kingdom. Over the past decade, the UK government has introduced a number of major policy initiatives to improve the quality of health care. One such initiative was the introduction of the Quality and Outcomes Framework (QOF), a pay for performance programme for general practices launched in April 2004. The QOF aimed to improve the primary care management of common chronic conditions including diabetes. The introduction of QOF has been associated with improvements in the quality indicators for diabetes care included in the framework. However, it is difficult to disentangle the impact of QOF from other quality initiatives as few studies have adjusted for underlying trends in quality. QOF may also have reduced inequalities in diabetes care between affluent and deprived areas. Less is known about the impact of QOF on aspects of diabetes care ...

The London Research Design Services will be holding a drop-in session at the Reynolds Building on Thursday March 25 2010. RDS London provides guidance and support to clinicians and academics preparing grant applications to he NIHR. The drop-in sessions are open to all, whether you just want to find out more about the service or would like to discuss a proposal with one of RDS London’s experts. There will be a number of RDS advisers available on the day that will be able to offer you advice on all aspects of your proposal.

Last week, I attended a seminar at the University of Tokyo, organised by the Todai Policy Alternatives Research Institute . I spoke about the secondary uses of data from electronic patient records in the UK (the primary use is defined as their role in providing direct clinical care). Also speaking at the conference were John Halamka from Harvard and Nikolaus Forgo from Hanover, as well as speakers from the University of Tokyo, such as Professor Morita , Professor Akiyama, and Professor Sakata. Amongst the audience of 250 were representatives from clinical medicine, academia, government and health service management. I was very impressed by the expertise and commitment to this area of work in Japan. You can view a summary of the proceedings in Japanese .

There is currently an ongoing debate in the USA about whether the US government should expand health coverage to include some groups that have limited access to health care. In the UK, we have had universal health coverage since 1948, when the NHS was introduced. The US health system has some stark disparities between ethnic groups. A recent article from Imperial College published in the Journal of Public Health examined change in the quality of care for people with diabetes over a 10 year period from 1997-2006. We found that although Although ethnic disparities persist in diabetes management, these are starting to be addressed, particularly in the South Asian group. It appears therefore that all ethnic groups have benefited from recent quality improvement initiatives in the UK.

A recent article in Informatics in Primary Care discussed how we can build on a Wellcome Trust report on the use of electronic patient records (EPRs) from general practice for research. The UK could significantly enhance its health research capability by making effective use of data from electronic patient records for secondary research. The Wellcome Trust report provides useful guidance to researchers and clinicians on why secondary research using data from electronic records in primary care is important. Combined with advances in NHS Information Technology systems, particularly the Research Capability Programme, and financial support from the NIHR, we need to make this potential a reality and ensure that the UK remains a world leader in primary care informatics.

The department hosted a visit this week by a delegation from Singapore, with help from the Lillie Road Surgery. The visit was to discuss collaboration between Singapore and Imperial College in the areas of undergraduate education and research.

A recent report from the NHS Confederation and the Royal College of Physicians examines the growing cost to the NHS of treating people with alcohol-related diseases. The report was also covered by the BBC News . One of the important complications of excessive alcohol intake is liver disease. In a paper published in 2008 in the journal Alcohol and Alcoholism , along with colleagues from St.Georges Hospital and the Office for National Statistics, I examined trends in hospital admissions and mortality in England from chronic liver disease. Hospital admission rates for chronic liver disease increased by 71% in males and 43% in females between 1989 to 2003. This increase was largely due to alcoholic liver disease, admission rates for which more than doubled between 1989/1990 and 2002/2003. Mortality rates for chronic liver disease more than doubled between 1979 and 2005 with two thirds of these deaths attributable to alcohol-related liver disease in 2005. The highest rate of alcoholic live...

Earlier this year, the Department of Primary Care & Public Health at Imperial College hosted a visit from a delegation from the Ministry of Health in the Republic of Macedonia . During the visit, academics in the department discussed the primary healthcare system in the Republic of Macedonia and ways in which the Department of Primary Care & Public Health could support both undergraduate and postgraduate training in primary care. The Republic of Macedonia faces major challenges in improving its health system and the development of high-quality primary care services is seen as a key step in achieving improved access to healthcare.

A recent article in the journal Diabetes Research and Clinical Practice examined trends in lower extremity amputations in people with and without diabetes in England during the period 1996-2005. The study, which was reported on the BBC News Website , found that although overall numbers of amputations fell, the number occurring in people with type 2 diabetes increased. This may be because the prevalence of type 2 diabetes increased over this period and because surgeons are intervening earlier to prevent more serious damage to the feet and legs of people with type 2 diabetes.

Research Design Service (RDS) London is part of the NIHR and provides help to those preparing research proposals for submission to the NIHR for applied health or social care research. With centres based at King's College London, Imperial College London , Queen Mary and University College London, it is focused on supporting applications for funding from NHS researchers and those working in partnership with the NHS. Priority is given to those applying for NIHR Research for Patient Benefit (RfPB) and Programme Grant funding. Advice is provided free of charge and is available through use of online resource and consultations with experts.

One of my professional roles is acting as Associate Director (Primary Care) for the Diabetes Research Network . Diabetes is one of the most common chronic diseases that primary care professionals treat, affecting nearly 4% of the population of England. A key aim for Diabetes Research Network will be to encourage general practitioners, practice nurses and other primary care professionals to take part in its activities and to help recruit patients for clinical trials and other studies. A recent article in the journal Primary Care Diabetes discusses how primary health care professionals and the Diabetes Research Network can work together.

A study from Imperial College , LSHTM and the University of Leicester published online in the BMJ this week compared the safety of drugs used for the treatment of type 2 diabetes. The findings of the study confirm that Metformin remains the first choice drug for the treatment of type 2 diabetes. Patients taking sulphonylureas were more likely to suffer from heart attacks and heart failure or to die, compared to people taking Metformin. Doctors should therefore consider Metformin as their first choice when treating people with type 2 diabetes, as recommended by national guidelines from NICE . The study was reported by a number of media outlets, including the Guardian , Telegraph and NHS Choices .