LIVIVO - Search results -

Search results

Result 1 - 10 of total 16

Search options

Article ; Online: Multi-centre randomised controlled trial of a smart phone-based event recorder alongside standard care versus standard care for patients presenting to the Emergency Department with palpitations and pre-syncope - the IPED (Investigation of Palpitations in the ED) study

Matthew J. Reed / Neil R. Grubb / Christopher C. Lang / Rachel O’Brien / Kirsty Simpson / Mia Padarenga / Alison Grant / Sharon Tuck

Trials, Vol 19, Iss 1, Pp 1-

study protocol for a randomised controlled trial

2018 Volume 9

Abstract: Abstract Background Palpitations and pre-syncope are together responsible for 300,000 annual Emergency Department (ED) attendances in the United Kingdom (UK). Diagnosis of the underlying rhythm is difficult as many patients are fully recovered on ED ... ...

Abstract	Abstract Background Palpitations and pre-syncope are together responsible for 300,000 annual Emergency Department (ED) attendances in the United Kingdom (UK). Diagnosis of the underlying rhythm is difficult as many patients are fully recovered on ED arrival; and examination and presenting electrocardiogram (ECG) are commonly normal. The only way to establish the underlying heart rhythm is to capture an ECG during symptoms. Recent technology advances have led to several novel ECG monitoring devices appearing on the market. This trial aims to compare the symptomatic rhythm detection rate at 90 days of one such smart phone-based event recorder (AliveCor Heart Monitor and AliveECG) with standard care for participants presenting to the ED with palpitations and pre-syncope and no obvious cause in the ED. Methods/Design This is a multi-centre hospital ED / Acute Medical Unit (AMU) open label, randomised controlled trial. Participants will be recruited in 10 tertiary and district general hospitals in the UK. Participants aged ≥ 16 years presenting with an episode of palpitations or pre-syncope with no obvious cause and whose underlying ECG rhythm during these episodes remains undiagnosed after clinical assessment will be included. Participants will be randomised to either: (1) the intervention arm, standard care plus the use of a smart phone-based event recorder; or (2) the control arm, standard care. Primary endpoint will be symptomatic rhythm detection rate at 90 days. A number of secondary clinical, process and cost-effectiveness endpoints will be collected and analysed. Analysis will be on an intention-to-treat basis. Discussion The Investigation of Palpitations in the ED (IPED) study aims to recruit 242 participants across 10 hospital sites. It will be the first study to investigate the ability of a smart phone-based event recorder to detect symptomatic cardiac rhythms compared to standard care for ED patients with palpitations and pre-syncope with no obvious cause in the ED. This smart phone event recorder will ...
Keywords	Ambulatory electrocardiography monitoring ; Cardiac arrhythmias ; Palpitations ; Pre-syncope ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2018-12-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

Full text online

Full text

Inter-library loan at ZB MED

Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

Article ; Online: Delays and loss to follow-up before treatment of drug-resistant tuberculosis following implementation of Xpert MTB/RIF in South Africa

Helen Cox / Lindy Dickson-Hall / Norbert Ndjeka / Anja Van't Hoog / Alison Grant / Frank Cobelens / Wendy Stevens / Mark Nicol

PLoS Medicine, Vol 14, Iss 2, p e

A retrospective cohort study.

2017 Volume 1002238

Abstract: Background South Africa has a large burden of rifampicin-resistant tuberculosis (RR-TB), with 18,734 patients diagnosed in 2014. The number of diagnosed patients has increased substantially with the introduction of the Xpert MTB/RIF test, used for ... ...

Abstract	Background South Africa has a large burden of rifampicin-resistant tuberculosis (RR-TB), with 18,734 patients diagnosed in 2014. The number of diagnosed patients has increased substantially with the introduction of the Xpert MTB/RIF test, used for tuberculosis (TB) diagnosis for all patients with presumptive TB. Routine aggregate data suggest a large treatment gap (pre-treatment loss to follow-up) between the numbers of patients with laboratory-confirmed RR-TB and those reported to have started second-line treatment. We aimed to assess the impact of Xpert MTB/RIF implementation on the delay to treatment initiation and loss to follow-up before second-line treatment for RR-TB across South Africa. Methods and findings A nationwide retrospective cohort study was conducted to assess second-line treatment initiation and treatment delay among laboratory-diagnosed RR-TB patients. Cohorts, including approximately 300 sequentially diagnosed RR-TB patients per South African province, were drawn from the years 2011 and 2013, i.e., before and after Xpert implementation. Patients with prior laboratory RR-TB diagnoses within 6 mo and currently treated patients were excluded. Treatment initiation was determined through data linkage with national and local treatment registers, medical record review, interviews with health care staff, and direct contact with patients or household members. Additional laboratory data were used to track cases. National estimates of the percentage of patients who initiated treatment and time to treatment were weighted to account for the sampling design. There were 2,508 and 2,528 eligible patients in the 2011 and 2013 cohorts, respectively; 92% were newly diagnosed with RR-TB (no prior RR-TB diagnoses). Nationally, among the 2,340 and 2,311 new RR-TB patients in the 2011 and 2013 cohorts, 55% (95% CI 53%-57%) and 63% (95% CI 61%-65%), respectively, started treatment within 6 mo of laboratory receipt of their diagnostic specimen (p < 0.001). However, in 2013, there was no difference in the ...
Keywords	Medicine ; R
Subject code	616
Language	English
Publishing date	2017-02-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

Full text online

Full text

Inter-library loan at ZB MED

Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

Article ; Online: Detection of physiological deterioration by the SNAP40 wearable device compared to standard monitoring devices in the emergency department

Matthew J. Reed / Megan McGrath / Polly L. Black / Steff Lewis / Christopher McCann / Stewart Whiting / Rachel O’Brien / Alison Grant / Beth Harrison / Laura Skyrme / Miranda Odam

Diagnostic and Prognostic Research, Vol 2, Iss 1, Pp 1-

the SNAP40-ED study

2018 Volume 9

Abstract: Abstract Background In recent years, there has been increasing focus on the earlier detection of deterioration in the clinical condition of hospital patients with the aim of instigating earlier treatment to reverse this deterioration and prevent adverse ... ...

Abstract	Abstract Background In recent years, there has been increasing focus on the earlier detection of deterioration in the clinical condition of hospital patients with the aim of instigating earlier treatment to reverse this deterioration and prevent adverse outcomes. This is especially important in the ED, a dynamic environment with large volumes of undifferentiated patients, which carries inherent patient risk. SNAP40 is an innovative medical-grade device that can be worn on the upper arm that continuously monitors patients’ vital signs including relative changes in systolic blood pressure, respiratory rate, heart rate, movement, blood oxygen saturation and temperature. It uses automated risk analysis to potentially allow clinical staff to easily and quickly identify high-risk patients. The aim of this study is to investigate whether the SNAP40 device is able to identify deterioration in the vital sign physiology of an ED patient earlier than current standard monitoring and observation charting techniques. Methods/design Single centre, teaching hospital ED open label, prospective, observational cohort study recruiting 250 high acuity participants aged 16 years or over presenting to the ED. Participants will be approached and enrolled in the ED and after consent will have the SNAP40 wearable monitoring device attached which will be used alongside standard care monitoring. Participants will be observed throughout their time in the ED. Any SNAP40 device alarm, standard monitoring alarms or standard practice vital sign observations indicating a deterioration in a patient’s vital sign physiology (defined as an increase in NEWS score) will be recorded. Primary outcome is time to detection of deterioration. Secondary outcomes include staff time spent performing observations and responding to standard monitoring alarms, clinical escalation of care when deterioration is detected and participants and staff rating of experience of both SNAP40 and current monitoring. Discussion The SNAP40-ED study aims to recruit 250 patients. ...
Keywords	Ambulatory monitoring ; Monitoring ; physiological ; Patient monitoring ; Clinical deterioration ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2018-09-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

Full text online

Full text

Inter-library loan at ZB MED

Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

Article ; Online: The Impact of Company-Level ART Provision to a Mining Workforce in South Africa

Gesine Meyer-Rath / Jan Pienaar / Brian Brink / Andrew van Zyl / Debbie Muirhead / Alison Grant / Gavin Churchyard / Charlotte Watts / Peter Vickerman

PLoS Medicine, Vol 12, Iss 9, p e

A Cost-Benefit Analysis.

2015 Volume 1001869

Abstract: HIV impacts heavily on the operating costs of companies in sub-Saharan Africa, with many companies now providing antiretroviral therapy (ART) programmes in the workplace. A full cost-benefit analysis of workplace ART provision has not been conducted ... ...

Abstract	HIV impacts heavily on the operating costs of companies in sub-Saharan Africa, with many companies now providing antiretroviral therapy (ART) programmes in the workplace. A full cost-benefit analysis of workplace ART provision has not been conducted using primary data. We developed a dynamic health-state transition model to estimate the economic impact of HIV and the cost-benefit of ART provision in a mining company in South Africa between 2003 and 2022.A dynamic health-state transition model, called the Workplace Impact Model (WIM), was parameterised with workplace data on workforce size, composition, turnover, HIV incidence, and CD4 cell count development. Bottom-up cost analyses from the employer perspective supplied data on inpatient and outpatient resource utilisation and the costs of absenteeism and replacement of sick workers. The model was fitted to workforce HIV prevalence and separation data while incorporating parameter uncertainty; univariate sensitivity analyses were used to assess the robustness of the model findings. As ART coverage increases from 10% to 97% of eligible employees, increases in survival and retention of HIV-positive employees and associated reductions in absenteeism and benefit payments lead to cost savings compared to a scenario of no treatment provision, with the annual cost of HIV to the company decreasing by 5% (90% credibility interval [CrI] 2%-8%) and the mean cost per HIV-positive employee decreasing by 14% (90% CrI 7%-19%) by 2022. This translates into an average saving of US$950,215 (90% CrI US$220,879-US$1.6 million) per year; 80% of these cost savings are due to reductions in benefit payments and inpatient care costs. Although findings are sensitive to assumptions regarding incidence and absenteeism, ART is cost-saving under considerable parameter uncertainty and in all tested scenarios, including when prevalence is reduced to 1%-except when no benefits were paid out to employees leaving the workforce and when absenteeism rates were half of what data suggested. Scaling up ART further through a universal test and treat strategy doubles savings; incorporating ART for family members reduces savings but is still marginally cost-saving compared to no treatment. Our analysis was limited to the direct cost of HIV to companies and did not examine the impact of HIV prevention policies on the miners or their families, and a few model inputs were based on limited data, though in sensitivity analysis our results were found to be robust to changes to these inputs along plausible ranges.Workplace ART provision can be cost-saving for companies in high HIV prevalence settings due to reductions in healthcare costs, absenteeism, and staff turnover. Company-sponsored HIV counselling and voluntary testing with ensuing treatment of all HIV-positive employees and family members should be implemented universally at workplaces in countries with high HIV prevalence.
Keywords	Medicine ; R
Subject code	670
Language	English
Publishing date	2015-09-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

Full text online

Full text

Inter-library loan at ZB MED

Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

Article ; Online: Multi-centre Randomised Controlled Trial of a Smartphone-based Event Recorder Alongside Standard Care Versus Standard Care for Patients Presenting to the Emergency Department with Palpitations and Pre-syncope

Matthew J. Reed / Neil R. Grubb / Christopher C. Lang / Rachel O'Brien / Kirsty Simpson / Mia Padarenga / Alison Grant / Sharon Tuck / Liza Keating / Frank Coffey / Lucy Jones / Tim Harris / Gavin Lloyd / James Gagg / Jason E. Smith / Tim Coats

EClinicalMedicine, Vol 8, Iss , Pp 37-

The IPED (Investigation of Palpitations in the ED) study

2019 Volume 46

Abstract: Background: Patients with palpitations and pre-syncope commonly present to Emergency Departments (EDs) but underlying rhythm diagnosis is often not possible during the initial presentation. This trial compares the symptomatic rhythm detection rate of a ... ...

Abstract	Background: Patients with palpitations and pre-syncope commonly present to Emergency Departments (EDs) but underlying rhythm diagnosis is often not possible during the initial presentation. This trial compares the symptomatic rhythm detection rate of a smartphone-based event recorder (AliveCor) alongside standard care versus standard care alone, for participants presenting to the ED with palpitations and pre-syncope with no obvious cause evident at initial consultation. Methods: Multi-centre open label, randomised controlled trial. Participants ≥16 years old presenting to 10 UK hospital EDs were included. Participants were randomised to either (a) intervention group; standard care plus the use of a smartphone-based event recorder or (b) control group; standard care alone. Primary endpoint was symptomatic rhythm detection rate at 90 days. Trial registration number NCT02783898 (ClinicalTrials.gov). Findings: Two hundred forty-three participants were recruited over an 18-month period. A symptomatic rhythm was detected at 90 days in 69 (n = 124; 55.6%; 95% CI 46.9–64.4%) participants in the intervention group versus 11 (n = 116; 9.5%; 95% CI 4.2–14.8) in the control group (RR 5.9, 95% CI 3.3–10.5; p < 0.0001). Mean time to symptomatic rhythm detection in the intervention group was 9.5 days (SD 16.1, range 0–83) versus 42.9 days (SD 16.0, range 12–66; p < 0.0001) in the control group. The commonest symptomatic rhythms detected were sinus rhythm, sinus tachycardia and ectopic beats. A symptomatic cardiac arrhythmia was detected at 90 days in 11 (n = 124; 8.9%; 95% CI 3.9–13.9%) participants in the intervention group versus 1 (n = 116; 0.9%; 95% CI 0.0–2.5%) in the control group (RR 10.3, 95% CI 1.3–78.5; p = 0.006). Interpretation: Use of a smartphone-based event recorder increased the number of patients in whom an ECG was captured during symptoms over five-fold to more than 55% at 90 days. This safe, non-invasive and easy to use device should be considered part of on-going care to all patients presenting acutely with unexplained palpitations or pre-syncope. Funding: This study was funded by research awards from Chest, Heart and Stroke Scotland (CHSS) and British Heart Foundation (BHF) which included funding for purchasing the devices. MR was supported by an NHS Research Scotland Career Researcher Clinician award. Keywords: Ambulatory electrocardiography monitoring, Cardiac arrhythmias, Palpitations, Pre-syncope
Keywords	Medicine (General) ; R5-920
Subject code	150
Language	English
Publishing date	2019-02-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

Full text online

Full text

Inter-library loan at ZB MED

Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

Article ; Online: The cost of diagnostic uncertainty

Simon Leigh / Alison Grant / Nicola Murray / Brian Faragher / Henal Desai / Samantha Dolan / Naeema Cabdi / James B. Murray / Yasmin Rejaei / Stephanie Stewart / Karl Edwardson / Jason Dean / Bimal Mehta / Shunmay Yeung / Frans Coenen / Louis W. Niessen / Enitan D. Carrol

BMC Medicine, Vol 17, Iss 1, Pp 1-

a prospective economic analysis of febrile children attending an NHS emergency department

2019 Volume 15

Abstract: Abstract Background Paediatric fever is a common cause of emergency department (ED) attendance. A lack of prompt and definitive diagnostics makes it difficult to distinguish viral from potentially life-threatening bacterial causes, necessitating a ... ...

Abstract	Abstract Background Paediatric fever is a common cause of emergency department (ED) attendance. A lack of prompt and definitive diagnostics makes it difficult to distinguish viral from potentially life-threatening bacterial causes, necessitating a cautious approach. This may result in extended periods of observation, additional radiography, and the precautionary use of antibiotics (ABs) prior to evidence of bacterial foci. This study examines resource use, service costs, and health outcomes. Methods We studied an all-year prospective, comprehensive, and representative cohort of 6518 febrile children (aged < 16 years), attending Alder Hey Children’s Hospital, an NHS-affiliated paediatric care provider in the North West of England, over a 1-year period. Performing a time-driven and activity-based micro-costing, we estimated the economic impact of managing paediatric febrile illness, with focus on nurse/clinician time, investigations, radiography, and inpatient stay. Using bootstrapped generalised linear modelling (GLM, gamma, log), we identified the patient and healthcare provider characteristics associated with increased resource use, applying retrospective case-note identification to determine rates of potentially avoidable AB prescribing. Results Infants aged less than 3 months incurred significantly higher resource use than any other age group, at £1000.28 [95% CI £82.39–£2993.37] per child, (p < 0.001), while lesser experienced doctors exhibited 3.2-fold [95% CI 2.0–5.1-fold] higher resource use than consultants (p < 0.001). Approximately 32.4% of febrile children received antibiotics, and 7.1% were diagnosed with bacterial infections. Children with viral illnesses for whom antibiotic prescription was potentially avoidable incurred 9.9-fold [95% CI 6.5–13.2-fold] cost increases compared to those not receiving antibiotics, equal to an additional £1352.10 per child, predominantly resulting from a 53.9-h increase in observation and inpatient stay (57.1 vs. 3.2 h). Bootstrapped GLM suggested that infants ...
Keywords	Febrile ; Fever ; Pyrexia ; Children ; Health economics ; Cost of illness ; Medicine ; R
Subject code	360
Language	English
Publishing date	2019-03-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

Full text online

Full text

Inter-library loan at ZB MED

Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

Article ; Online: Cost-effectiveness of Xpert MTB/RIF for tuberculosis diagnosis in South Africa

Prof Anna Vassall, PhD / Mariana Siapka, MSc / Nicola Foster, MSc / Lucy Cunnama, MSc / Lebogang Ramma, MSc / Prof Katherine Fielding, PhD / Kerrigan McCarthy, MSc / Prof Gavin Churchyard, PhD / Prof Alison Grant, PhD / Edina Sinanovic, PhD

The Lancet Global Health, Vol 5, Iss 7, Pp e710-e

a real-world cost analysis and economic evaluation

2017 Volume 719

Abstract: Background: In 2010 a new diagnostic test for tuberculosis, Xpert MTB/RIF, received a conditional programmatic recommendation from WHO. Several model-based economic evaluations predicted that Xpert would be cost-effective across sub-Saharan Africa. We ... ...

Abstract	Background: In 2010 a new diagnostic test for tuberculosis, Xpert MTB/RIF, received a conditional programmatic recommendation from WHO. Several model-based economic evaluations predicted that Xpert would be cost-effective across sub-Saharan Africa. We investigated the cost-effectiveness of Xpert in the real world during national roll-out in South Africa. Methods: For this real-world cost analysis and economic evaluation, we applied extensive primary cost and patient event data from the XTEND study, a pragmatic trial examining Xpert introduction for people investigated for tuberculosis in 40 primary health facilities (20 clusters) in South Africa enrolled between June 8, and Nov 16, 2012, to estimate the costs and cost per disability-adjusted life-year averted of introducing Xpert as the initial diagnostic test for tuberculosis, compared with sputum smear microscopy (the standard of care). Findings: The mean total cost per study participant for tuberculosis investigation and treatment was US$312·58 (95% CI 252·46–372·70) in the Xpert group and $298·58 (246·35–350·82) in the microscopy group. The mean health service (provider) cost per study participant was $168·79 (149·16–188·42) for the Xpert group and $160·46 (143·24–177·68) for the microscopy group of the study. Considering uncertainty in both cost and effect using a wide range of willingness to pay thresholds, we found less than 3% probability that Xpert introduction improved the cost-effectiveness of tuberculosis diagnostics. Interpretation: After analysing extensive primary data collection during roll-out, we found that Xpert introduction in South Africa was cost-neutral, but found no evidence that Xpert improved the cost-effectiveness of tuberculosis diagnosis. Our study highlights the importance of considering implementation constraints, when predicting and evaluating the cost-effectiveness of new tuberculosis diagnostics in South Africa. Funding: Bill & Melinda Gates Foundation.
Keywords	Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2017-07-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

Full text online

Full text

Inter-library loan at ZB MED

Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

Article ; Online: Effect of second booster vaccinations and prior infection against SARS-CoV-2 in the UK SIREN healthcare worker cohortResearch in context

Peter D. Kirwan / Victoria J. Hall / Sarah Foulkes / Ashley D. Otter / Katie Munro / Dominic Sparkes / Anna Howells / Naomi Platt / Jonathan Broad / David Crossman / Chris Norman / Diane Corrigan / Christopher H. Jackson / Michelle Cole / Colin S. Brown / Ana Atti / Jasmin Islam / Anne M. Presanis / Andre Charlett /

Daniela De Angelis / Susan Hopkins / Tracy Lewis / Steve Bain / Rebeccah Thomas / John Geen / Carla Pothecary / Sean Cutler / John Northfield / Cathy Price / Johanne Tomlinson / Sarah Knight / Emily Macnaughton / Ekaterina Watson / Rajeka Lazarus / Aaran Sinclair / Joanne Galliford / Bridgett Masunda / Tabitha Mahungu / Alison Rodger / Esther Hanison / Simon Warren / Swati Jain / Mariyam Mirfenderesky / Natasha Mahabir / Rowan Pritchard-Jones / Diane Wycherley / Claire Gabriel / Elijah Matovu / Philippa Bakker / Simantee Guha / S. Gormley / James Pethick / Georgina Butt / Stacey Pepper / Luke Bedford / Paul Ridley / Jane Democratis / Manjula Meda / Anu Chawla / Fran Westwell / Nagesh Kalakonda / Sheena Khanduri / Allison Doel / Sumita Pai / Christian Hacon / Davis Nwaka / Veronica Mendez Moro / A. Moody / Cressida Auckland / Stephanie Prince / Thushan de Silva / Helen Shulver / A. Shah / C. Jones / Banerjee Subhro-Osuji / Angela Houston / Tim Planche / Martin Booth / Christopher Duff / Jonnie Aeron-Thomas / Ray Chaudhuri / David Hilton / Hannah Jory / Zehra'a Al-Khafaji / Philippa Kemsley / Ruth Longfellow / David Boss / Simon Brake / Louise Coke / Ngozi Elumogo / Scott Latham / Chinari Subudhi / Ina Hoad / Claire Thomas / Nihil Chitalia / Tracy Edmunds / Helen Ashby / John Elliott / Beverley Wilkinson / Abby Rand / Catherine Thompson / K. Agwuh / Anna Grice / Kelly Moran / Vijayendra Waykar / Yvonne Lester / Lauren Sach / Kathryn Court / Nikki White / Clair Favager / Kyra Holliday / Jayne Harwood / Brendan Payne / Karen Burns / Lynda Fothergill / Alejandro Arenas-Pinto / Abigail Severn / Kerryanne Brown / Katherine Gray / Jane Dare / Qi Zheng / Kathryn Hollinshead / Robert Shorten / Alun Roebuck / Christopher Holmes / Martin Wiselka / Barzo Faris / Liane Marsh / Clare McAdam / Lisa Ditchfield / Zaman Qazzafi / G. Boyd / N. Wong / Sarah Brand / Jack Squires / John Ashcroft / Ismaelette Del Rosario / Joanne Howard / Emma Ward / Gemma Harrison / Joely Morgan / Claire Corless / Ruth Penn / Nick Wong / Manny Bagary / Nadezda Starkova / Mandy Beekes / Mandy Carnahan / Shivani Khan / Shekoo Mackay / Keneisha Lewis / Graham Pickard / Joy Dawson / Lauren Finlayson / Euan Cameron / Anne Todd / Sebastien Fagegaltier / Sally Mavin / Alexandra Cochrane / Andrew Gibson / Sam Donaldson / Kate Templeton / Martin Malcolm / Beth Smith / Devesh Dhasmana / Susan Fowler / Antonia Ho / Michael Murphy / Claire Beith / Manish Patel / Elizabeth Boyd / Val Irvine / Alison Grant / Rebecca Temple-Purcell / Clodagh Loughrey / Elinor Hanna / Frances Johnston / Angel Boulos / Fiona Thompson / Yuri Protaschik / Susan Regan / Tracy Donaghy / Maurice O'Kane / Omolola Akinbami / Paola Barbero / Tim Brooks / Meera Chand / Ferdinando Insalata / Palak Joshi / Anne-Marie O'Connell / Mary Ramsay / Ayoub Saei / Maria Zambon / Ezra Linley / Simon Tonge / Enemona Adaji / Omoyeni Adebiyi / Nick Andrews / Joanna Conneely / Paul Conneely / Angela Dunne / Simone Dyer / Hannah Emmett / Nipunadi Hettiarachchi / Nishanthan Kapirial / Jameel Khawam / Edward Monk / Sophie Russell / Andrew Taylor-Kerr / Jean Timeyin / Silvia D'Arcangelo / Cathy Rowe / Amanda Semper / Eileen Gallagher / Robert Kyffin / Lisa Cromey / Desmond Areghan / Jennifer Bishop / Melanie Dembinsky / Laura Dobbie / Josie Evans / David Goldberg / Lynne Haahr / Annelysse Jorgenson / Ayodeji Matuluko / Laura Naismith / Desy Nuryunarsih / Alexander Olaoye / Caitlin Plank / Lesley Price / Nicole Sergenson / Sally Stewart / Andrew Telfer / Jennifer Weir / Ellen De Lacy / Yvette Ellis / Susannah Froude / Guy Stevens / Linda Tyson / Susanna Dunachie / Paul Klenerman / Chris Duncan / Rebecca Payne / Lance Turtle / Alex Richter / Thushan De Silva / Eleanor Barnes / Daniel Wootton / Oliver Galgut / Jonathan Heeney / Helen Baxendale / Javier Castillo-Olivares / Rupert Beale / Edward Carr / Wendy Barclay / Maya Moshe / Massimo Palmarini / Brian Willett / John Kenneth Baillie / Jennie Evans / Erika Aquino

The Lancet Regional Health. Europe, Vol 36, Iss , Pp 100809- (2024)

1481

Abstract: Summary: Background: The protection of fourth dose mRNA vaccination against SARS-CoV-2 is relevant to current global policy decisions regarding ongoing booster roll-out. We aimed to estimate the effect of fourth dose vaccination, prior infection, and ... ...

Abstract	Summary: Background: The protection of fourth dose mRNA vaccination against SARS-CoV-2 is relevant to current global policy decisions regarding ongoing booster roll-out. We aimed to estimate the effect of fourth dose vaccination, prior infection, and duration of PCR positivity in a highly-vaccinated and largely prior-COVID-19 infected cohort of UK healthcare workers. Methods: Participants underwent fortnightly PCR and regular antibody testing for SARS-CoV-2 and completed symptoms questionnaires. A multi-state model was used to estimate vaccine effectiveness (VE) against infection from a fourth dose compared to a waned third dose, with protection from prior infection and duration of PCR positivity jointly estimated. Findings: 1298 infections were detected among 9560 individuals under active follow-up between September 2022 and March 2023. Compared to a waned third dose, fourth dose VE was 13.1% (95% CI 0.9 to 23.8) overall; 24.0% (95% CI 8.5 to 36.8) in the first 2 months post-vaccination, reducing to 10.3% (95% CI −11.4 to 27.8) and 1.7% (95% CI −17.0 to 17.4) at 2–4 and 4–6 months, respectively. Relative to an infection >2 years ago and controlling for vaccination, 63.6% (95% CI 46.9 to 75.0) and 29.1% (95% CI 3.8 to 43.1) greater protection against infection was estimated for an infection within the past 0–6, and 6–12 months, respectively. A fourth dose was associated with greater protection against asymptomatic infection than symptomatic infection, whilst prior infection independently provided more protection against symptomatic infection, particularly if the infection had occurred within the previous 6 months. Duration of PCR positivity was significantly lower for asymptomatic compared to symptomatic infection. Interpretation: Despite rapid waning of protection, vaccine boosters remain an important tool in responding to the dynamic COVID-19 landscape; boosting population immunity in advance of periods of anticipated pressure, such as surging infection rates or emerging variants of concern. Funding: UK ...
Keywords	SARS-CoV-2 ; Vaccine effectiveness ; Asymptomatic ; Symptomatic ; Healthcare worker ; Cohort study ; Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2024-01-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

Full text online

Full text

Inter-library loan at ZB MED

Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

Book: Bibliography of statistical literature

Kendall, Maurice George / Doig, Alison Grant

1968

Author's details	Maurice G. Kendall and Alison G. Doig
Language	English
Size	356 S
Publisher	Oliver and Boyd
Publishing place	Edinburgh u.a.
Document type	Book
Database	Former special subject collection: coastal and deep sea fishing

Inter-library loan at ZB MED

Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

Details ▾

Book: Bibliography of statistical literature

Kendall, Maurice G / Doig, Alison Grant

1968

Author's details	Maurice G. Kendall and Alison G. Doig
Keywords	Statistik ; Statistiktheorie ; Bibliographie der Periodikaaufsätze
Language	English
Size	356 S
Document type	Book
Database	ECONomics Information System

Inter-library loan at ZB MED

Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

Details ▾

To top

Full text online

More links

Kategorien

Inter-library loan at ZB MED

Full text online

More links

Kategorien

Inter-library loan at ZB MED

Full text online

More links

Kategorien

Inter-library loan at ZB MED

Full text online

More links

Kategorien

Inter-library loan at ZB MED

Full text online

More links

Kategorien

Inter-library loan at ZB MED

Full text online

More links

Kategorien

Inter-library loan at ZB MED

Full text online

More links

Kategorien

Inter-library loan at ZB MED

Full text online

More links

Kategorien

Inter-library loan at ZB MED

More links

Kategorien

Inter-library loan at ZB MED

More links

Kategorien

Inter-library loan at ZB MED