Leveraging real-world data to improve cochlear implant outcomes: Is the data available?

OBJECTIVES: A small but persistent proportion of individuals do not gain the expected benefit from cochlear implants(CI). A step-change in the understanding of factors affecting outcomes could come through data science. This study evaluates clinical data capture to assess the quality and utility of CI user's health records for data science, by assessing the recording of otitis media. Otitis media was selected as it is associated with the development of sensorineural hearing loss and may affect cochlear implant outcomes. METHODS: A retrospective service improvement project evaluating the medical records of 594 people with a CI under the care of the University of Southampton Auditory Implant Service between 2014 and 2020. RESULTS: The clinical records are suitable for data science research. Of the cohort studied 20% of Adults and more than 40% of the paediatric cases have a history of middle ear inflammation. DISCUSSION: Data science has potential to improve cochlear implant outcomes and improve understanding of the mechanisms underlying poor performance, through retrospective secondary analysis of real-world data. CONCLUSION: Implant centres and the British Cochlear Implant Group National Hearing Implant Registry are urged to consider the importance of consistently and accurate recording of patient data over time for each CI user. Data where links to hearing loss have been identified, such as middle ear inflammation, may be particularly valuable in future analyses and to inform clinical trials.

Implementing criteria-led discharge for acute admissions to facilitate the elective recovery from COVID-19: an example in acute tonsillitis.

BACKGROUND: Healthcare systems face unprecedented numbers of patients waiting for elective treatments in the wake of the COVID-19 pandemic. Hospitals must urgently optimise patient pathways and build capacity to meet the populations health needs. Criteria-led discharge (CLD) is frequently used to optimise elective care pathways but may hold potential in discharging patients at the end of an acute hospital admission. METHODS: We conducted a quality improvement project to design and introduce a novel inpatient pathway using CLD for patients with severe acute tonsillitis. Our analysis compared the standardisation of treatment, length of stay, discharge time and readmission rate between those treated on the novel pathway compared with standard treatment. RESULTS: The study population included 137 patients admitted to a tertiary centre with acute tonsillitis. Introduction of the tonsillitis pathway using CLD resulted in a significant reduction in median length of stay from 24 hours to 18 hours. Of those treated on the tonsillitis pathway, 52.2% were discharged prior to midday compared with 29.1% who received standard treatment. No patient discharged using CLD required readmission. CONCLUSION: CLD is safe and effective at reducing length of stay in patients requiring acute hospital admission for acute tonsillitis. CLD should be used and evaluated in further novel patient pathways across different areas of medicine to optimise care and build capacity for provision of elective healthcare services. Further research is required to investigate safe and optimal criteria which indicate patients are fit for discharge.

Refractory catatonia in old age: a case report.

BACKGROUND: Catatonia is a clinical syndrome characterized by psychomotor disruption, which often goes undiagnosed. Most reports have focused on interventions and outcomes for catatonia in younger people and those with schizophrenia. The clinical characteristics and course of catatonia in old age are poorly understood. We present a report of an older person whose catatonia was refractory to extensive treatment, and we identify important implications for the management of catatonia in old age. CASE PRESENTATION: We describe a 73-year-old white man with longstanding autistic spectrum disorder who presented with symptoms of depression. Following a period of diagnostic uncertainty and failure to improve with antidepressant medication, a lorazepam challenge yielded an abrupt improvement in presentation. The patient was treated extensively with lorazepam, zolpidem, and electroconvulsive therapy during his 16-month hospital admission, but his catatonia ultimately proved refractory to treatment. CONCLUSIONS: Catatonia should be considered promptly as a differential diagnosis in older people presenting with atypical features of functional mental illness. Although partial improvement of catatonic features was achieved using benzodiazepines and electroconvulsive therapy, these were not sustained in our patient. We identified comorbid autistic spectrum disorder, prolonged duration of catatonia, and sensitivity to benzodiazepines as important factors in prognostication in old age.

Design and implementation of the stacked, synchronised and iconographic timeline-structured electronic patient record in a UK NHS Global Digital Exemplar hospital.

BACKGROUND: Conventional electronic screen visualisation formats, which use tabs, dropdown menus, lists and multiple windows, present huge navigation challenges to health professionals. A unifying and intuitive interface for the electronic patient record (EPR) has been an elusive goal for software developers for decades. METHODS: Since 2009, by working in an agile way, we have built and implemented a fully operational and dynamic system, the University Hospital Southampton Lifelines (UHSL), within our clinical data estate, in a UK university hospital. UHSL permits the continuously updated display of the EPR on a single desktop computer screen in an intuitive format. During this iterative evolution, we have resolved a number of practical challenges in data display, while maintaining our core aims of end-user optimisation and radical simplification of the interface. Concurrently, we have upcycled a significant volume of clinical e-content, some from as far back as 1991, into UHSL, and at a marginal cost. OUTCOMES: UHSL went live in 2017 for all authorised staff at the hospital. It displays all e-records for 2.5 million patients and for more than 100 million documents and reports. It significantly reduces the screen time to navigate the individual EPR, and it offers substantial productivity gains in designated clinical services. CONCLUSIONS: UHSL has considerable further development potential as a National Health Service EPR interface, for the integration, display and ease of understanding of medical records across primary, secondary and community care.

The teaching of neurosurgery in UK medical schools: a message from British medical students.

BACKGROUND: A great variability exists in the clinical exposure of neurosurgery across all academic years in UK medical schools, although the effects of this on knowledge level and confidence in referring cases appropriately to specialists have not been reported. METHODS: A cross-sectional study was carried out involving students in years 1-5 across nine British medical schools. An electronic questionnaire was sent out which consisted of questions concerning the teaching of the subject; and questions assessing the knowledge of basic neurosurgery through mini clinical scenarios testing which specialty should receive a referral. RESULTS: Of 417 participants, 60 were excluded due to incomplete participation. Senior years outperformed students in junior years for correctly answered questions on five neurosurgical scenarios (mean score: years 1-3 (184/357) = 3.33/5, years 4-5 (173/357) = 3.79/5, p < 0.05). Participants in years 1-5 with prior clinical exposure in neurosurgery scored higher than participants who had no exposure (mean score: exposed (247/357) = 4.21/5, not-exposed (110/357) = 3 · 50/5, p < 0.05). Sixty-one percent prefer receiving neurosurgical teaching via increased exposure to operations. Students in years 4-5 with exposure in both classroom and operating theatre scored higher than students with classroom-only experience (mean classroom (69/131) = 3.62/5, mean classroom and operating theatre (62/131) = 4.21/5, p < 0.05); 33.3 % of final-year students reported difficulty in identifying patients that require neurosurgical referral. CONCLUSIONS: Students with exposure to an operating theatre outperformed those students exposed to just classroom teaching. Students indicated an increased preference for teaching through the operating theatre scene. One in three final-year medical students had difficulty identifying the need for a neurosurgical referral.If neurosurgical teaching were further enhanced at medical school, it could lead to increased confidence and efficiency in junior-year doctors when facing the neurosurgical referral process. Increased exposure to clinical neurosurgery may significantly improve the ability of future doctors to tackle neurosurgical scenarios.