The Tommy’s National Centre for Miscarriage Research aims to support the diagnosis and treatment ... more The Tommy’s National Centre for Miscarriage Research aims to support the diagnosis and treatment for couples suffering from recurrent miscarriage. Tommy’s Net is an electronic data gathering tool, collecting miscarriage data and links with hospital Clinical Information System databases. The gathering of patient reported data is an important aspect, especially as data relating to pregnancy and miscarriage events are often left unreported. Methods: Both traditional paper-based and electronic patient reported outcome (ePRO) solutions have been explored to improve response rates, minimize data redundancy and reduce burden on staff. Popular ePRO survey solutions have been compared, including REDCap, SurveyMonkey, Qualtrics and LimeSurvey. Results: LimeSurvey was selected as the most appropriate solution as it provided self-hosting capability, SMS integration and ease of use. Conclusion: We have implemented a LimeSurvey based ePRO system for collection of baseline and follow-up data for p...
Modern healthcare providers rely upon Electronic Healthcare Records (EHR) systems to record patie... more Modern healthcare providers rely upon Electronic Healthcare Records (EHR) systems to record patient data inside their own organization. Some healthcare providers share this data to facilitate patient care with other providers. Medical devices and healthcare providers can use differing standards of recording healthcare information. The Structural and Semantic Mapper Proxy API solution offers a practical way to tackles the issues of Structural and Semantic mapping of Application Programing Interfaces (API) in a healthcare context to enable connection of all existing systems to a healthcare providers EHR creating a single source of truth regarding the treatment of patients and enabling healthcare providers to bridge the gap between external EHR systems.
Left-ventricular (LV) remodelling, associated with diastolic heart failure, is driven by an incre... more Left-ventricular (LV) remodelling, associated with diastolic heart failure, is driven by an increase in myocardial stress. Therefore, normalisation of LV wall stress is the cornerstone of many therapeutic treatments. However, information regarding such regional stress-strain for human LV is still limited. Thus, the objectives of our study were to determine local diastolic stress-strain field in healthy LVs, and consequently, to identify the regional variations amongst them due to geometric heterogeneity. Effects of LV base movement on diastolic model predictions, which were ignored in the literature, were further explored. Personalised finite-element modelling of five normal human bi-ventricles was carried out using subject-specific myocardium properties. Model prediction was validated individually through comparison with end-diastolic volume and a new shape-volume based measurement of LV cavity, extracted from magnetic resonance imaging. Results indicated that incorporation of LV b...
Information flow between the thalamus and cerebral cortex is a crucial component of adaptive brai... more Information flow between the thalamus and cerebral cortex is a crucial component of adaptive brain function, but the details of thalamocortical interactions in human subjects remain unclear. The principal aim of this study was to evaluate the agreement between functional thalamic network patterns, derived using seed-based connectivity analysis and independent component analysis (ICA) applied separately to resting state functional MRI (fMRI) data from 21 healthy participants. For the seed-based analysis, functional thalamic parcellation was achieved by computing functional connectivity (FC) between thalamic voxels and a set of pre-defined cortical regions. Thalamus-constrained ICA provided an alternative parcellation. Both FC analyses demonstrated plausible and comparable group-level thalamic subdivisions, in agreement with previous work. Quantitative assessment of the spatial overlap between FC thalamic segmentations, and comparison of each to a histological "gold-standard"...
Proceedings of the Royal Society A: Mathematical, Physical and Engineering Sciences, 2005
We present a possible way to study large-size packet-switched networks capable of accounting for ... more We present a possible way to study large-size packet-switched networks capable of accounting for interactions between adjacent queues. The interaction between queues arises, because of the influence of the routing protocol on each switching decision, and the stochastic nature of packet lengths and inter-arrival times.Both the methodology and the analysis tools are adaptations of methods of statistical mechanics. The justification for their use lies in recent experimental evidence indicating that aggregate, core-network IP traffic, exhibits quasi-Markovian properties when the network is heavily loaded.In this paper, we present a general methodology and introduce approximations that greatly simplify the analysis. These approximations, are owing to the quasi-Markovian nature of the traffic and the large size of the network.
ObjectiveRemote or mobile consulting (mConsulting) is being promoted to strengthen health systems... more ObjectiveRemote or mobile consulting (mConsulting) is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during COVID-19 and beyond. We explored whether mConsulting is a viable option for communities with minimal resources in low- and middle-income countries (LMICs).MethodsWe reviewed evidence published since 2018 about mConsulting in LMICs and undertook a scoping study (pre-COVID) in two rural settings (Pakistan, Tanzania) and five urban slums (Kenya, Nigeria, Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites), and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mConsulting providers, local and national decision-makers. Project advisory groups guided the study in each country.ResultsWe reviewed five empirical studies and seven reviews, analysed data from 5,219 urban slum households and engag...
CAREPATH project is focusing on providing an integrated solution for sustainable care for multimo... more CAREPATH project is focusing on providing an integrated solution for sustainable care for multimorbid elderly patients with dementia or mild cognitive impairment. The project has a digitally enhanced integrated patient-centered care approach clinical decision and associated intelligent tools with the aim to increase patients’ independence, quality of life and intrinsic capacity. In this paper, the conceptual aspects of the CAREPATH project, in terms of technical and clinical requirements and considerations, are presented.
There is a need to constantly tackle a range of diverse and, sometimes, contradictory requirement... more There is a need to constantly tackle a range of diverse and, sometimes, contradictory requirements of people with multiple chronic conditions. Integrated Care provides a potential solution to this need and digital technology can be the proposition for addressing its implementation challenge. Digital technology can support clinical teams to achieve care across all levels and provide independence in patients’ lives, by supporting them in enhanced and integrated activity within our societal structures.
Introduction: (comprising context and problem statement) There is an increasing need to organise ... more Introduction: (comprising context and problem statement) There is an increasing need to organise the care around the patient and not the disease, taking into account his or her multiple physical and psycho-social conditions. An integrated, patient-centred care and cure delivery architecture needs to be developed considering the realities of multi-morbidity and poly-pharmacy. This needs to address the medical, technological, organisational and socio-economical challenges of creating a collaboration environment for all of the stakeholders involved in the holistic continuum of care. Short description of practice change implemented: The project C3-Cloud (H2020, PHC-25-2015, 689181) aims to enable the development of personalised care plans for multi-morbid conditions supported by innovative ICT components to improve delivery of integrated care services to elderly patients with multi-morbidity through continuous coordination of patient-centred care activities by a multidisciplinary care t...
The reuse of routinely collected clinical data for clinical research is being explored as part of... more The reuse of routinely collected clinical data for clinical research is being explored as part of the drive to reduce duplicate data entry and to start making full use of the big data potential in the healthcare domain. Clinical researchers often need to extract data from patient registries and other patient record datasets for data analysis as part of clinical studies. In the TRANSFoRm project, researchers define their study requirements via a Query Formulation Workbench. We use a standardised approach to data extraction to retrieve relevant information from heterogeneous data sources, using semantic interoperability enabled via detailed clinical modelling. This approach is used for data extraction from data sources for analysis and for pre-population of electronic Case Report Forms from electronic health records in primary care clinical systems.
BACKGROUND There is an increasing need to organise the care around the patient and not the diseas... more BACKGROUND There is an increasing need to organise the care around the patient and not the disease, as well as taking into account the complex realities of multiple physical, psycho-social conditions and polypharmacy. Integrated patient-centred care delivery platforms have been developed for both patients and clinicians. These platforms could provide a promising way to achieve a collaborative environment that improves the provision of integrated care for patients via enhanced ICT solutions. OBJECTIVE The C3-Cloud project has developed two collaborative computer platforms for patients and members of the Multi-Disciplinary Team and deployed these in three different European settings. The objective of this study is to pilot test the platforms and evaluate their impact on patients, informal caregivers, healthcare professionals and, in extend, healthcare systems. METHODS This paper describes the protocol for conducting an evaluation of the user-centred design, user experience, acceptabil...
International journal of medical informatics, Oct 1, 2017
The Learning Health System (LHS) requires integration of research into routine practice. 'eSo... more The Learning Health System (LHS) requires integration of research into routine practice. 'eSource' or embedding clinical trial functionalities into routine electronic health record (EHR) systems has long been put forward as a solution to the rising costs of research. We aimed to create and validate an eSource solution that would be readily extensible as part of a LHS. The EU FP7 TRANSFoRm project's approach is based on dual modelling, using the Clinical Research Information Model (CRIM) and the Clinical Data Integration Model of meaning (CDIM) to bridge the gap between clinical and research data structures, using the CDISC Operational Data Model (ODM) standard. Validation against GCP requirements was conducted in a clinical site, and a cluster randomised evaluation by site nested into a live clinical trial. Using the form definition element of ODM, we linked precisely modelled data queries to data elements, constrained against CDIM concepts, to enable automated patient i...
BRIDG is a widely known domain model of protocol-driven biomedical/clinical research. During a pr... more BRIDG is a widely known domain model of protocol-driven biomedical/clinical research. During a project to design a clinical trials management system for primary care research we developed a standard, computable representation of an RCT--the Primary Care Research Object Model (PCROM). We compared the PCROM Model to BRIDG and found significant overlap of concepts but also several areas important to our work that were either not yet represented or represented quite differently in BRIDG.
The Tommy’s National Centre for Miscarriage Research aims to support the diagnosis and treatment ... more The Tommy’s National Centre for Miscarriage Research aims to support the diagnosis and treatment for couples suffering from recurrent miscarriage. Tommy’s Net is an electronic data gathering tool, collecting miscarriage data and links with hospital Clinical Information System databases. The gathering of patient reported data is an important aspect, especially as data relating to pregnancy and miscarriage events are often left unreported. Methods: Both traditional paper-based and electronic patient reported outcome (ePRO) solutions have been explored to improve response rates, minimize data redundancy and reduce burden on staff. Popular ePRO survey solutions have been compared, including REDCap, SurveyMonkey, Qualtrics and LimeSurvey. Results: LimeSurvey was selected as the most appropriate solution as it provided self-hosting capability, SMS integration and ease of use. Conclusion: We have implemented a LimeSurvey based ePRO system for collection of baseline and follow-up data for p...
Modern healthcare providers rely upon Electronic Healthcare Records (EHR) systems to record patie... more Modern healthcare providers rely upon Electronic Healthcare Records (EHR) systems to record patient data inside their own organization. Some healthcare providers share this data to facilitate patient care with other providers. Medical devices and healthcare providers can use differing standards of recording healthcare information. The Structural and Semantic Mapper Proxy API solution offers a practical way to tackles the issues of Structural and Semantic mapping of Application Programing Interfaces (API) in a healthcare context to enable connection of all existing systems to a healthcare providers EHR creating a single source of truth regarding the treatment of patients and enabling healthcare providers to bridge the gap between external EHR systems.
Left-ventricular (LV) remodelling, associated with diastolic heart failure, is driven by an incre... more Left-ventricular (LV) remodelling, associated with diastolic heart failure, is driven by an increase in myocardial stress. Therefore, normalisation of LV wall stress is the cornerstone of many therapeutic treatments. However, information regarding such regional stress-strain for human LV is still limited. Thus, the objectives of our study were to determine local diastolic stress-strain field in healthy LVs, and consequently, to identify the regional variations amongst them due to geometric heterogeneity. Effects of LV base movement on diastolic model predictions, which were ignored in the literature, were further explored. Personalised finite-element modelling of five normal human bi-ventricles was carried out using subject-specific myocardium properties. Model prediction was validated individually through comparison with end-diastolic volume and a new shape-volume based measurement of LV cavity, extracted from magnetic resonance imaging. Results indicated that incorporation of LV b...
Information flow between the thalamus and cerebral cortex is a crucial component of adaptive brai... more Information flow between the thalamus and cerebral cortex is a crucial component of adaptive brain function, but the details of thalamocortical interactions in human subjects remain unclear. The principal aim of this study was to evaluate the agreement between functional thalamic network patterns, derived using seed-based connectivity analysis and independent component analysis (ICA) applied separately to resting state functional MRI (fMRI) data from 21 healthy participants. For the seed-based analysis, functional thalamic parcellation was achieved by computing functional connectivity (FC) between thalamic voxels and a set of pre-defined cortical regions. Thalamus-constrained ICA provided an alternative parcellation. Both FC analyses demonstrated plausible and comparable group-level thalamic subdivisions, in agreement with previous work. Quantitative assessment of the spatial overlap between FC thalamic segmentations, and comparison of each to a histological "gold-standard"...
Proceedings of the Royal Society A: Mathematical, Physical and Engineering Sciences, 2005
We present a possible way to study large-size packet-switched networks capable of accounting for ... more We present a possible way to study large-size packet-switched networks capable of accounting for interactions between adjacent queues. The interaction between queues arises, because of the influence of the routing protocol on each switching decision, and the stochastic nature of packet lengths and inter-arrival times.Both the methodology and the analysis tools are adaptations of methods of statistical mechanics. The justification for their use lies in recent experimental evidence indicating that aggregate, core-network IP traffic, exhibits quasi-Markovian properties when the network is heavily loaded.In this paper, we present a general methodology and introduce approximations that greatly simplify the analysis. These approximations, are owing to the quasi-Markovian nature of the traffic and the large size of the network.
ObjectiveRemote or mobile consulting (mConsulting) is being promoted to strengthen health systems... more ObjectiveRemote or mobile consulting (mConsulting) is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during COVID-19 and beyond. We explored whether mConsulting is a viable option for communities with minimal resources in low- and middle-income countries (LMICs).MethodsWe reviewed evidence published since 2018 about mConsulting in LMICs and undertook a scoping study (pre-COVID) in two rural settings (Pakistan, Tanzania) and five urban slums (Kenya, Nigeria, Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites), and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mConsulting providers, local and national decision-makers. Project advisory groups guided the study in each country.ResultsWe reviewed five empirical studies and seven reviews, analysed data from 5,219 urban slum households and engag...
CAREPATH project is focusing on providing an integrated solution for sustainable care for multimo... more CAREPATH project is focusing on providing an integrated solution for sustainable care for multimorbid elderly patients with dementia or mild cognitive impairment. The project has a digitally enhanced integrated patient-centered care approach clinical decision and associated intelligent tools with the aim to increase patients’ independence, quality of life and intrinsic capacity. In this paper, the conceptual aspects of the CAREPATH project, in terms of technical and clinical requirements and considerations, are presented.
There is a need to constantly tackle a range of diverse and, sometimes, contradictory requirement... more There is a need to constantly tackle a range of diverse and, sometimes, contradictory requirements of people with multiple chronic conditions. Integrated Care provides a potential solution to this need and digital technology can be the proposition for addressing its implementation challenge. Digital technology can support clinical teams to achieve care across all levels and provide independence in patients’ lives, by supporting them in enhanced and integrated activity within our societal structures.
Introduction: (comprising context and problem statement) There is an increasing need to organise ... more Introduction: (comprising context and problem statement) There is an increasing need to organise the care around the patient and not the disease, taking into account his or her multiple physical and psycho-social conditions. An integrated, patient-centred care and cure delivery architecture needs to be developed considering the realities of multi-morbidity and poly-pharmacy. This needs to address the medical, technological, organisational and socio-economical challenges of creating a collaboration environment for all of the stakeholders involved in the holistic continuum of care. Short description of practice change implemented: The project C3-Cloud (H2020, PHC-25-2015, 689181) aims to enable the development of personalised care plans for multi-morbid conditions supported by innovative ICT components to improve delivery of integrated care services to elderly patients with multi-morbidity through continuous coordination of patient-centred care activities by a multidisciplinary care t...
The reuse of routinely collected clinical data for clinical research is being explored as part of... more The reuse of routinely collected clinical data for clinical research is being explored as part of the drive to reduce duplicate data entry and to start making full use of the big data potential in the healthcare domain. Clinical researchers often need to extract data from patient registries and other patient record datasets for data analysis as part of clinical studies. In the TRANSFoRm project, researchers define their study requirements via a Query Formulation Workbench. We use a standardised approach to data extraction to retrieve relevant information from heterogeneous data sources, using semantic interoperability enabled via detailed clinical modelling. This approach is used for data extraction from data sources for analysis and for pre-population of electronic Case Report Forms from electronic health records in primary care clinical systems.
BACKGROUND There is an increasing need to organise the care around the patient and not the diseas... more BACKGROUND There is an increasing need to organise the care around the patient and not the disease, as well as taking into account the complex realities of multiple physical, psycho-social conditions and polypharmacy. Integrated patient-centred care delivery platforms have been developed for both patients and clinicians. These platforms could provide a promising way to achieve a collaborative environment that improves the provision of integrated care for patients via enhanced ICT solutions. OBJECTIVE The C3-Cloud project has developed two collaborative computer platforms for patients and members of the Multi-Disciplinary Team and deployed these in three different European settings. The objective of this study is to pilot test the platforms and evaluate their impact on patients, informal caregivers, healthcare professionals and, in extend, healthcare systems. METHODS This paper describes the protocol for conducting an evaluation of the user-centred design, user experience, acceptabil...
International journal of medical informatics, Oct 1, 2017
The Learning Health System (LHS) requires integration of research into routine practice. 'eSo... more The Learning Health System (LHS) requires integration of research into routine practice. 'eSource' or embedding clinical trial functionalities into routine electronic health record (EHR) systems has long been put forward as a solution to the rising costs of research. We aimed to create and validate an eSource solution that would be readily extensible as part of a LHS. The EU FP7 TRANSFoRm project's approach is based on dual modelling, using the Clinical Research Information Model (CRIM) and the Clinical Data Integration Model of meaning (CDIM) to bridge the gap between clinical and research data structures, using the CDISC Operational Data Model (ODM) standard. Validation against GCP requirements was conducted in a clinical site, and a cluster randomised evaluation by site nested into a live clinical trial. Using the form definition element of ODM, we linked precisely modelled data queries to data elements, constrained against CDIM concepts, to enable automated patient i...
BRIDG is a widely known domain model of protocol-driven biomedical/clinical research. During a pr... more BRIDG is a widely known domain model of protocol-driven biomedical/clinical research. During a project to design a clinical trials management system for primary care research we developed a standard, computable representation of an RCT--the Primary Care Research Object Model (PCROM). We compared the PCROM Model to BRIDG and found significant overlap of concepts but also several areas important to our work that were either not yet represented or represented quite differently in BRIDG.
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