WUTH publication: Developments in Transduction, Connectivity and AI/Machine Learning for Point-of-Care Testing

Citation: Sensors. 2019, 19(8),  pii: E1917
Author: O'Sullivan S, Ali Z, Jiang X, Abdolvand R, Ünlü MS, Silva HPD, Baca JT, Kim B, Scott S, Sajid MI, Moradian S, Mansoorzare H, Holzinger A
Abstract: We review some emerging trends in transduction, connectivity and data analytics for Point-of-Care Testing (POCT) of infectious and non-communicable diseases. The patient need for POCT is described along with developments in portable diagnostics, specifically in respect of Lab-on-chip and microfluidic systems. We describe some novel electrochemical and photonic systems and the use of mobile phones in terms of hardware components and device connectivity for POCT. Developments in data analytics that are applicable for POCT are described with an overview of data structures and recent AI/Machine learning trends. The most important methodologies of machine learning, including deep learning methods, are summarised. The potential value of trends within POCT systems for clinical diagnostics within Lower Middle Income Countries (LMICs) and the Least Developed Countries (LDCs) are highlighted.
KEYWORDS: POCT; artificial intelligence; deep learning; microfluidics; mobile phone; photonics

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Release your potential this Spring!

Is writing a joy? Do you find it hard to get going? Do you find yourself out of balance and pulled in different directions? Would you benefit from more confidence in your research experience? Due to the success of the previous workshop earlier this year, NHS R&D North West are offering another opportunity to enhance your research experience through coaching with Will Medd. Write here, right now: coaching writing workshop - 23rd April 2019, 9.30am-5pm, Federation House, Manchester Our coaching approach is tailored to the full experience of being a researcher, improving your professional and personal impact. This workshop is a full day event from 9.30am - 5pm, held at Federation House in Manchester City Centre. It is a £45 + VAT to attend for NHS Staff (50% is funded by Health Education England). For non-NHS staff, it is £90 + vat to attend. A purchase order number will be required upon booking to secure your place

Writing is a huge part of research and yet, as a skill, the focus of training is often on how to produce scientific papers, whilst retreats tend to focus on blocking out the time and space to write.  That’s great and important. What about the experience of writing itself?  How can researchers learn to be productive, to keep writing and even enjoy the process? While working on a current piece of writing (a paper, proposal etc) it aims to explore what happens if you unlock the possibility of enjoying writing! This workshop explores confidence, fears, values, goals and habits while experimenting with different writing moods. The day will include identifying new writing habits that you can start putting into practice! You'll come away with: Dedicated writing time on your work. Greater awareness of what gets in the way of your writing and how to overcome that. Learning from others about their writing experiences and strategies. A commitment to new writing habits. Click here to read more  Book your place here

WUTH publication: Localised bullous pemphigoid overlying knee arthroplasty: a diagnostic challenge

Citation: BMJ Case Reports. 2019, 12(4), e227440
Author: Truss A, Papalexandris S, Gardner S, Harvey R
Abstract: An elderly Caucasian woman developed bullous pemphigoid (BP) overlying the site of total knee arthroplasty for osteoarthritis 2 days after surgery. The clinical findings were consistent with blistering due to soft tissue swelling, bullous impetigo or allergic contact dermatitis. The blistering spread over weeks to months down the ipsilateral leg and then to the other leg and hips. A biopsy for H&E and direct immunofluorescence established the diagnosis of BP. A concomitantly occurring wound infection was identified and treated. The blistering responded well to superpotent topical steroids and local care.
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS: dermatology; joint interposition; orthopaedics

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WUTH publication: The shift to integrated care in the NHS: implications of the new care models for dentistry

Citation: British Dental Journal. 2019, 226(5), 319-322
Author: Willcocks S, Willcocks E
Abstract: This article explores the implications for dentistry of the policy of integration and collaboration in health and social care. In particular, it explores the advantages and disadvantages for dentistry of involvement in one of the new integrated care models currently being piloted, and the barriers and enabling factors that may need to be addressed if dentistry is to become involved. We argue that the advantages may outweigh the disadvantages and such involvement may be necessary at least in the longer term, otherwise there is a risk of missed opportunities and the possibility of dentistry being left out of major policy decisions affecting health and social care. However, such involvement of dentistry would require a considerable change to its current form and organisation. Any involvement will require the commitment and agreement of the dental profession, and its active engagement in the decision making process.

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WUTH publication: The cost of diagnostic uncertainty: a prospective economic analysis of febrile children attending an NHS emergency department

Citation: BMC Medicine. 2019, 17(1), 48
Author: Leigh S, Grant A, Murray N, Faragher B, Desai H, Dolan S, Cabdi N, Murray JB, Rejaei Y, Stewart S, Edwardson K, Dean J, Mehta B, Yeung S, Coenen F, Niessen LW, Carrol ED
Abstract: BACKGROUND: Paediatric fever is a common cause of emergency department (ED) attendance. A lack of prompt and definitive diagnostics makes it difficult to distinguish viral from potentially life-threatening bacterial causes, necessitating a cautious approach. This may result in extended periods of observation, additional radiography, and the precautionary use of antibiotics (ABs) prior to evidence of bacterial foci. This study examines resource use, service costs, and health outcomes.
METHODS: We studied an all-year prospective, comprehensive, and representative cohort of 6518 febrile children (aged < 16 years), attending Alder Hey Children's Hospital, an NHS-affiliated paediatric care provider in the North West of England, over a 1-year period. Performing a time-driven and activity-based micro-costing, we estimated the economic impact of managing paediatric febrile illness, with focus on nurse/clinician time, investigations, radiography, and inpatient stay. Using bootstrapped generalised linear modelling (GLM, gamma, log), we identified the patient and healthcare provider characteristics associated with increased resource use, applying retrospective case-note identification to determine rates of potentially avoidable AB prescribing.
RESULTS: Infants aged less than 3 months incurred significantly higher resource use than any other age group, at £1000.28 [95% CI £82.39-£2993.37] per child, (p < 0.001), while lesser experienced doctors exhibited 3.2-fold [95% CI 2.0-5.1-fold] higher resource use than consultants (p < 0.001). Approximately 32.4% of febrile children received antibiotics, and 7.1% were diagnosed with bacterial infections. Children with viral illnesses for whom antibiotic prescription was potentially avoidable incurred 9.9-fold [95% CI 6.5-13.2-fold] cost increases compared to those not receiving antibiotics, equal to an additional £1352.10 per child, predominantly resulting from a 53.9-h increase in observation and inpatient stay (57.1 vs. 3.2 h). Bootstrapped GLM suggested that infants aged below 3 months and those prompting a respiratory rate 'red flag', treatment by lesser experienced doctors, and Manchester Triage System (MTS) yellow or higher were statistically significant predictors of higher resource use in 100% of bootstrap simulations.
CONCLUSION: The economic impact of diagnostic uncertainty when managing paediatric febrile illness is significant, and the precautionary use of antibiotics is strongly associated with increased costs. The use of ED resources is highest among infants (aged less than 3 months) and those infants managed by lesser experienced doctors, independent of clinical severity. Diagnostic advances which could increase confidence to withhold antibiotics may yield considerable efficiency gains in these groups, where the perceived risks of failing to identify potentially life-threatening bacterial infections are greatest.
KEYWORDS: Antibiotics; Children; Cost of illness; Febrile; Fever; Health economics; Pyrexia; United Kingdom

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WUTH publication: Pneumatosis intestinalis after fistuloclysis

Citation: Nutrition. Nutrition. 2019, 62, 18-9. Epub 2018 Dec 3
Author: Appleton N, Day N, Walsh C
Abstract: We present an unique case report of pneumatosis intestinalis after fistuloclysis.
Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.
KEYWORDS: Pneumatosis intestinalis; fistuloclysis

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WUTH publication: Can C-Reactive Protein Be Used to Predict Acute Septic Arthritis in the Adult Population?

Citation: Southern Medical Journal. 2019, 112(2), 108-111
Author: Thornton L, Ormsby N, Allgar V, Thomas G
Abstract: OBJECTIVES: The objective of this study was to establish whether C-reactive protein (CRP) could be used to predict native joint septic arthritis (SA) in the adult population.
METHODS: All patients who underwent native joint aspiration in accident and emergency settings between April 2012 and September 2016 were identified from laboratory microbiology records. Patients were divided into three groups for analysis: patients with SA, patients with crystal arthropathy, and patients with normal or osteo/inflammatory arthritic joints.
RESULTS: Fifteen patients (7.9%) were deemed to have SA, 18 patients had crystal arthropathy (9.5%), and 157 patients (82.6%) were deemed to have normal or osteo/inflammatory arthritic joints. All of the patients with CRP >200 mg/L had SA. Patients with CRP 90 to 200 mg/L had a mix of crystal arthropathy and SA, and patients with CRP <90 mg/L had either normal or osteo/inflammatory arthritic joints or crystal arthropathy. The mean CRP in patients with a normal or osteo/inflammatory arthritic joint was 25 mg/L. This was compared with 100 mg/L (P ≤ 0.001) in patients with crystal arthropathy and 308 mg/L (P ≤ 0.001) in patients with SA.
CONCLUSIONS: We demonstrated CRP to be a reliable independent marker to help differentiate among SA, crystal arthropathy, and normal/arthritic joints in an adult population. No patients with CRP <90 mg/L had SA.

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WUTH publication: Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals

Citation: British Journal of Anaesthesia. 2018, 121(4), 730-738. Epub 2018 Sep 7.
Author: Wong DJN, Harris SK, Moonesinghe SR, SNAP-2: EPICCS collaborators, Health Services Research Centre, National Institute of Academic Anaesthesia, Study Steering Group, Net Solving Limited, Trainee Research Networks, Abertawe Bro Morgannwg University Health Board, Aintree University Hospitals NHS Foundation Trust, Airedale NHS Foundation Trust, Aneurin Bevan Health Board, Ashford & St Peters NHS Foundation Trust, Barking, Havering and Redbridge University Hospitals NHS Trust, Barnsley Hospital NHS Foundation Trust, Barts Health NHS Trust, Basildon and Thurrock University Hospitals NHS Foundation Trust, Bedford Hospital NHS Trust, Belfast Health and Social Care Trust, Betsi Cadwaladr University Health Board, Birmingham Women's NHS Foundation Trust, Blackpool Teaching Hospitals NHS Foundation Trust, Bolton Hospital NHS Foundation Trust, Bradford Teaching Hospitals NHS Foundation Trust, Brighton and Sussex University Hospitals NHS Trust, Buckinghamshire Healthcare NHS Trust, Burton Hospitals NHS Foundation Trust, Calderdale and Huddersfield NHS Foundation Trust, Cambridge University Hospitals NHS Foundation Trust, Cardiff and Vale University Health Board, Central Manchester University Hospitals NHS Foundation Trust, Chelsea and Westminster Hospital NHS Foundation Trust, Chesterfield Royal Hospital NHS Foundation Trust, Christie Hospital NHS Foundation Trust, City Hospitals Sunderland NHS Foundation Trust, Colchester Hospital University NHS Foundation Trust, Countess of Chester NHS Foundation Trust, County Durham and Darlington NHS Foundation Trust, Croydon Health Services NHS Trust, Cwm Taf University Health Board, Dartford and Gravesham NHS Trust, Derby Hospitals NHS Foundation Trust, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Dorset County Hospital NHS Foundation Trust, Dudley Group NHS Foundation Trust, East and North Hertfordshire NHS Trust, East Kent Hospitals University NHS Foundation Trust, East Lancashire Hospitals NHS Trust, East Sussex Healthcare NHS Trust, Epsom and St Helier University Hospitals NHS Trust, Frimley Health NHS Foundation Trust, Gateshead Health NHS Foundation Trust, Gloucestershire Hospitals NHS Foundation Trust, Great Western Hospitals NHS Foundation Trust, Guy's and St Thomas' NHS Foundation Trust, Hampshire Hospitals NHS Foundation Trust, Harrogate and District NHS Foundation Trust, Heart Of England NHS Foundation Trust, Hillingdon Hospitals NHS Foundation Trust, Homerton University Hospital NHS Foundation Trust, Hull and East Yorkshire Hospitals NHS Trust, Hywel Dda Health Board, Imperial College Healthcare NHS Trust, Ipswich Hospital NHS Trust, Isle of Wight NHS Trust, James Paget University Hospitals NHS Foundation Trust, Kettering General Hospital NHS Foundation Trust, King's College Hospital NHS Foundation Trust, Kingston Hospital NHS Foundation Trust, Lancashire Teaching Hospitals NHS Foundation Trust, Leeds Teaching Hospitals NHS Trust, Lewisham and Greenwich NHS Trust, Liverpool Women's NHS Foundation Trust, Luton and Dunstable University Hospital NHS Foundation Trust, Medway NHS Foundation Trust, Mid Cheshire Hospitals NHS Foundation Trust, Mid Essex Hospital Services NHS Trust, Mid Yorkshire Hospitals NHS Trust, Milton Keynes University Hospital NHS Foundation Trust, Newcastle upon Tyne Hospitals NHS Foundation Trust, NHS Ayrshire & Arran, NHS Dumfries & Galloway, NHS Fife, NHS Greater Glasgow & Clyde, NHS Highland, NHS Lanarkshire, NHS Lothian, NHS Scotland Special Board, NHS Shetland, NHS Tayside, Norfolk and Norwich University Hospitals NHS Foundation Trust, Northampton General Hospital NHS Trust, North Bristol NHS Trust, North Cumbria University Hospitals NHS Trust, Northern Devon Healthcare NHS Trust, Northern Health and Social Care Trust, Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, North Middlesex University Hospital NHS Trust, North Tees and Hartlepool NHS Trust, Northumbria Healthcare NHS Foundation Trust, North West Anglia NHS Foundation Trust, Nottingham University Hospitals NHS Trust, Oxford University Hospitals NHS Foundation Trust, Papworth Hospital NHS Foundation Trust, Pennine Acute NHS Trust, Plymouth Hospitals NHS Trust, Poole Hospital NHS Foundation Trust, Portsmouth Hospitals NHS Trust, Princess Alexandra Hospital NHS Trust, Queen Elizabeth Hospital NHS Foundation Trust, Queen Victoria Hospital NHS Foundation Trust, Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust, Rotherham NHS Foundation Trust, Royal Berkshire NHS Foundation Trust, Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust, Royal Cornwall Hospitals NHS Trust, Royal Devon and Exeter NHS Foundation Trust, Royal Free London NHS Foundation Trust, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Royal Marsden NHS Foundation Trust, Royal National Orthopaedic Hospital NHS Trust, Royal Orthopaedic Hospital NHS Foundation Trust, Royal Surrey County Hospital NHS Foundation Trust, Royal United Hospitals Bath NHS Trust, Royal Wolverhampton Hospitals NHS Trust, Salford Royal NHS Foundation Trust, Salisbury NHS Foundation Trust, Sandwell and West Birmingham Hospitals NHS Trust, Sheffield Teaching Hospitals NHS Foundation Trust, Shrewsbury and Telford Hospital NHS Trust, South Eastern Health and Social Care Trust, Southport and Ormskirk Hospital NHS Trust, South Tees Hospitals NHS Foundation Trust, South Tyneside NHS Foundation Trust, South Warwickshire NHS Foundation Trust, St George's Healthcare NHS Trust, St Helens and Knowsley Teaching Hospitals NHS Trust, Stockport NHS Foundation Trust, Surrey and Sussex Healthcare NHS Trust, Tameside Hospital NHS Foundation Trust, Taunton and Somerset NHS Foundation Trust, Torbay and South Devon NHS Foundation Trust, United Lincolnshire Hospitals NHS Trust, University College London Hospitals NHS Foundation Trust, University Hospital of North Midlands NHS Trust, University Hospital of South Manchester NHS Foundation Trust, University Hospitals Birmingham NHS Foundation Trust, University Hospitals Bristol NHS Foundation Trust, University Hospitals Coventry and Warwickshire NHS Trust, University Hospitals of Leicester NHS Trust, University Hospitals of Morecambe Bay NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, Walsall Healthcare NHS Trust, Warrington & Halton Hospitals NHS Foundation Trust, Western Health and Social Care Trust, Western Sussex Hospitals NHS Foundation Trust, West Herts Hospitals NHS Trust, Weston Area Health NHS Trust, West Suffolk NHS Foundation Trust, Whittington Hospital NHS Trust, Wirral University Teaching Hospital NHS Foundation Trust, Worcestershire Acute Hospitals NHS Trust, Wrightington, Wigan and Leigh NHS Foundation Trust, Wye Valley NHS Trust, Yeovil District Hospital NHS Foundation Trust, York Teaching Hospital NHS Foundation Trust
Abstract: BACKGROUND: Cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS.
METHODS: We conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical cancellations were recorded. Using multilevel logistic regression, we identified patient- and hospital-level factors associated with cancellation due to inadequate bed capacity.
RESULTS: We analysed data from 14 936 patients undergoing planned surgery. A total of 1499 patients (10.0%) reported previous cancellation for the same procedure; contemporaneous hospital census data indicated that 13.9% patients attending inpatient operations were cancelled on the day of surgery. Non-clinical reasons, predominantly inadequate bed capacity, accounted for a large proportion of previous cancellations. Independent risk factors for cancellation due to inadequate bed capacity included requirement for postoperative critical care [odds ratio (OR)=2.92; 95% confidence interval (CI), 2.12-4.02; P<0.001] and the presence of an emergency department in the treating hospital (OR=4.18; 95% CI, 2.22-7.89; P<0.001). Patients undergoing cancer surgery (OR=0.32; 95% CI, 0.22-0.46; P<0.001), obstetric procedures (OR=0.17; 95% CI, 0.08-0.32; P<0.001), and expedited surgery (OR=0.39; 95% CI, 0.27-0.56; P<0.001) were less likely to be cancelled.
CONCLUSIONS: A significant proportion of patients presenting for surgery have experienced a previous cancellation for the same procedure. Cancer surgery is relatively protected, but bed capacity, including postoperative critical care requirements, are significant risk factors for previous cancellations.
Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
KEYWORDS: Health Services Research; medical resource utilisation; operating room management; surgery

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WUTH publication: The Liverpool Peritonsillar abscess Score (LPS): Development of a predictive score through a prospective multi-centre observational study

Citation: Clinical Otolarygology. 2019 Jan 21 [Epub ahead of print]
Author: Lau AS, Selwyn DM, Yang D, Swainbank L, Ridley P, Carmichael N, Metcalfe C, Watson G, Emerson H
Abstract: OBJECTIVES: While uncommon in the population at large, peritonsillar abscess (PTA) is a common subject of ENT referrals. Missed or uncertain diagnosis is a source of concern for non-specialist referrers. In line with the NHS England Second Sepsis Action Plan, we aimed to develop a predictive score for the presence of PTA. This would help to improve non-specialist colleagues' diagnostic certainty as well as to support ENT surgeons' triage of these referrals.
DESIGN: Prospective, multi-centre observational study.
SETTING: Primary and secondary care.
PARTICIPANTS: Patients >16 years with symptoms of sore throat.
DATA: We prospectively collected comprehensive data on patient demographics, symptoms and clinical status. We documented whether the patient had aspiration-proven PTA or not. We performed binary logistic regression analysis, iterative development of a predictive score which we validated internally.
RESULTS: 100 patients were included (46 PTA and 54 tonsillitis). Five variables added significantly to the logistic regression model: unilateral sore throat; trismus; male gender; pharyngeal voice change; uvular deviation. Using the odds ratio outputs, we developed the Liverpool Peritonsillar abscess Score (LPS) iteratively. We validated the latest (third) iteration of the LPS internally (ie on the same sample), yielding sensitivity 96%; specificity 85%; positive predictive value 85% and negative predictive value 96%. Area under the receiver operating characteristics (AUROC) curve was 0.970.
CONCLUSIONS: We have developed the first predictive score for PTA based on symptoms and signs that do not require the user to have specialist experience. Its high negative predictive value may be particularly helpful to non-specialist colleagues. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
KEYWORDS: Peritonsillar abscess; Predictive score; Sore throat; Swallowing; Trismus

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WUTH publication: Diagnostic accuracy of the T-MACS decision aid with a contemporary point-of-care troponin assay

Citation: Heart. 2019, 105(10), 768-74 Epub 2019 Jan 12
Author: Body R, Almashali M, Morris N, Moss P, Jarman H, Appelboam A, Parris R, Chan L, Walker A, Harrison M, Wootten A, McDowell G
Abstract: OBJECTIVES: The rapid turnaround time of point-of-care (POC) cardiac troponin (cTn) assays is highly attractive for crowded emergency departments (EDs). We evaluated the diagnostic accuracy of the Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid with a POC cTn assay.
METHODS: In a prospective diagnostic accuracy study at eight EDs, we included patients with suspected acute coronary syndromes (ACS). Blood drawn on arrival and 3 hours later was analysed for POC cTnI (i-Stat, Abbott Point of Care). The primary outcome was a diagnosis of ACS, which included both an adjudicated diagnosis of acute myocardial infarction (AMI) based on serial laboratory cTn testing and major adverse cardiac events (death, AMI or coronary revascularisation) within 30 days.
RESULTS: Of 716 patients included, 105 (14.7%) had ACS. Using serial POC cTnI concentrations over 3 hours could have 'ruled out' ACS in 198 (31.2%) patients with a sensitivity of 99.0% (95% CI 94.4% to 100.0%) and negative predictive value 99.5% (95% CI 96.5% to 99.9%). No AMIs were missed. T-MACS 'ruled in' ACS for 65 (10.4%) patients with a positive predictive value of 91.2% (95% CI 82.1% to 95.9%) and specificity 98.9% (97.6% to 99.6%).
CONCLUSION: With a POC cTnI assay, T-MACS could 'rule out' ACS for approximately one-third of patients within 3 hours while 'ruling in' ACS for another 10%. The rapid turnaround time and portability of the POC assay make this an attractive pathway for use in crowded EDs or urgent care centres. Future work should also evaluate use in the prehospital environment.
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS: acute coronary syndromes; cardiac troponin; clinical decision rules; sensitivity and specificity

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