Applicability of the electronic frailty index in younger and older adults in England: a population-based cohort study.

Background: The electronic frailty index (eFI) was developed in older adults (aged ≥65 years). There are currently no validated frailty scores in clinical practice for younger adults (aged 18-64 years). The aim of this study was to examine whether the eFI score in younger adults had similar or different associations with adverse health outcomes compared with older adults.

Opportunities for optimising care transitions of adults with multiple long-term conditions: a qualitative interview study.

Background: The number of adults with multiple long-term conditions (MLTC) who experience frequent care transitions is rising. Improving care transitions for adults MLTC is important because transitions between and within care settings commonly lead to preventable adverse events. We explored multidisciplinary professional perspectives and experiences of managing care transitions for patients with MLTC to identify opportunities for improvement.

Infusing clinical knowledge into language models by subword optimisation and embedding initialisation.

Objective: This study introduces a novel tokenisation methodology, K-Tokeniser, to infuse clinical knowledge into language models for clinical text processing.

Methods: Technically, at initialisation stage, K-Tokeniser populates global representations of tokens based on semantic types of domain concepts (such as drugs or diseases) from either a domain ontology like Unified Medical Language System or the training data of the task related corpus. At training or inference stage, sentence level localised context will be utilised for choosing the optimal global token representation to realise the semantic-based tokenisation.

Robustly measuring multimorbidity using disparate linked datasets.

Background: Measurement of multimorbidity, the co-occurrence of two or more conditions in the same individual, is highly variable which limits the consistency and reproducibility of research.

Methods: Using data from 172,563 UK Biobank (UKB) participants and a cross-sectional approach, we examined how choice of data source affected estimated prevalence of 80 individual long-term conditions (LTCs) and multimorbidity. We developed code-list-based algorithms to determine the prevalence of 80 LTCs in (1) primary care records, (2) UKB baseline assessment, (3) hospital/cancer registry records, and (4) all three data sources together.

Measuring frailty: a comparison of the cumulative deficit model of frailty in survey and routine data.

Purpose: Frailty, a state of increased vulnerability to adverse health outcomes, impacts individuals and healthcare systems. The cumulative deficit model provides a flexible frailty measure but its application across diverse data remains underexplored. This study compares frailty indices derived from survey and routine data.

Patients' experiences of a patient-centred polypharmacy medication review intervention: a mixed-methods study.

Background People prescribed multiple medications need regular review to optimise medication and improve health outcomes. While the most effective method to improve inappropriate polypharmacy remains unclear, medication reviews incorporating patient-centred care and shared decision-making are believed key to achieving optimal outcomes. Aim To explore patients' experiences of an intervention to deliver patient-centred polypharmacy medication review in primary care.

Effect of UK Quality and Outcomes Framework pay-for-performance programme on quality of primary care: systematic review with quantitative synthesis.

Objective: To systematically review the one and three year impact on quality of care of the introduction and withdrawal of financial incentives in the UK Quality and Outcomes Framework pay-for-performance programme.

Design: Systematic review with quantitative synthesis.

Data Sources: MEDLINE, Embase, CINAHL, PsycINFO, and Scopus databases were searched from 1 January 2004 to 3 September 2024.

CT Angiography, Healthy Lifestyle Behaviors, and Preventive Therapy: A Nested Substudy of the SCOT-HEART 2 Randomized Clinical Trial.

Importance: Healthy lifestyles and uptake of primary preventive therapies for cardiovascular disease remain poor.

Objective: To determine the impact of coronary computed tomography (CT) angiography on healthy lifestyle behaviors, acceptance of recommended treatments, and modification of risk factors as compared with guideline-directed cardiovascular risk scoring.

Design, Setting, And Participants: This was a nested substudy conducted from September 2020 to August 2024 of a randomized clinical trial where participants underwent cardiovascular risk scoring or coronary CT angiography.

Using scores from the 4AT delirium detection tool as an indicator of possible dementia: a study of 75 221 older adult hospital admissions.

Introduction: Overall dementia diagnosis rates are substantially below true rates. Hospital admissions of older people involve cognitive and functional assessments relevant to dementia diagnosis. These assessments could be harnessed to contribute to identifying patients for further assessment.

Characteristics of people with severe mental illness excluded from incentivised physical health checks in the UK: electronic healthcare record study.

Background: Physical health checks in primary care for people with severe mental illness ((SMI) defined as schizophrenia, bipolar disorders and non-organic psychosis) aim to reduce health inequalities. Patients who decline or are deemed unsuitable for screening are removed from the denominator used to calculate incentivisation, termed exception reporting.

Aims: To describe the prevalence of, and patient characteristics associated with, exception reporting in patients with SMI.

Cluster and survival analysis of UK biobank data reveals associations between physical multimorbidity clusters and subsequent depression.

Background: Multimorbidity, the co-occurrence of two or more conditions within an individual, is a growing challenge for health and care delivery as well as for research. Combinations of physical and mental health conditions are highlighted as particularly important. Here, we investigated associations between physical multimorbidity and subsequent depression.

Patient satisfaction with general practice in Scotland 2011/12 to 2021/22.

Background: The Scottish Government introduced the first phase of a new General Practice (GP) contract in 2018, aiming to transform primary care and address health inequalities. However, the impact of these changes on patient satisfaction is unclear.

Aim: To assess temporal changes in overall patient satisfaction, and satisfaction with access and consultation quality, in general practice between 2011/12 and 2021/22, focusing on disparities across sociodemographic groups.

Lessons from the PROTECT-CH COVID-19 platform trial in care homes.

Background: Coronavirus disease-2019 was associated with significant mortality and morbidity in care homes in 2020-1. Repurposed antiviral drugs might reduce morbidity and mortality through reducing viral transmission, infection, replication and inflammation. We aimed to compare the safety and efficacy of potential antiviral drugs in care home residents.

Delirium on presentation with a hip fracture is associated with adverse outcomes : a multicentre observational study of 18,040 patients using national clinical registry data.

Aims: Delirium is common in hip fracture patients, but large-scale routine data studies examining the prevalence and associations of delirium at the time of initial presentation with a hip fracture are rare. This study aimed to describe the prevalence and outcomes of delirium on initial presentation with a hip fracture in a large national population sample.

Methods: This study analyzed routinely collected national clinical registry data for all people in Scotland aged 50 years and over presenting with a hip fracture between 1 July 2019 and 31 December 2021.

Understanding hospital activity and outcomes for people with multimorbidity using electronic health records.

As the prevalence of multimorbidity grows, provision of effective healthcare is more challenging. Both multimorbidity and complexity in healthcare delivery may be associated with worse outcomes. We studied consecutive, unique emergency non-surgical hospitalisations for patients over 50 years old to three hospitals in Scotland, UK between 2016 and 2024 using linked primary care and hospital records to define multimorbidity (2 + long-term conditions), and timestamped hospital electronic health record (EHR) contacts with nursing and rehabilitation providers to describe intensity of inpatient care.

Health conditions in adults with atrial fibrillation compared with the general population: a population-based cross-sectional analysis.

Background: Atrial fibrillation (AF) prevalence is rising due to population ageing and comorbidity is an increasing problem. The aim of this study was to examine the prevalence and association of coexisting health conditions among adults with AF in the general population.

Methods: Cross-sectional analysis of Clinical Practice Research Datalink (CPRD) primary care electronic medical records in England linked to hospital admissions as of 30 November 2015.

Impact of household size and co-resident multimorbidity on unplanned hospitalisation and transition to care home.

The ability to manage ill health and care needs might be affected by who a person lives with. This study examined how the risk of unplanned hospitalisation and transition to living in a care home varied according to household size and co-resident multimorbidity. Here we show results from a cohort study using  Welsh nationwide linked healthcare and census data, that employed multilevel multistate models to account for the competing risk of death and clustering within households.

Depression and physical multimorbidity: A cohort study of physical health condition accrual in UK Biobank.

Background: Depression is associated with a range of adverse physical health outcomes. We aimed to quantify the association between depression and the subsequent rate of accrual of long-term physical health conditions in middle and older age.

Methods And Findings: We included 172,556 participants from the UK Biobank (UKB) cohort study, aged 40-71 years old at baseline assessment (2006-2010), who had linked primary care data available.

Natural language processing for detecting adverse drug events: A systematic review protocol.

Background: Detecting Adverse Drug Events (ADEs) is an emerging research area, attracting great interest in the research community. Better anticipatory management of predisposing factors has considerable potential to improve outcomes. Automatic extraction of ADEs using Natural Language Processing (NLP) has a great potential to significantly facilitate efficient and effective distillation of such knowledge, to better understand and predict risk of adverse events.

Does remission of type 2 diabetes matter? A qualitative study of healthcare professionals' perspectives and views about supporting remission in primary care.

Background: Trials conducted in highly selected populations have shown that type 2 diabetes (T2D) remission is possible, but the feasibility and acceptability of supporting remission in routine clinical practice remain uncertain.

Aim: We explored primary care professionals' perceptions and understandings of T2D remission and their views about supporting remission within routine clinical care.

Methods: Semi-structured interviews were conducted with 14 GPs and nine nurses working in Scottish general practices.

A Digital Tool for Clinical Evidence-Driven Guideline Development by Studying Properties of Trial Eligible and Ineligible Populations: Development and Usability Study.

Background: Clinical guideline development preferentially relies on evidence from randomized controlled trials (RCTs). RCTs are gold-standard methods to evaluate the efficacy of treatments with the highest internal validity but limited external validity, in the sense that their findings may not always be applicable to or generalizable to clinical populations or population characteristics. The external validity of RCTs for the clinical population is constrained by the lack of tailored epidemiological data analysis designed for this purpose due to data governance, consistency of disease or condition definitions, and reduplicated effort in analysis code.

Prevalence and patient characteristics associated with cardiovascular disease risk factor screening in UK primary care for people with severe mental illness: an electronic healthcare record study.

Background: People with severe mental illness (SMI) are at increased risk of cardiovascular disease (CVD), and initiatives for CVD risk factor screening in the UK have not reduced disparities.

Objectives: To describe the annual screening prevalence for CVD risk factors in people with SMI from April 2000 to March 2018, and to identify factors associated with receiving no screening and regular screening.

Methods: We identified adults with a diagnosis of SMI (schizophrenia, bipolar disorder or 'other psychosis') from UK primary care records in Clinical Practice Research Datalink.

Antibiotic prescribing for care-home residents: a population-based, cross-classified multilevel analysis in Scotland, UK.

Background: There is wide variation in antibiotic prescribing across care-homes for older people, with implications for resident outcomes and antimicrobial resistance.

Objective: To quantify variation in antibiotic prescribing and associations with resident, care-home and general practice characteristics.

Design: Population-based analyses using administrative data.

Primary care transformation in Scotland: a comparison of two cross-sectional national surveys of GPs' views in 2018 and 2023.

Background: The 2018 Scottish GP contract established GP Clusters and multidisciplinary team (MDT) expansion. Qualitative studies have suggested suboptimal progress with these initiatives.

Aim: To quantify progress since the introduction of the new contract.

Benzodiazepine and z-drug prescribing in critical care survivors and the risk of rehospitalisation or death due to falls/trauma and due to any cause: a retrospective matched cohort study using the UK Clinical Practice Research Datalink.

Purpose: Benzodiazepines and z-drugs are often prescribed to critical care survivors due to high prevalence of mental health problems and insomnia. However, their safety has not been studied in this population.

Methods: Retrospective cohort study of 28,678 adult critical care survivors hospitalised in 2010 and 2018: 4844 prescribed benzodiazepines or z-drugs, matched to 23,834 unexposed survivors using UK Clinical Practice Research Datalink linked datasets.