NHS National Services Scotland

Edinburgh, United Kingdom

NHS National Services Scotland

Edinburgh, United Kingdom
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The I-MOVE\ Consortium includes European Union (EU) Public Health Institutes, SME and Universities. It aims at measuring and comparing the effectiveness (VE) and impact (VI) of influenza and Pneumococcal vaccines and vaccination strategies a in the elderly population in Europe. The goal is to develop a sustainable platform of primary care practices, hospitals and laboratory networks that share validated methods to evaluate post marketing vaccine performances. The objectives are to identify, pilot test, and disseminate in EU the best study designs to measure, on a real time basis, VE (direct effect) and the VI of vaccination programmes (indirect and overall effect) against laboratory confirmed cases of influenza (types/subtypes) and pneumococcal disease (serotypes), and clinical outcomes. Cost effectiveness analysis will be conducted. Results will allow to understand factors affecting specific VE, the duration of protection of influenza and pneumococcal vaccines, the interaction between vaccines, the role of repeated vaccinations, the occurrence of serotype replacement (pneumococcus); identify vaccine types and brands with low VE; guide the decision of the WHO committees on vaccine strain selection (influenza); provide robust benefit indicators (VE and VI) and cost benefit and effectiveness results; guide vaccination strategies (schedules, doses, boosters). This EU member state collaboration will respond to questions that require studies based on large sample sizes and sharing of expertise that cannot be achieved by one country alone. It will allow the best methods to be used and results to benefit to all EU countries whatever their current public health achievements. Results will be shared with international partners.


Under Mainframe Solutions Transformation Programme, NextGate EMPI replaces legacy system to modernize management of Electronic Health Record EDINBURGH, SCOTLAND and PASADENA, CA--(Marketwired - February 16, 2017) - NextGate, a global leader in healthcare identity management, has secured a multi-year contract with NHS National Services Scotland to replace the existing Community Health Index (CHI) with a modern enterprise master patient index (EMPI) solution that will issue and maintain the unique patient identifiers used by health systems to identify a patient and corresponding electronic health records. By deploying a system that supports multiple legacy identifiers, the aim is to provide the 'single source of truth' for demographics across the service, and for partner agencies. Under the agreement and as part of the Mainframe Solutions Transformation Programme (MSTP), NextGate will deliver its #1 ranked MatchMetrix© EMPI software and services to become the issuing authority for the CHI Number, a number critical to the creation and maintenance of the electronic patient record across NHS Scotland. The deal signals further international expansion by NextGate and acceptance of its identity matching technology as an integral element in accurate patient identification and a cornerstone for the reliable electronic storage and administration of patient data. The new CHI solution will, among other benefits: By providing a modern, well supported solution, Health Boards will be able to generate and reference the most up to date demographics for patients, improve positive patient identification, and, with the increased use of the patient's electronic health record, facilitate patient centred health care delivery. The CHI solution provided by NextGate is built on open standards allowing for integration with the Scottish Child Public Health and Wellbeing System, with other existing legacy systems, and enable co-ordination and co-operation with providers of other services and systems to NHS Scotland. "We are pleased to be working with NextGate, the leader in identity management, to move our MSTP initiative forward," said Andy Robertson, Director of IT at NHS NSS. "The modernization of our CHI system with their technology will help us deliver the highest standards of healthcare to the people of Scotland in a cost effective and efficient manner." "We look forward to helping NHS Scotland transform their use of electronic patient records and enhance the patient experience," said Andy Aroditis, NextGate CEO. "In today's data rich environment, connecting patients to all of their records is a broad and important task that leads directly to more comprehensive quality care." About NHS Scotland NHS Scotland is the collective name for the 22 Health Boards across Scotland. About NextGate NextGate helps connect the healthcare ecosystem by accurately identifying and linking patient and provider data from different applications. NextGate's iDAS (Intelligent Data Aggregation Server) solution framework leverages the company's industry-leading identity management technology to organize and relate data from enterprise systems to provide a more complete and accurate view of the total healthcare experience. NextGate's KLAS Category Leader EMPI technology currently manages more than 200 million lives and is deployed by the nation's most successful healthcare systems and health information exchanges. For more information, visit NextGate.com.


Under Mainframe Solutions Transformation Programme, NextGate EMPI replaces legacy system to modernize management of Electronic Health Record EDINBURGH, SCOTLAND and PASADENA, CA--(Marketwired - February 16, 2017) - NextGate, a global leader in healthcare identity management, has secured a multi-year contract with NHS National Services Scotland to replace the existing Community Health Index (CHI) with a modern enterprise master patient index (EMPI) solution that will issue and maintain the unique patient identifiers used by health systems to identify a patient and corresponding electronic health records. By deploying a system that supports multiple legacy identifiers, the aim is to provide the 'single source of truth' for demographics across the service, and for partner agencies. Under the agreement and as part of the Mainframe Solutions Transformation Programme (MSTP), NextGate will deliver its #1 ranked MatchMetrix© EMPI software and services to become the issuing authority for the CHI Number, a number critical to the creation and maintenance of the electronic patient record across NHS Scotland. The deal signals further international expansion by NextGate and acceptance of its identity matching technology as an integral element in accurate patient identification and a cornerstone for the reliable electronic storage and administration of patient data. The new CHI solution will, among other benefits: By providing a modern, well supported solution, Health Boards will be able to generate and reference the most up to date demographics for patients, improve positive patient identification, and, with the increased use of the patient's electronic health record, facilitate patient centred health care delivery. The CHI solution provided by NextGate is built on open standards allowing for integration with the Scottish Child Public Health and Wellbeing System, with other existing legacy systems, and enable co-ordination and co-operation with providers of other services and systems to NHS Scotland. "We are pleased to be working with NextGate, the leader in identity management, to move our MSTP initiative forward," said Andy Robertson, Director of IT at NHS NSS. "The modernization of our CHI system with their technology will help us deliver the highest standards of healthcare to the people of Scotland in a cost effective and efficient manner." "We look forward to helping NHS Scotland transform their use of electronic patient records and enhance the patient experience," said Andy Aroditis, NextGate CEO. "In today's data rich environment, connecting patients to all of their records is a broad and important task that leads directly to more comprehensive quality care." NHS Scotland is the collective name for the 22 Health Boards across Scotland. NextGate helps connect the healthcare ecosystem by accurately identifying and linking patient and provider data from different applications. NextGate's iDAS (Intelligent Data Aggregation Server) solution framework leverages the company's industry-leading identity management technology to organize and relate data from enterprise systems to provide a more complete and accurate view of the total healthcare experience. NextGate's KLAS Category Leader EMPI technology currently manages more than 200 million lives and is deployed by the nation's most successful healthcare systems and health information exchanges. For more information, visit NextGate.com.


Jenkins P.J.,Queen Margaret Hospital | Watts A.C.,Queen Margaret Hospital | Norwood T.,NHS National Services Scotland | Duckworth A.D.,Queen Margaret Hospital | And 2 more authors.
Acta Orthopaedica | Year: 2013

Background and purpose Total elbow replacement (TER) is used in the treatment of inflammatory arthropathy, osteoarthritis, and posttraumatic arthrosis, or as the primary management for distal humeral fractures. We determined the annual incidence of TER over an 18-year period. We also examined the effect of surgeon volume on implant survivorship and the rate of systemic and joint-specific complications. Methodology We examined a national arthroplasty register and used linkage with national hospital episode statistics, and population and mortality data to determine the incidence of complications and implant survivorship. Results There were 1,146 primary TER procedures (incidence: 1.4 per 105 population per year). The peak incidence was seen in the eighth decade and TER was most often performed in females (F:M ratio = 2.9:1). The primary indications for surgery were inflammatory arthropathy (79%), osteoarthritis (9%), and trauma (12%). The incidence of TER fell over the period (r = -0.49; p = 0.037). This may be due to a fall in the number of procedures performed for inflammatory arthropathy (p < 0.001). The overall 10-year survivorship was 90%. Implant survival was better if the surgeon performed more than 10 cases per year. Interpretation The prevalence of TER has fallen over 18 years, and implant survival rates are better in surgeons who perform more than 10 cases per year. A strong argument can be made for a managed clinic network for total elbow arthroplasty.


Bird S.M.,MRC Biostatistics Unit | Fischbacher C.M.,NHS National Services Scotland | Graham L.,NHS National Services Scotland | Fraser A.,NHS Health Scotland
Addiction | Year: 2015

Aim: To assess whether the introduction of a prison-based opioid substitution therapy (OST) policy was associated with a reduction in drug-related deaths (DRD) within 14days after prison release. Design: Linkage of Scotland's prisoner database with death registrations to compare periods before (1996-2002) and after (2003-07) prison-based OST was introduced. Setting: All Scottish prisons. Participants: People released from prison between 1January 1996 and 8October 2007 following an imprisonment of at least 14days and at least 14 weeks after the preceding qualifying release. Measurements: Risk of DRD in the 12 weeks following release; percentage of these DRDs which occurred during the first 14 days. Findings: Before prison-based OST (1996-2002), 305 DRDs occurred in the 12weeks after 80200 qualifying releases, 3.8 per 1000 releases [95% confidence interval (CI) = 3.4-4.2]; of these, 175 (57%) occurred in the first 14days. After the introduction of prison-based OST (2003-07), 154 DRDs occurred in the 12weeks after 70317 qualifying releases, a significantly reduced rate of 2.2 per 1000 releases (95% CI = 1.8-2.5). However, there was no change in the proportion which occurred in the first 14days, either for all DRDs (87: 56%) or for opioid-related DRDs. Conclusions: Following the introduction of a prison-based opioid substitution therapy (OST) policy in Scotland, the rate of drug-related deaths in the 12weeks following release fell by two-fifths. However, the proportion of deaths that occurred in the first 14days did not change appreciably, suggesting that in-prison OST does not reduce early deaths after release. © 2015 The Authors.


Oliver-Williams C.,University of Cambridge | Fleming M.,NHS National Services Scotland | Monteath K.,NHS National Services Scotland | Wood A.M.,University of Cambridge | Smith G.C.S.,University of Cambridge
PLoS Medicine | Year: 2013

Background:Numerous studies have demonstrated that therapeutic termination of pregnancy (abortion) is associated with an increased risk of subsequent preterm birth. However, the literature is inconsistent, and methods of abortion have changed dramatically over the last 30 years. We hypothesized that the association between previous abortion and the risk of preterm first birth changed in Scotland between 1 January 1980 and 31 December 2008.Methods and Findings:We studied linked Scottish national databases of births and perinatal deaths. We analysed the risk of preterm birth in relation to the number of previous abortions in 732,719 first births (≥24 wk), adjusting for maternal characteristics. The risk (adjusted odds ratio [95% CI]) of preterm birth was modelled using logistic regression, and associations were expressed for a one-unit increase in the number of previous abortions. Previous abortion was associated with an increased risk of preterm birth (1.12 [1.09-1.16]). When analysed by year of delivery, the association was strongest in 1980-1983 (1.32 [1.21-1.43]), progressively declined between 1984 and 1999, and was no longer apparent in 2000-2003 (0.98 [0.91-1.05]) or 2004-2008 (1.02 [0.95-1.09]). A statistical test for interaction between previous abortion and year was highly statistically significant (p<0.001). Analysis of data for abortions among nulliparous women in Scotland 1992-2008 demonstrated that the proportion that were surgical without use of cervical pre-treatment decreased from 31% to 0.4%, and that the proportion of medical abortions increased from 18% to 68%.Conclusions:Previous abortion was a risk factor for spontaneous preterm birth in Scotland in the 1980s and 1990s, but the association progressively weakened and disappeared altogether by 2000. These changes were paralleled by increasing use of medical abortion and cervical pre-treatment prior to surgical abortion. Although it is plausible that the two trends were related, we could not test this directly as the data on the method of prior abortions were not linked to individuals in the cohort. However, we speculate that modernising abortion methods may be an effective long-term strategy to reduce global rates of preterm birth.Please see later in the article for the Editors' Summary. © 2013 Oliver-Williams et al.


Fischbacher C.M.,NHS National Services Scotland | Fischbacher C.M.,University of Edinburgh | Cezard G.,University of Edinburgh | Bhopal R.S.,University of Edinburgh | And 2 more authors.
International Journal of Epidemiology | Year: 2014

Background: Ethnic health inequalities are substantial. One explanation relates to socioeconomic differences between groups. However, socioeconomic variables need to be comparable across ethnic groups as measures of socioeconomic position (SEP) and indicators of health outcomes. Methods: We linked self-reported SEP and ethnicity data on 4.65 million individuals from the 2001 Scottish Census to hospital admission and mortality data for cardiovascular disease (CVD). We examined the direction, strength and linearity of association between eight individual, household and area socioeconomic measures and CVD in 10 ethnic groups and the impact of SEP adjustment. Results: There was wide socioeconomic variation between groups. All eight measures showed consistent, positive associations with CVD in White populations, as did educational qualification in non-White ethnic groups. For other SEP measures, associations tended to be consistent with those of White groups though there were one or two exceptions in each non-White group. Multiple SEP adjustment had little effect on relative risk of CVD for most groups. Where it did, the effect varied in direction and magnitude (for example increasing adjusted risk by 23% in Indian men but attenuating it by 11% among Pakistani women). Conclusions: Across groups, SEP measures were inconsistently associated with CVD hospitalization or death, with effect size and direction of effect after adjustment varying across ethnic groups. We recommend that researchers systematically explore the effect of their choice of SEP indicators, using standard multivariate methods where appropriate, to demonstrate their cross-ethnic group validity Published by Oxford University Press on behalf of the Intas potential confounding variables for the specific groups and outcomes of interest. © The Author 2013; all rights reserved.


Bhopal R.S.,University of Edinburgh | Humphry R.W.,University of Edinburgh | Fischbacher C.M.,NHS National Services Scotland
BMJ Open | Year: 2013

Objectives: Reducing disease inequalities requires risk factors to decline quickest in the most disadvantaged populations. Our objective was to assess whether this happened across the UK's ethnic groups. Design: Secondary analysis of repeated but independent cross-sectional studies focusing on Health Surveys for England 1999 and 2004. Setting: Community-based population level surveys in England. Participants: Seven populations from the major ethnic groups in England (2004 sample sizes): predominantly White general (6704), Irish (1153), Chinese (723), Indian (1184), Pakistani (941), Bangladeshi (899) and Black Caribbean (1067) populations. The numbers were smaller for specific variables, especially blood tests. Outcome measures: Data on 10 established cardiovascular risk factors were extracted from published reports. Differences between 1999 and 2004 were defined a priori as occurring when the 95% CI excluded 0 (for prevalence differences), or 1 (for risk ratios) or when there was a 5% or more change (independent of CIs). Results: Generally, there were reductions in smoking and blood pressure and increases in the waist-hip ratio, body mass index and diabetes. Changes between 1999 and 2004 indicated inconsistent progress and increasing inequalities. For example, total cholesterol increased in Pakistani (0.3 mmol/L) and Bangladeshi men (0.3 mmol/L), and in Pakistani (0.3 mmol/L), Bangladeshi (0.4 mmol/L) and Black Caribbean women (0.3 mmol/L). Increases in absolute risk factor levels were common, for example, in Pakistani (five risk factors), Bangladeshi (four factors) and general population women (four factors). For men, Black Caribbeans had the most (five factor) increases. The changes relative to the general population were also adverse for three risk factors in Pakistani and Black Caribbean men, four in Bangladeshi women and three in Pakistani women. Conclusions: Changes in populations with the most cardiovascular disease and diabetes did not decline the quickest. Cardiovascular screening programmes need more targeting.


Smith G.C.S.,University of Cambridge | Wood A.M.,University of Cambridge | Pell J.P.,University of Glasgow | Hattied J.,NHS National Services Scotland
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2011

Objective: To determine whether women experiencing recurrent miscarriage were more likely to have a family history of cardiovascular disease. Design: Retrospective cohort study. Setting: Women having a first birth in Scotland between 1992 and 2006. Sample: A total of 74 730 first births were linked to the hospital admission and death certification data for the women's parents through the women's birth certificates. Methods: The incidence of cardiovascular disease in the women's parents was related to the number of miscarriages experienced before their daughters' first births using a Cox proportional hazards model. Main outcome measures: Death or hospital admission of the women's parents for ischaemic heart disease (IHD), cerebrovascular disease (CVD) or venous thromboembolism (VTE). Main results: There was an increased incidence of IHD in the parents of women who experienced two miscarriages before their first birth (hazard ratio 1.25, 95% CI 1.04-1.49) and parents of women who experienced three or more miscarriages before their first birth (hazard ratio 1.56, 95% CI 1.14-2.15). Adjustment for the characteristics of the women at the time of the first birth was without material effect. There was no significant association between miscarriage and family history of CVD or VTE. There was no significant association between the number of therapeutic terminations of pregnancy before the first birth and the incidence of any type of cardiovascular disease in the women's parents. Conclusions: The parents of women who experience recurrent miscarriage are more likely to experience IHD. Recurrent miscarriage and IHD may have common patho-physiological pathways and genetic predispositions. © 2011 The Authors Journal compilation © RCOG 2011 BJOG An International Journal of Obstetrics and Gynaecology.


Grant
Agency: GTR | Branch: ESRC | Program: | Phase: Research Grant | Award Amount: 623.09K | Year: 2016

This proposal is motivated by the need to reduce the public deficit. One way to do this is by achieving efficiency savings in procurement for large public institutions such as the National Health Service, city councils, or the Ministry of Defence. We propose to contribute towards this goal by attempting to better align the stylised theoretical analysis of tendering - a form of trading mechanism - with the facts on the ground. The focus of our study is the provision and use of information in the tendering process, building on two recent methodological developments: Information Design and Simple Auctions. Trading mechanisms have been the subject of a great deal of study, especially in the last half a century. More recently, the enormously successful sale of the 3G mobile phone licences by simultaneous auctions - £22.5 billion was raised for the public purse and the band of radio frequency was efficiently assigned - in 2000, provided vivid evidence of how useful this theory can be. The literature on auctions is focussed on finding the optimal trading mechanism, which maximizes expected benefits. However, on the one hand, this optimization assumes that the information available to the bidders is predetermined. This is often too strong an assumption as the bid taker may have significant leeway in choosing what information to gather and disclose. On the other hand, the optimization traditionally leaves both the complexity of the mechanism and its use of the information revealed by the bidders unconstrained. This often results in very complicated optimal mechanisms, which are hard to implement in practice. We propose to push out the research frontier by analysing what information, and in which form, is presented to the potential traders and how information revealed by them is used by the designer to determine prices and trades. The first of these novel ideas is information design: the optimal provision of information to a group of interacting agents by a desiner with a certain objective. By strategically choosing its method for scoring the bids and by seeking out and revealing additional facts that might affect the cost of suppliers, the designer can create interdependence between the agents information; this can then be exploited through the competitive bidding process, ultimately benefiting the designers objective. The second idea is based on the observation that due to the complex objective of the buyer (quality, timing, transparency, sustainability etc. in addition to price) most actual tenders are multi-dimensional: the bids submitted include several different factors besides price. While a pre-announced scoring rule can transform these bids into readily comparable one-dimensional scores, it does not eliminate the complexity of bids and of the bidders beliefs about the bids of others. For practical reasons, the designer needs to compensate for this innate complication by simplifying the mechanism, resulting in additional restrictions on the set of mechanisms she can choose from. These restrictions imply that families of mechanisms previously discarded as sub-optimal, now become relevant. To capture this scenario, we analyse decentralised mechanisms, where conditional on trading, prices are independent of the bids of competitors. In the context of scoring auctions, this would correspond to a discriminatory first-score auction. According to the existing theoretical literature, when the quantity traded is not set beforehand, these auctions are not optimal. Together, these two approaches make it possible to advance our understanding of issues like simultaneous bidding and realistic mechanisms that deal with interdependent valuations. While doing that we will also pay particular attention not to be hemmed in by the artificial boundary between micro- and macro-economic analyses, so that our insights can be exported to system-wide markets, such as the labour and credit markets.

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