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Journal articleWhitlock GG, Gibbons DC, Longford N, et al., 2018,
Rapid testing and treatment for sexually transmitted infections improve patient care and yield public health benefits
, International Journal of STD and AIDS, Vol: 29, Pages: 474-482, ISSN: 0956-4624A service evaluation of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing and result notification in patients attending a rapid testing service (Dean Street Express [DSE]) compared with those attending an existing ‘standard’ sexual health clinic (56 Dean Street [56DS]), and modelling the impact of the new service from 1 June 2014 to 31 May 2015. Primary outcome: time from patients’ sample collection to notification of test results at DSE compared with 56DS. Secondary outcomes estimated using a model: number of transmissions prevented and the number of new partner visits avoided and associated cost savings achieved due to rapid testing at DSE. In 2014/15, there were a total of 81,352 visits for CT/NG testing across 56DS (21,086) and DSE (60,266). Rapid testing resulted in a reduced mean time to notification of 8.68 days: 8.95 days for 56DS (95% CI 8.91–8.99) compared to 0.27 days for DSE (95% CI 0.26–0.28). Our model estimates that rapid testing at DSE would lead to 196 CT and/or NG transmissions prevented (2.5–97.5% centile range = 6–956) and lead to annual savings attributable to reduced numbers of partner attendances of £124,283 (2.5–97.5% centile range = £4260–590,331). DSE, a rapid testing service for asymptomatic infections, delivers faster time to result notification for CT and/or NG which enables faster treatment, reduces infectious periods and leads to fewer transmissions, partner attendances and clinic costs.
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Journal articleModi N, 2018,
The case for child health
, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 103, Pages: 316-318, ISSN: 0003-9888- Author Web Link
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Journal articleKaneko T, Shekar P, Ivkovic V, et al., 2018,
Should the dilated ascending aorta be repaired at the time of bicuspid aortic valve replacement?
, European Journal of Cardio-Thoracic Surgery, Vol: 53, Pages: 560-568, ISSN: 1010-7940OBJECTIVESBicuspid aortic valve (BAV) is the most common congenital valvular abnormality and frequently presents with accelerated calcific aortic valve disease, requiring aortic valve replacement (AVR) and thoracic aortic aneurysm and dissection. Supporting evidence for Association Guidelines of aortic dimensions for aortic resection is sparse. We sought to determine whether concurrent repair of dilated or aneurysmal aortic disease during AVR in patients with BAV substantially improves morbidity and mortality outcomes.METHODSMortality and reoperation outcomes of 1301 adults with BAV and dilated aorta undergoing AVR-only surgery were compared to patients undergoing AVR with aortic resection (AVR-AR) using Cox proportional hazards modelling and patient matching.RESULTSClinically important differences in patient characteristics, aortic valve function and aortic dimensions were identified between cohorts. Event rates were low, with rates of reoperation and death within 1 year of only 1.8% and 5.4%, respectively, and no aortic dissection observed during follow-up. There were no significant differences in reoperation or mortality outcomes between the AVR-only and AVR-AR cohorts. Age, aortic dimension or a combination thereof was not associated with better or worse outcomes after each AVR-AR compared with AVR.CONCLUSIONSWe conclude AVR-only and AVR-AR surgery have low morbidity and mortality and have utility over a wide range of age and aortic sizes. Our results do not provide support for the 45-mm aortic dimension recommended in the current guidelines for aortic resection while performing AVR or any other specific dimension.
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Journal articleLongford NT, 2018,
Searching for causes of necrotising enterocolitis. An application of propensity matching
, Statistics in Transition new series, Vol: 19, ISSN: 1234-7655Necrotising enterocolitis (NEC) is a disease of the gastrointestinal tract afflicting preterm-born infants in the first few weeks of their lives. We estimate the effect of changing the feeding regimen of infants in their first 14 postnatal days by analysing the data from the UK National Neonatal Research Database. We avoid some problems with drawing causal inferences from observational data by reducing the analysis to the infants who spent the first 14 postnatal days (or longer) in neonatal care and for whom NEC was not suspected in this period. This reduction enables us to use summaries of the feeding regimen in this period as background variables in a potential outcomes framework. Large size of the cohort is a distinct advantage of our study. Its results inform the design of a randomised clinical trial for preventing NEC, and the choice of its active treatment(s) in particular.
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Journal articleBattersby C, Mousinho RMA, Longford N, et al., 2018,
Use of pasteurised human donor milk across neonatal networks in England
, EARLY HUMAN DEVELOPMENT, Vol: 118, Pages: 32-36, ISSN: 0378-3782ObjectivesTo describe the use of pasteurised human donor milk (pHDM) in England and the influence of a human milk bank in the network.DesignProspective observational studySettingAll 163 neonatal units (23 networks) in England 2012–2013.PatientsPreterm infants born at <32 weeks gestational age (GA).Main outcome measuresProportion of infants and care-days fed pHDM during the first 30 postnatal days by networkMethodsWe extracted daily patient-level data from the National Neonatal Research Database (NNRD). We fitted a logistic regression of pHDM exposure on the presence of a pHDM bank within the network, with GA, BW z score and network as covariates. Significance was assessed by the likelihood ratio (chi-squared) test.ResultsData for 13,463 infants were included in the study. Across the networks, the proportion (95%CI) of infants ranged from 2.0% (1.0, 3.0) to 61.0% (57.4%, 64.6%), and the proportion of care-days in which pHDM was fed from 0.08% (0.04%, 0.10%) to 21.9% (19.9%, 24.0%). In three networks <5%, and in seven networks >30% of infants received any pHDM. Variation in the use of pHDM across networks remained significant after adjustment for presence of a human milk bank within the network and all covariates (p < 0.001).ConclusionsWide variation of pHDM use in England is not fully explained by presence of a pHDM bank or patient characteristics. This suggests clinical uncertainty about the use of pHDM.
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Journal articleBattersby CWS, Santhalingam T, Costeloe K, et al., 2018,
Incidence of neonatal Necrotising Enterocolitis in high income countries: a systematic review
, Archives of Disease in Childhood. Fetal and Neonatal Edition, Vol: 103, Pages: F182-F189, ISSN: 1359-2998Objective To conduct a systematic review of neonatal necrotising enterocolitis (NEC) rates in high-income countries published in peer-reviewed journals.Methods We searched MEDLINE, Embase and PubMed databases for observational studies published in peer-reviewed journals. We selected studies reporting national, regional or multicentre rates of NEC in 34 Organisation for Economic Co-operation and Development countries. Two investigators independently screened studies against predetermined criteria. For included studies, we extracted country, year of publication in peer-reviewed journal, study time period, study population inclusion and exclusion criteria, case definition, gestation or birth weight-specific NEC and mortality rates.Results Of the 1888 references identified, 120 full manuscripts were reviewed, 33 studies met inclusion criteria, 14 studies with the most recent data from 12 countries were included in the final analysis. We identified an almost fourfold difference, from 2% to 7%, in the rate of NEC among babies born <32 weeks’ gestation and an almost fivefold difference, from 5% to 22%, among those with a birth weight <1000 g but few studies covered the entire at-risk population. The most commonly applied definition was Bell’s stage ≥2, which was used in seven studies. Other definitions included Bell’s stage 1–3, definitions from the Centers for Disease Control and Prevention, International Classification for Diseases and combinations of clinical and radiological signs as specified by study authors.Conclusion The reasons for international variation in NEC incidence are an important area for future research. Reliable inferences require clarity in defining population coverage and consistency in the case definition applied.
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Journal articleLongford NT, 2018,
Decision theory for comparing institutions
, Statistics in Medicine, Vol: 37, Pages: 457-472, ISSN: 0277-6715Various forms of performance assessment are applied to public service institutions, such as hospitals, schools, police units, and local authorities. Difficulties arise in the interpretation of the results presented in some established formats because they require a good understanding and appreciation of the uncertainties involved. Usually the results have to be adapted to the perspectives of the users—managers of the assessed units, a consumer, or a central authority (a watchdog) that dispenses awards and sanctions. We present a decision‐theoretical approach to these and related problems in which the perspectives are integrated in the analysis and its results are choices from a finite list of options (alternative courses of action).
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ReportLongford N, Modi N, 2018,
Analysis of neonatal mortality data for year 2016
, Analysis of neonatal mortality data for year 2016, https://www.imperial.ac.uk/neonatal-data-analysis-unit/our-research/reports/, Publisher: The Neonatal Data Analysis Unit, Imperial College LondonThis report presents an analysis of neonatal mortality in infants born in 2016 at agestational age (GA) less that 32 weeks, and who were admitted to neonatal units thatform the UK Neonatal Collaborative in England, Wales and Scotland (part). Everyneonatal unit was informed of the analysis in advance and was requested to confirmthe accuracy and completeness, or make amendments, in the data they had entered onthe Badger.Net platform. The analysis in this report is based on these data, held inthe National Neonatal Research Database (NNRD).
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Journal articleBinder C, Longford N, Gale CRK, et al., 2018,
Body composition following necrotising enterocolitis in preterm infants
, Neonatology, Vol: 113, Pages: 242-248, ISSN: 1661-7800Background: The optimal nutritional regimen for preterm infants, including those that develop necrotising enterocolitis (NEC), is unknown. Objective: The objective here was to evaluate body composition at term in infants following NEC, in comparison with healthy infants. The primary outcome measure was non-adipose tissue mass (non-ATM). Methods: We compared body composition assessed by magnetic resonance imaging at term in infants born <31 weeks of gestational age that participated in NEON, a trial comparing incremental versus immediate delivery of parenteral amino acids on non-ATM, and SMOF versus intralipid on intrahepatocellular lipid content. There were no differences in the primary outcomes. We compared infants that received surgery for NEC (NEC-surgical), infants with medically managed NEC (NEC-medical), and infants without NEC (reference). Results: A total of 133 infants were included (8 NEC-surgical; 15 NEC-medical; 110 reference). In comparison with the reference group, infants in the NEC-surgical and NEC-medical groups were significantly lighter [adjusted mean difference (95% CI) NEC-surgical: –630 g (–1,010, –210), p = 0.003; NEC-medical: –440 g (–760, –110), p = 0.009] and the total adipose tissue volume (ATV) was significantly lower [NEC-surgical: –360 cm3 (–516, –204), p < 0.001; NEC-medical: –127 cm3 (–251, –4); p = 0.043]. There were no significant differences in non-ATM [adjusted mean difference (95% CI) NEC-surgical: –46 g (–281, 189), p = 0.70; NEC-medical: –122 g (–308, 63), p = 0.20]. Conclusion: The lower weight at term in preterm infants following surgically and medically managed NEC, in comparison to preterm infants that did not develop the disease, was secondary to a reduction in ATV. This suggests that the nutritional regimen received was adequate to preserve non-ATM but not to support the normal third-trimester deposition of adipose tissue
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Journal articleWebbe J, Modi N, Gale C, 2018,
Core quality and outcome measures for pediatric health
, JAMA Pediatrics, Vol: 172, Pages: 299-300, ISSN: 2168-6203
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