A5089836433- Health Systems, Economic Evaluations, Quality of Life
- Advanced Causal Inference Techniques
- Healthcare Policy and Management
- Economic and Environmental Valuation
- Sepsis Diagnosis and Treatment
- Statistical Methods and Bayesian Inference
- Healthcare cost, quality, practices
- Cardiac, Anesthesia and Surgical Outcomes
- Statistical Methods in Clinical Trials
- COVID-19 and healthcare impacts
- Neonatal Respiratory Health Research
- Respiratory Support and Mechanisms
- COVID-19 Clinical Research Studies
- Statistical Methods and Inference
- Hemodynamic Monitoring and Therapy
- Primary Care and Health Outcomes
- Pharmaceutical Economics and Policy
- Chronic Disease Management Strategies
- Intensive Care Unit Cognitive Disorders
- Traumatic Brain Injury and Neurovascular Disturbances
- Cardiac Arrest and Resuscitation
- Antifungal resistance and susceptibility
- Meta-analysis and systematic reviews
- Aortic aneurysm repair treatments
- Family and Patient Care in Intensive Care Units
London School of Hygiene & Tropical Medicine
2016-2025
Qatar University
2024
Science Oxford
2024
Faculty of Public Health
2011-2023
University of London
2011-2022
AstraZeneca (Sweden)
2019
University of Auckland
2018
Karolinska Institutet
2018
George Institute for Global Health
2018
University of Oxford
2018
Early, goal-directed therapy (EGDT) is recommended in international guidelines for the resuscitation of patients presenting with early septic shock. However, adoption has been limited, and uncertainty about its effectiveness remains.We conducted a pragmatic randomized trial an integrated cost-effectiveness analysis 56 hospitals England. Patients were randomly assigned to receive either EGDT (a 6-hour protocol) or usual care. The primary clinical outcome was all-cause mortality at 90 days.We...
XTRACORPOREAL MEMBRANE OXYgenation (ECMO) can support gas exchange independently of mechanical ventilation in patients with severe acute respiratory failure.ECMO may be used either as a rescue intervention or to minimize ventilator-associated lung injury 1 and its associated multiple organ dysfunction, 2 both crucial determinants survival for distress syndrome (ARDS).
Abstract Background Establishing who is at risk from a novel rapidly arising cause of death, and why, requires new approach to epidemiological research with very large datasets timely data. Working on behalf NHS England we therefore set out deliver secure pseudonymised analytics platform inside the data centre major primary care electronic health records vendor establishing coverage across detailed for substantial proportion all patients in England. The following results are preliminary....
<h2>Summary</h2><h3>Background</h3> COVID-19 has disproportionately affected minority ethnic populations in the UK. Our aim was to quantify differences SARS-CoV-2 infection and outcomes during first second waves of pandemic England. <h3>Methods</h3> We conducted an observational cohort study adults (aged ≥18 years) registered with primary care practices England for whom electronic health records were available through OpenSAFELY platform, who had at least 1 year continuous registration start...
This paper examines the synthetic control method in contrast to commonly used difference-in-differences (DiD) estimation, context of a re-evaluation pay-for-performance (P4P) initiative, Advancing Quality scheme. The aims estimate treatment effects by constructing weighted combination units, which represents what treated group would have experienced absence receiving treatment. While DiD estimation assumes that unobserved confounders are constant over time, allows for these change...
<h3>Importance</h3> Vasopressors are commonly administered to intensive care unit (ICU) patients raise blood pressure. Balancing risks and benefits of vasopressors is a challenge, particularly in older patients. <h3>Objective</h3> To determine whether reducing exposure through permissive hypotension (mean arterial pressure [MAP] target, 60-65 mm Hg) reduces mortality at 90 days ICU aged 65 years or with vasodilatory hypotension. <h3>Design, Setting, Participants</h3> A multicenter,...
Whether an insulin infusion should be used for tight control of hyperglycemia in critically ill children remains unclear.We randomly assigned (≤16 years age) who were admitted to the pediatric intensive care unit (ICU) and expected require mechanical ventilation vasoactive drugs at least 12 hours either glycemic control, with a target blood glucose range 72 126 mg per deciliter (4.0 7.0 mmol liter), or conventional level below 216 (12.0 liter). The primary outcome was number days alive free...
Difference-in-differences (DiD) estimators provide unbiased treatment effect estimates when, in the absence of treatment, average outcomes for treated and control groups would have followed parallel trends over time. This assumption is implausible many settings. An alternative that potential are independent status, conditional on past outcomes. paper considers three methods share this assumption: synthetic method, a lagged dependent variable (LDV) regression approach, matching Our motivating...
Headline Evaluating service innovations in health care and public requires flexibility, collaboration pragmatism; this collection identifies robust, innovative mixed methods to inform such evaluations.
The HTA Programme was
Abstract Objective To evaluate the cost effectiveness of acupuncture in management chronic headache. Design Cost analysis a randomised controlled trial. Setting General practices England and Wales. Participants 401 patients with headache, predominantly migraine. Interventions Patients were randomly allocated to receive up 12 treatments over three months from appropriately trained physiotherapists, or usual care alone. Main outcome measure Incremental per quality adjusted life year (QALY)...
Abstract Cost‐effectiveness analyses (CEA) alongside randomised controlled trials commonly estimate incremental net benefits (INB), with 95% confidence intervals, and compute cost‐effectiveness acceptability curves ellipses. Two alternative non‐parametric methods for estimating INB are to apply the central limit theorem (CLT) or use bootstrap method, although it is unclear which method preferable. This paper describes statistical rationale underlying each of these illustrates their...
Abstract Background Single-centre series of the management patients with ruptured abdominal aortic aneurysm (AAA) are usually too small to identify clinical factors that could improve patient outcomes. Methods IMPROVE is a pragmatic, multicentre randomized trial in which eligible diagnosis were allocated strategy endovascular repair (EVAR) or open repair. The influences time and manner hospital presentation, fluid volume status, type anaesthesia, on 30-day mortality investigated according...
Summary Randomized controlled trials (RCTs) can provide unbiased estimates of sample average treatment effects. However, a common concern is that RCTs may fail to population We derive the assumptions are required identify effects from RCTs. placebo tests, which formally follow identifying and assess whether they hold. offer new research designs for estimating use non-randomized studies adjust RCT data. This approach considered in cost-effectiveness analysis clinical intervention: pulmonary...
Aim. Cost-effectiveness analyses (CEAs) may use data from cluster randomized trials (CRTs), where the unit of randomization is cluster, not individual. However, most studies analytical methods that ignore clustering. This article compares alternative statistical for accommodating clustering in CEAs CRTs. Methods. Our simulation study compared performance CRTs with 2 treatment arms. The considered a method ignored clustering—seemingly unrelated regression (SUR) without robust standard error...
<b>Objective</b> To compare the cost effectiveness of three most commonly chosen types prosthesis for total hip replacement. <b>Design</b> Lifetime model with parameters estimated from individual patient data obtained large national databases. <b>Setting</b> English National Health Service. <b>Participants</b> Adults aged 55 to 84 undergoing primary replacement osteoarthritis. <b>Interventions</b> Total using either cemented, cementless, or hybrid prostheses. <b>Main outcome measures</b>...
Early goal-directed therapy (EGDT) is recommended in international guidance for the resuscitation of patients presenting with early septic shock. However, adoption has been limited and uncertainty remains over its clinical effectiveness cost-effectiveness.The primary objective was to estimate effect EGDT compared usual on mortality at 90 days following randomisation incremental cost-effectiveness 1 year. The secondary objectives were compare requirement for, duration of, critical care unit...
Cost-effectiveness analyses (CEA) of randomised controlled trials are a key source information for health care decision makers. Missing data are, however, common issue that can seriously undermine their validity. A major concern is the chance being missing may be directly linked to unobserved value itself [missing not at random (MNAR)]. For example, patients with poorer less likely complete quality-of-life questionnaires. However, extent which this occurs cannot ascertained from hand....
A meta-analysis of outcomes during the 6 months after intensive care unit (ICU) discharge indicate a prevalence for clinically important posttraumatic stress disorder (PTSD) symptoms 25%.To determine whether nurse-led preventive, complex psychological intervention, initiated in ICU, reduces patient-reported PTSD symptom severity at months.A multicenter, parallel-group, cluster-randomized clinical trial with integrated economic and process evaluations conducted 24 ICUs United Kingdom....
<h3>Importance</h3> The optimal first-line mode of noninvasive respiratory support following extubation critically ill children is not known. <h3>Objective</h3> To evaluate the noninferiority high-flow nasal cannula (HFNC) therapy as extubation, compared with continuous positive airway pressure (CPAP), on time to liberation from support. <h3>Design, Setting, and Participants</h3> This was a pragmatic, multicenter, randomized, trial conducted at 22 pediatric intensive care units in United...
The optimal first-line mode of noninvasive respiratory support for acutely ill children is not known.To evaluate the noninferiority high-flow nasal cannula therapy (HFNC) as acute illness, compared with continuous positive airway pressure (CPAP), time to liberation from all forms support.Pragmatic, multicenter, randomized clinical trial conducted in 24 pediatric critical care units United Kingdom among 600 aged 0 15 years who were clinically assessed require support, recruited between August...
Abstract Objective To compare the effectiveness of three commonly prescribed oral antidiabetic drugs added to metformin for people with type 2 diabetes mellitus requiring second line treatment in routine clinical practice. Design Cohort study emulating a comparative trial (target trial). Setting Linked primary care, hospital, and death data England, 2015-21. Participants 75 739 adults who initiated sulfonylurea, DPP-4 inhibitor, or SGLT-2 inhibitor metformin. Main outcome measures Primary...