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Article ; Online: Exclusion of pregnant and lactating women from COVID-19 vaccine trials: a missed opportunity.

2021 Volume 42, Issue 28, Page(s) 2724–2726

MeSH term(s)	COVID-19 ; COVID-19 Vaccines ; Female ; Humans ; Lactation ; Pregnancy ; SARS-CoV-2
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2021-03-08
Publishing country	England
Document type	Journal Article
ZDB-ID	603098-1
ISSN	1522-9645 ; 0195-668X
ISSN (online)	1522-9645
ISSN	0195-668X
DOI	10.1093/eurheartj/ehab103
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Article ; Online: Medical publishing under review.

Van Spall, Harriette Gillian Christine / Whitelaw, Sera

European heart journal

2020 Volume 42, Issue 7, Page(s) 723–725

MeSH term(s)	Humans ; Publishing
Language	English
Publishing date	2020-11-23
Publishing country	England
Document type	Journal Article
ZDB-ID	603098-1
ISSN	1522-9645 ; 0195-668X
ISSN (online)	1522-9645
ISSN	0195-668X
DOI	10.1093/eurheartj/ehaa856
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Zs.A 1563: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Systematic review of academic bullying in medical settings: dynamics and consequences.

Averbuch, Tauben / Eliya, Yousif / Van Spall, Harriette Gillian Christine

BMJ open

2021 Volume 11, Issue 7, Page(s) e043256

Abstract: Purpose: To characterise the dynamics and consequences of bullying in academic medical settings, report factors that promote academic bullying and describe potential interventions.: Design: Systematic review.: Data sources: We searched EMBASE and ... ...

Abstract	Purpose: To characterise the dynamics and consequences of bullying in academic medical settings, report factors that promote academic bullying and describe potential interventions. Design: Systematic review. Data sources: We searched EMBASE and PsycINFO for articles published between 1 January 1999 and 7 February 2021. Study selection: We included studies conducted in academic medical settings in which victims were consultants or trainees. Studies had to describe bullying behaviours; the perpetrators or victims; barriers or facilitators; impact or interventions. Data were assessed independently by two reviewers. Results: We included 68 studies representing 82 349 respondents. Studies described academic bullying as the abuse of authority that impeded the education or career of the victim through punishing behaviours that included overwork, destabilisation and isolation in academic settings. Among 35 779 individuals who responded about bullying patterns in 28 studies, the most commonly described (38.2% respondents) was overwork. Among 24 894 individuals in 33 studies who reported the impact, the most common was psychological distress (39.1% respondents). Consultants were the most common bullies identified (53.6% of 15 868 respondents in 31 studies). Among demographic groups, men were identified as the most common perpetrators (67.2% of 4722 respondents in 5 studies) and women the most common victims (56.2% of 15 246 respondents in 27 studies). Only a minority of victims (28.9% of 9410 victims in 25 studies) reported the bullying, and most (57.5%) did not perceive a positive outcome. Facilitators of bullying included lack of enforcement of institutional policies (reported in 13 studies), hierarchical power structures (7 studies) and normalisation of bullying (10 studies). Studies testing the effectiveness of anti-bullying interventions had a high risk of bias. Conclusions: Academic bullying commonly involved overwork, had a negative impact on well-being and was not typically reported. Perpetrators were most commonly consultants and men across career stages, and victims were commonly women. Methodologically robust trials of anti-bullying interventions are needed. Limitations: Most studies (40 of 68) had at least a moderate risk of bias. All interventions were tested in uncontrolled before-after studies.
MeSH term(s)	Bullying ; Female ; Humans ; Male ; Organizational Policy
Language	English
Publishing date	2021-07-12
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2020-043256
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Article ; Online: Systematic review of academic bullying in medical settings

Harriette Gillian Christine Van Spall / Yousif Eliya / Tauben Averbuch

BMJ Open, Vol 11, Iss

dynamics and consequences

2021 Volume 7

Abstract: Purpose To characterise the dynamics and consequences of bullying in academic medical settings, report factors that promote academic bullying and describe potential interventions.Design Systematic review.Data sources We searched EMBASE and PsycINFO for ... ...

Abstract	Purpose To characterise the dynamics and consequences of bullying in academic medical settings, report factors that promote academic bullying and describe potential interventions.Design Systematic review.Data sources We searched EMBASE and PsycINFO for articles published between 1 January 1999 and 7 February 2021.Study selection We included studies conducted in academic medical settings in which victims were consultants or trainees. Studies had to describe bullying behaviours; the perpetrators or victims; barriers or facilitators; impact or interventions. Data were assessed independently by two reviewers.Results We included 68 studies representing 82 349 respondents. Studies described academic bullying as the abuse of authority that impeded the education or career of the victim through punishing behaviours that included overwork, destabilisation and isolation in academic settings. Among 35 779 individuals who responded about bullying patterns in 28 studies, the most commonly described (38.2% respondents) was overwork. Among 24 894 individuals in 33 studies who reported the impact, the most common was psychological distress (39.1% respondents). Consultants were the most common bullies identified (53.6% of 15 868 respondents in 31 studies). Among demographic groups, men were identified as the most common perpetrators (67.2% of 4722 respondents in 5 studies) and women the most common victims (56.2% of 15 246 respondents in 27 studies). Only a minority of victims (28.9% of 9410 victims in 25 studies) reported the bullying, and most (57.5%) did not perceive a positive outcome. Facilitators of bullying included lack of enforcement of institutional policies (reported in 13 studies), hierarchical power structures (7 studies) and normalisation of bullying (10 studies). Studies testing the effectiveness of anti-bullying interventions had a high risk of bias.Conclusions Academic bullying commonly involved overwork, had a negative impact on well-being and was not typically reported. Perpetrators were most commonly ...
Keywords	Medicine ; R
Subject code	306
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Derivation and validation of a two-variable index to predict 30-day outcomes following heart failure hospitalization.

Averbuch, Tauben / Lee, Shun Fu / Mamas, Mamas Andreas / Oz, Urun Erbas / Perez, Richard / Connolly, Stuart James / Ko, Dennis Tien-Wei / Van Spall, Harriette Gillian Christine

ESC heart failure

2021 Volume 8, Issue 4, Page(s) 2690–2697

Abstract: Background: The LACE index-length of stay (L), acuity (A), Charlson co-morbidities (C), and emergent visits (E)-predicts 30-day outcomes following heart failure (HF) hospitalization but is complex to score. A simpler LE index (length of stay and ... ...

Abstract	Background: The LACE index-length of stay (L), acuity (A), Charlson co-morbidities (C), and emergent visits (E)-predicts 30-day outcomes following heart failure (HF) hospitalization but is complex to score. A simpler LE index (length of stay and emergent visits) could offer a practical advantage in point-of-care risk prediction. Methods and results: This was a sub-study of the patient-centred care transitions in HF (PACT-HF) multicentre trial. The derivation cohort comprised patients hospitalized for HF, enrolled in the trial, and followed prospectively. External validation was performed retrospectively in a cohort of patients hospitalized for HF. We used log-binomial regression models with LACE or LE as the predictor and either 30-day composite all-cause readmission or death or 30-day all-cause readmission as the outcomes, adjusting only for post-discharge services. There were 1985 patients (mean [SD] age 78.1 [12.1] years) in the derivation cohort and 378 (mean [SD] age 73.1 [13.2] years) in the validation cohort. Increments in the LACE and LE indices were associated with 17% (RR 1.17; 95% CI 1.12, 1.21; C-statistic 0.64) and 21% (RR 1.21; 95% CI 1.15, 1.26; C-statistic 0.63) increases, respectively, in 30-day composite all-cause readmission or death; and 16% (RR 1.16; 95% CI 1.11, 1.20; C-statistic 0.64) and 18% (RR 1.18; 95% CI 1.13, 1.24; C-statistic 0.62) increases, respectively, in 30-day all-cause readmission. The LE index provided better risk discrimination for the 30-day outcomes than did the LACE index in the external validation cohort. Conclusions: The LE index predicts 30-day outcomes following HF hospitalization with similar or better performance than the more complex LACE index.
MeSH term(s)	Aftercare ; Aged ; Emergency Service, Hospital ; Heart Failure/epidemiology ; Heart Failure/therapy ; Humans ; Length of Stay ; Patient Discharge ; Patient Readmission ; Retrospective Studies
Language	English
Publishing date	2021-05-01
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2814355-3
ISSN	2055-5822 ; 2055-5822
ISSN (online)	2055-5822
ISSN	2055-5822
DOI	10.1002/ehf2.13324
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: When my father died.

Van Spall, Harriette Gillian Christine

Annals of internal medicine

2007 Volume 146, Issue 12, Page(s) 893–894

MeSH term(s)	Coronary Artery Disease/surgery ; Elective Surgical Procedures/psychology ; Father-Child Relations ; Humans ; Medical Errors/psychology ; Physicians, Women/psychology ; Preoperative Care/psychology
Language	English
Publishing date	2007-06-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/0003-4819-146-12-200706190-00013
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Article ; Online: Readmission and processes of care across weekend and weekday hospitalisation for acute myocardial infarction, heart failure or stroke

Purvi Parwani / Glen Philip Martin / Chadi AlRaies / Harriette Gillian Christine Van Spall / Annabelle Santos Volgman / Erin Michos / Ritu Thamman

BMJ Open, Vol 9, Iss

an observational study of the National Readmission Database

2019 Volume 8

Abstract: ObjectivesVariation in hospital resource allocations across weekdays and weekends have led to studies of the ‘weekend effect’ for ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), heart failure (HF) and stroke. ... ...

Abstract	ObjectivesVariation in hospital resource allocations across weekdays and weekends have led to studies of the ‘weekend effect’ for ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), heart failure (HF) and stroke. However, few studies have explored the ‘weekend effect’ on unplanned readmission. We aimed to investigate 30-day unplanned readmissions and processes of care across weekend and weekday hospitalisations for STEMI, NSTEMI, HF and stroke.DesignWe grouped hospitalisations for STEMI, NSTEMI, HF or stroke into weekday or weekend admissions. Multivariable adjusted ORs for binary outcomes across weekend versus weekday (reference) groups were estimated using logistic regression.SettingWe included all non-elective hospitalisations for STEMI, NSTEMI, HF or stroke, which were recorded in the US Nationwide Readmissions Database between 2010 and 2014.ParticipantsThe analysis sample included 659 906 hospitalisations for STEMI, 1 420 600 hospitalisations for NSTEMI, 3 027 699 hospitalisations for HF, and 2 574 168 hospitalisations for stroke.Main outcome measuresThe primary outcome was unplanned 30-day readmission. As secondary outcomes, we considered length of stay and the following processes of care: coronary angiography, primary percutaneous coronary intervention, coronary artery bypass graft, thrombolysis, brain scan/imaging, thrombectomy, echocardiography and cardiac resynchronisation therapy/implantable cardioverter-defibrillator.ResultsUnplanned 30-day readmission rates were 11.0%, 15.1%, 23.0% and 10.9% for STEMI, NSTEMI, HF and stroke, respectively. Weekend hospitalisations for HF were associated with a statistically significant but modest increase in 30-day readmissions (OR of 1.045, 95% CI 1.033 to 1.058). Weekend hospitalisation for STEMI, NSTEMI or stroke was not associated with increased risk of 30-day readmission.ConclusionThere was no clinically meaningful evidence against the supposition that weekend and weekday hospitalisations have the same 30-day unplanned ...
Keywords	Medicine ; R
Subject code	610
Language	English
Publishing date	2019-08-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Effectiveness of implementation interventions in improving physician adherence to guideline recommendations in heart failure: a systematic review.

Shanbhag, Deepti / Graham, Ian D / Harlos, Karen / Haynes, R Brian / Gabizon, Itzhak / Connolly, Stuart J / Van Spall, Harriette Gillian Christine

BMJ open

2018 Volume 8, Issue 3, Page(s) e017765

Abstract: Background: The uptake of guideline recommendations that improve heart failure (HF) outcomes remains suboptimal. We reviewed implementation interventions that improve physician adherence to these recommendations, and identified contextual factors ... ...

Abstract	Background: The uptake of guideline recommendations that improve heart failure (HF) outcomes remains suboptimal. We reviewed implementation interventions that improve physician adherence to these recommendations, and identified contextual factors associated with implementation success. Methods: We searched databases from January 1990 to November 2017 for studies testing interventions to improve uptake of class I HF guidelines. We used the Cochrane Effective Practice and Organisation of Care and Process Redesign frameworks for data extraction. Primary outcomes included: proportion of eligible patients offered guideline-recommended pharmacotherapy, self-care education, left ventricular function assessment and/or intracardiac devices. We reported clinical outcomes when available. Results: We included 38 studies. Provider-level interventions (n=13 studies) included audit and feedback, reminders and education. Organisation-level interventions (n=18) included medical records system changes, multidisciplinary teams, clinical pathways and continuity of care. System-level interventions (n=3) included provider/institutional incentives. Four studies assessed multi-level interventions. We could not perform meta-analyses due to statistical/conceptual heterogeneity. Thirty-two studies reported significant improvements in at least one primary outcome. Clinical pathways, multidisciplinary teams and multifaceted interventions were most consistently successful in increasing physician uptake of guidelines. Among randomised controlled trials (RCT) (n=10), pharmacist and nurse-led interventions improved target dose prescriptions. Eleven studies reported clinical outcomes; significant improvements were reported in three, including a clinical pathway, a multidisciplinary team and a multifaceted intervention. Baseline assessment of barriers, staff training, iterative intervention development, leadership commitment and policy/financial incentives were associated with intervention effectiveness. Most studies (n=20) had medium risk of bias; nine RCTs had low risk of bias. Conclusion: Our study is limited by the quality and heterogeneity of the primary studies. Clinical pathways, multidisciplinary teams and multifaceted interventions appear to be most consistent in increasing guideline uptake. However, improvements in process outcomes were rarely accompanied by improvements in clinical outcomes. Our work highlights the need for improved research methodology to reliably assess the effectiveness of implementation interventions.
MeSH term(s)	Guideline Adherence ; Heart Failure/therapy ; Humans ; Physicians ; Quality Improvement ; Quality of Health Care
Language	English
Publishing date	2018-03-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
ZDB-ID	2747269-3
ISSN	2044-6055 ; 2044-6055 ; 2053-3624
ISSN (online)	2044-6055
ISSN	2044-6055 ; 2053-3624
DOI	10.1136/bmjopen-2017-017765
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Article ; Online: Readmission and processes of care across weekend and weekday hospitalisation for acute myocardial infarction, heart failure or stroke: an observational study of the National Readmission Database.

Martin, Glen Philip / Kwok, Chun Shing / Van Spall, Harriette Gillian Christine / Volgman, Annabelle Santos / Michos, Erin / Parwani, Purvi / Alraies, Chadi / Thamman, Ritu / Kontopantelis, Evangelos / Mamas, Mamas

BMJ open

2019 Volume 9, Issue 8, Page(s) e029667

Abstract: Objectives: Variation in hospital resource allocations across weekdays and weekends have led to studies of the 'weekend effect' for ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), heart failure (HF) and ... ...

Abstract	Objectives: Variation in hospital resource allocations across weekdays and weekends have led to studies of the 'weekend effect' for ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), heart failure (HF) and stroke. However, few studies have explored the 'weekend effect' on unplanned readmission. We aimed to investigate 30-day unplanned readmissions and processes of care across weekend and weekday hospitalisations for STEMI, NSTEMI, HF and stroke. Design: We grouped hospitalisations for STEMI, NSTEMI, HF or stroke into weekday or weekend admissions. Multivariable adjusted ORs for binary outcomes across weekend versus weekday (reference) groups were estimated using logistic regression. Setting: We included all non-elective hospitalisations for STEMI, NSTEMI, HF or stroke, which were recorded in the US Nationwide Readmissions Database between 2010 and 2014. Participants: The analysis sample included 659 906 hospitalisations for STEMI, 1 420 600 hospitalisations for NSTEMI, 3 027 699 hospitalisations for HF, and 2 574 168 hospitalisations for stroke. Main outcome measures: The primary outcome was unplanned 30-day readmission. As secondary outcomes, we considered length of stay and the following processes of care: coronary angiography, primary percutaneous coronary intervention, coronary artery bypass graft, thrombolysis, brain scan/imaging, thrombectomy, echocardiography and cardiac resynchronisation therapy/implantable cardioverter-defibrillator. Results: Unplanned 30-day readmission rates were 11.0%, 15.1%, 23.0% and 10.9% for STEMI, NSTEMI, HF and stroke, respectively. Weekend hospitalisations for HF were associated with a statistically significant but modest increase in 30-day readmissions (OR of 1.045, 95% CI 1.033 to 1.058). Weekend hospitalisation for STEMI, NSTEMI or stroke was not associated with increased risk of 30-day readmission. Conclusion: There was no clinically meaningful evidence against the supposition that weekend and weekday hospitalisations have the same 30-day unplanned readmissions. Thirty-day readmission rates were high, especially for HF, which has implications for service provision. Strategies to reduce readmission rates should be explored, regardless of day of hospitalisation.
MeSH term(s)	After-Hours Care/statistics & numerical data ; Aged ; Cohort Studies ; Coronary Angiography/statistics & numerical data ; Coronary Artery Bypass/statistics & numerical data ; Databases, Factual ; Defibrillators, Implantable/statistics & numerical data ; Echocardiography/statistics & numerical data ; Female ; Heart Failure/epidemiology ; Heart Failure/therapy ; Hospitalization/statistics & numerical data ; Humans ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Non-ST Elevated Myocardial Infarction/epidemiology ; Non-ST Elevated Myocardial Infarction/therapy ; Patient Readmission/statistics & numerical data ; Percutaneous Coronary Intervention/statistics & numerical data ; Retrospective Studies ; ST Elevation Myocardial Infarction/epidemiology ; ST Elevation Myocardial Infarction/therapy ; Stroke/epidemiology ; Stroke/therapy ; Thrombectomy/statistics & numerical data ; United States/epidemiology
Language	English
Publishing date	2019-08-22
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2747269-3
ISSN	2044-6055 ; 2044-6055 ; 2053-3624
ISSN (online)	2044-6055
ISSN	2044-6055 ; 2053-3624
DOI	10.1136/bmjopen-2019-029667
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Article ; Online: Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis.

Qaddoura, Amro / Yazdan-Ashoori, Payam / Kabali, Conrad / Thabane, Lehana / Haynes, R Brian / Connolly, Stuart J / Van Spall, Harriette Gillian Christine

PloS one

2015 Volume 10, Issue 6, Page(s) e0129282

Abstract: Background: Heart failure (HF) is the commonest cause of hospitalization in older adults. Compared to routine hospitalization (RH), hospital at home (HaH)--substitutive hospital-level care in the patient's home--improves outcomes and reduces costs in ... ...

Abstract	Background: Heart failure (HF) is the commonest cause of hospitalization in older adults. Compared to routine hospitalization (RH), hospital at home (HaH)--substitutive hospital-level care in the patient's home--improves outcomes and reduces costs in patients with general medical conditions. The efficacy of HaH in HF is unknown. Methods and results: We searched MEDLINE, Embase, CINAHL, and CENTRAL, for publications from January 1990 to October 2014. We included prospective studies comparing substitutive models of hospitalization to RH in HF. At least 2 reviewers independently selected studies, abstracted data, and assessed quality. We meta-analyzed results from 3 RCTs (n = 203) and narratively synthesized results from 3 observational studies (n = 329). Study quality was modest. In RCTs, HaH increased time to first readmission (mean difference (MD) 14.13 days [95% CI 10.36 to 17.91]), and improved health-related quality of life (HrQOL) at both, 6 months (standardized MD (SMD) -0.31 [-0.45 to -0.18]) and 12 months (SMD -0.17 [-0.31 to -0.02]). In RCTs, HaH demonstrated a trend to decreased readmissions (risk ratio (RR) 0.68 [0.42 to 1.09]), and had no effect on all-cause mortality (RR 0.94 [0.67 to 1.32]). HaH decreased costs of index hospitalization in all RCTs. HaH reduced readmissions and emergency department visits per patient in all 3 observational studies. Conclusions: In the context of a limited number of modest-quality studies, HaH appears to increase time to readmission, reduce index costs, and improve HrQOL among patients requiring hospital-level care for HF. Larger RCTs are necessary to assess the effect of HaH on readmissions, mortality, and long-term costs.
MeSH term(s)	Emergency Service, Hospital ; Follow-Up Studies ; Heart Failure/epidemiology ; Heart Failure/mortality ; Hospitals/statistics & numerical data ; Humans ; Length of Stay ; Patient Readmission/economics ; Patient Readmission/statistics & numerical data ; Quality of Life ; Randomized Controlled Trials as Topic/statistics & numerical data ; Reproducibility of Results ; Treatment Outcome
Language	English
Publishing date	2015
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0129282
Database	MEDical Literature Analysis and Retrieval System OnLINE

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