When patients are discharged from hospital those with diabetes are at an increased risk of readmission and mortality, there are guidelines for discharging patients with diabetes to reduce these risks, however researchers from the Institute of Digital Healthcare at WMG, University of Warwick and Warwick Medical School have identified known risk factors for mortality in adult patients discharged from hospital with diabetes.
In the paper, ‘A Systematic Review Considering Risk factors for Mortality of Patients Discharged from Hospital with a Diagnosis of Diabetes’, published in the Journal of Diabetes and its Complications, researchers identified 35 studies that considered the risk factors relating to mortality for patients discharged from hospital with diabetes, they analysed these studies and identified 48 significant risk factors for mortality.
The 48 risk factors are grouped into the following nine categories:
· Patient medical factors
· Inpatient stay factors
· Medication related
· Laboratory results
· Glycaemic status
Professor Theo Arvanitis, from the Institute of Digital Healthcare at WMG, University of Warwick comments:
“The most common risk factor is in the demographic category of age and the second most important factor is co-morbidity burden; this comes under the patient medical factors category, and means patients have more than one condition. We also identified BMI as a significant risk within the patient medical factors category, with those who were at the heavier end of the scales to be more at risk.
“Thirty-seven of the risk factors we identified from one research paper. This tell us that this research in general is still very early, and more studies are needed to identify the importance and possibly any other risk factors. This could decrease the mortality rate of diabetics discharged from hospitals in the future.”
2 SEPTEMBER 2020
NOTES TO EDITORS
High-res images available at:
Caption: Professor Theo Arvanitis, from the Institute of Digital Healthcare at WMG, University of Warwick
Paper available to view: https://doi.org/10.1016/j.jdiacomp.2020.107705
- The C3-Cloud could be the future for supporting coordinated care across GPs, hospitals and specialties
- The novel solution would benefit patients with multiple conditions who are most in need of a holistic care plan
- It has been recognised by the European Innovation Radar as ‘tech ready’ and could be used to support remote care, not only in everyday use but also in the current and future pandemics
Typically, when a patient is receiving care from GPs and Hospitals, these are normally uncoordinated and the patient is often presented with conflicting advice, or clinicians are required to assess patients without access to all of the patient’s relevant history, often making care fragmented and inefficient, particularly for an ageing population who may have multiple conditions and need care from multiple specialists and stakeholders.
Healthcare has seen an explosive growth in the amount of data produced, which has led to more data driven and evidence based protocols. However, this has also presented challenges as data can become locked in silos or to particular vendors, limiting their availability for reuse, dissemination and potential to improve patient outcomes.
However, C3-Cloud (collaborative cure and care system) is a digital infrastructure offering integrated care capability for multi-morbidity management. It enables collaboration across a number of healthcare systems and settings, allowing clinicians to semi-automatically generate a holistic personalised care plan, which offers an integrated view of the patient’s conditions, measurements, medication and goals.
Patients and their multi-disciplinary care team can collaboratively create, review and edit the plan, empowering the patient to make decisions about their care. The care plan personalisation process is supported by a Clinical Decision Support module, implementing over 500 rules, consolidating and reconciling multiple clinical practice guidelines of common comorbidities (for example, diabetes, heart failure, renal failure and depression). The system accommodates local organisational aspects such as roles, as well interoperability to existing systems, it is currently deployed in three pilot sites in the UK, Spain and Sweden, integrating with their health systems and supporting coordinated care.
The C3-Cloud technology is flexible enough to support other conditions, including supporting remote management generally, which can be applied to situations, such as in the current COVID-19 pandemic. The project has recently investigated plans for deployment in such pandemic scenarios.
Professor Theo Arvanitis, the C3-Cloud project co-ordinator from the Institute of Digital Healthcare at WMG, University of Warwick comments:
“As the world develops and becomes more digital it is essential our healthcare system does too. With an ever growing population and life expectancies increasing it’s important to make a digital healthcare system that works for everyone and that is what the C3-Cloud does.
“Not only does the C3-Cloud work across all systems, it can recommend treatments for patients with multiple health problems, which is helpful when someone is seeing multiple care outlets such as their GP and local hospital for different care needs.
“Our first pilot has taken place, and with the European Innovation Radar identifying C3-Cloud’s key components as tech ready, our next step is to expand this to large scale trials in multiple countries, this could lead to an enrolment in the system, and if there’s ever a pandemic like Covid-19 again different strategies for people with different health problems could be deployed rapidly.”
NOTES TO EDITORS
High-res images available to view at:
Professor Theo Arvanitis, Institute of Digital Healthcare, WMG, University of Warwick
Credit: WMG, University of Warwick
Caption: C3-Cloud Logo
Credit: WMG, University of Warwick
Caption: C3-Cloud Platform
Credit: WMG, University of Warwick
C3-Cloud introductory video to the public at youtube channel:https://www.youtube.com/watch?v=Y3K_lUQkupg
C3-Cloud @European Innovation Radarhttps://www.innoradar.eu/resultbykeyword/c3-cloud
Researchers, from WMG’s Institute of Digital Healthcare (IDH), believe that remote consulting practices should be adopted widely during the COVID-19 pandemic to help low and middle income countries to help combat the virus, and to provide quality healthcare to patients in the long-term.
By implementing remote consulting practices - such as by mobile phone or mobile app - to maintain services during the COVID-19 pandemic, health services in countries in Africa and South Asia could provide communities permanent access to healthcare that they previously struggled to access.
Researchers, at the University of Warwick and King’s College London, have developed and implemented a training course with St Francis University College in Tanzania designed to equip nurses, doctors and medical officers in leadership roles with the knowledge and skills to integrate remote consulting into practice in their local service. It is based on research recently published in the journal Digital Health that provides a framework for healthcare leaders to consider how to implement it in their own services. The training takes the form of a short course using blended learning through an app on a smartphone and facilitated through social media. These healthcare leaders cascade the learning to other health workers in their service.
Professor Theodoros N. Arvanitis, Director of the Institute of Digital Healthcare, WMG at the University of Warwick and one of the co-authors, commented: “Digitally-enabled approaches to remote consultation provide the way forward in the new reality we are living. The COVID-19 pandemic has changed the way we will receive health care in the future, manage our health and wellbeing and go about our daily lives. Remote consultation and digital health solutions provide multiple benefits to individuals and society. Through such approaches, now and in the future, people’s health journeys are better understood and appropriate lifestyle choices can be better tailored and promoted to the individual.”
Using mobile technology to see patients is part of the World Health Organisation’s COVID-19 response strategy, but detail there is limited. The researchers have put together a policy brief written in response to the COVID-19 pandemic to raise awareness of remote consulting and encouraging healthcare leaders in low to middle income countries to undertake the training and disseminate the knowledge within their local health service.
Professor Frances Griffiths from Warwick Medical School, and lead author of the paper, said: “Moving healthcare workers in low to middle income countries to remote consulting is something that we think is really important to consider.
“In the context of COVID-19, the benefits of remote consulting are suddenly much greater. It protects the health worker and minimises physical contact with patients. It minimises the risk to patients. As a result, it also reduces the need for PPE.
“For communities with little healthcare, this is a better way of providing good quality healthcare for them. For people who live anywhere who have a long term condition, it is so much more convenient for them if we can do as much as possible remotely.
“I think it will embraced more widely and I think it should be. What COVID-19 has done is made people realise that they can do it differently. The experience of COVID-19 in the UK is ahead of Africa and South Asia, but if we can get remote consulting off the ground there because of the pandemic then the benefits will be seen afterwards. Particularly for long-term conditions and marginalised communities, although there can be benefits for acute illnesses as well.”
Read ‘Mobile consulting (mConsulting) and its potential for providing access to quality healthcare for populations living in low-resource settings of low- and middle-income countries’ published in Digital Health, here: 10.1177/2055207620919594
Professor Theo Arvanitis has been appointed as the new Director of the Institute of Digital Healthcare (IDH), at WMG.
Professor Arvanitis takes over the new role replacing Professor Sudhesh Kumar from Warwick Medical School.
Professor Arvanitis will manage his new role alongside his current research responsibilities within WMG. He will be supported by a new IDH Advisory Board which will be appointed in the new year.
New approach helps computers deal with conflicts and duplications when applying more than one clinical practice guideline to a patient
Researchers in WMG at the University of Warwick have developed a new method that could solve the problem of how to automate support of managing the complexities of care when applying multiple clinical practice guidelines, to patients with more than one medical issue.
This will preserve the speed and accuracy of automated treatment decisions without introducing serious treatment conflicts or wasteful duplication of treatments and procedures.
Clinical Practice Guidelines (CPGs) are evidence-based statements or flow charts, which are used to support the decision-making of health professionals. CPGs are a body of knowledge representing best practice, based on the available evidence. Guidelines are relatively straightforward to input into a computer (a.k.a Computer Interpretable Guidelines (CIGs)), enhancing the speed and accuracy of patient care in many situations.
However, it becomes more problematic for patients who have more than one conditions. In such cases (known as multimorbid patients), the guideline recommendations for each treatment can be at odds, produce serious treatment conflicts and ultimately potential harm to the patient.
For instance, one drug-based medication might assist one condition but could worsen the other. This is particularly critical for elderly patients who are most likely to have dynamic and multiple health conditions.
The research team from WMG’s Institute of Digital Healthcare at the University of Warwick (Ms Eda Bilici, Dr George Despotou and Professor Theodoros Arvanitis) have implemented a framework of automating computer-based management of multiple Clinical Practice Guidelines to overcome this problem.
The new framework is called MuCIGREF – (Multiple Computer Interpretable Guideline Representation and Execution Framework). It allows development CIG models for each CPG. Once the CIG models are created, they are then concurrently executed to generate a unified personal plan for each individual multimorbid patient.
It ensures care optimisation to avoid unnecessary resource use or potential care duplications because of the multiple plans (e.g., carer time, lab test).
It identifies potential conflicts in the care plan and resolves them through the modification of clinical activities (e.g., activity start time, duration), or its associated care element (e.g. the drug dose level)
The researchers tested the new framework on several CPGs from the UK National Institute of Care Excellence (NICE), and they hope to conduct further work that will involve user validation and application in real-world cases.
This first stage in the work has just been published in a chapter entitled “Concurrent Execution of Multiple Computer- interpretable Clinical Practice Guidelines and Their Interrelations” in the Ebook Health Informatics Vision: From Data via Information to Knowledge
4 OCTOBER 2019
NOTES TO EDITORS
Paper Available to view at: https://www.ncbi.nlm.nih.gov/pubmed/31349252
Eda Bilici has received a PhD scholarship from WMG, University of Warwick. Prof Theodoros Arvanitis and Dr George Despotou have been supported by the EU H2020 C3-Cloud Project
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Using Blockchain Technology, our team of Assistant Professor George Despotou, Research Assistant Jill Evans, Professor Theo Arvanitis and PhD student Tim Robbins are developing a digital consent service for the exchange of patient data across electronic health records in an integrated care setting. High levels of encryption allow information to be shared securely with consent, and audit records stored on a “Blockchain” to ensure compliance with information governance rules.
Patients using this consent mechanism will be able to actively control how they share their data, and approve or refuse (case-by-case), from a mobile app.
As life expectancy is at an all-time high, this type of research has become an international priority offering enormous potential to support individuals, communities, clinicians and policy makers.
Our Professor of e-Health Innovation and Head of Research, Theo Arvanitis, Dr Timothy Robbins and Dr Sarah Lim Choi Keung, worked alongside experts at University Hospitals Coventry and Warwickshire to establish the extent to which current research literature considers e-health-based and telemedicine-based active ageing interventions.
Researchers at our Institute of Digital Healthcare (IDH) have been working, with the health and fitness app Sweatcoin, to develop a new verification process that will now allow indoor steps to be tracked for the first time.
Sweatcoin monitors steps throughout the day, via an app downloaded to a smartphone. Users are rewarded with one Sweatcoin (SWC) per every 1,000 steps. The digital currency can then be redeemed for items including magazines, clothing, music downloads and even televisions.
Previously the app was only capable of tracking outdoor steps - a big disadvantage for those with active jobs indoors or even those using the gym.
The 12-month project, funded by Innovate UK, collected large amounts of data from the sensors built into smartphones in parallel with step-count data recorded using high accuracy activity monitors. Researchers on the project then used this data to create a new step-verification model to work in any environment, not just outdoors.
WMG, at the University of Warwick, is a key partner in the Midlands site helping to deliver a £30 million project by Health Data Research UK, to address challenging UK healthcare issues using data science, which is looking at making game-changing improvements in people’s health by harnessing data science at scale across the UK.
WMG will be part of the “Midlands HDR UK Substantive Site”, which will tackle the challenge of how to make NHS data more useable and accessible for research; and will develop, evaluate and apply appropriate analytical tools to NHS data in real time in order to inform decision making and improve health for both the patient and population. The Institute of Digital Healthcare (IDH), WMG will lead the Warwick part of the programme, together with colleagues from Warwick Medical School and Warwick’s Mathematics Institute.
Research to help identify women at risk of pregnancy complications is to receive a huge financial boost.
The biobank will be the most significant collection of reproductive health tissues in the UK. Operating on a virtual basis with its server based at University Hospitals Coventry and Warwickshire NHS Trust (UHCW) and will begin operating on 29 September. It will store biological samples collected by scientists and clinicians at UHCW, the University of Warwick, University of Birmingham, Imperial College, Kings College London, University of Edinburgh and University of Manchester. The tissues, donated by women who have a history of pregnancy problems, and clinical data will help scientists find new causes and cures for miscarriage, stillbirth, and premature birth.