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  1. Posted
    Categories
    • OpenPathology

    OpenPathology: Issues with reference ranges — Part 2

    This is the second installment in our series of commentaries on reference ranges used to interpret pathology test results. Here we describe two issues relating to how meaningful reference ranges are.

    Reference ranges are usually indicators of statistical outliers in a healthy reference population

    The most common type of reference range is defined as the interval between which 95% of the values of a healthy reference population fall into. In other words, 2.5% of the time, healthy people will have haemoglobin concentrations less than the lower limit.

  2. Posted
    Categories
    • OpenPathology

    OpenPathology: Issues with reference ranges — Part 1

    As the OpenPathology project has progressed, we have started to build measures to describe variation between practices, and groups of practices.

    While comparing rates of requests per head of population can be used as a simple measure of possible over- or under-use of tests compared to other practices, it doesn’t take into account the general health needs of the population, so it can be difficult to rule out warranted variation. Therefore, comparing variation in rates of abnormal results is another useful measure to consider.

  3. Posted
    Categories
    • OpenPathology

    OpenPathology: fake seasonality in potassium results — dangerous and avoidable

    In our initial analyses of pathology data from the South West for our OpenPathology.net project, there is a pronounced (sometimes extreme) increase in high potassium results during the winter months, and a corresponding increase in low-potassium results in summer:

    What’s causing it?

    The level of potassium in plasma within a blood sample is affected by temperature. Potassium can move into and out of blood cells during storage: in cooler temperatures, potassium diffuses out of cells into plasma, leading to the reading being artefactually higher, while in higher temperatures an enzyme works to pump potassium into the cells.

  4. Posted
    Categories
    • OpenPathology

    OpenPathology: Seasonality in Haemoglobin test results

    In our initial analyses of pathology data from the South West for our OpenPathology.net project, we have noticed subtle but consistent variation in haemoglobin test results throughout the year. Haemoglobin (Hb) levels falling below certain threshold values typically give a diagnosis of anaemia.

    In the following regional sample we see that the mean Hb concentration across both males and females differs by 2-3 g/l between the summer low and the winter peak:

  5. Posted
    Categories
    • OpenPrescribing

    New Measure — Inhalers and the Environment

    At the Bennett Institute we regularly collaborate on projects, both small and large, with users who get in touch. For development of this measure we would like to thank the NHS England Sustainable Unit and Centre for Sustainable Healthcare for their input on our work to support the NHS Long Term Plan. Another one of our collaborators on this work is Nicola Read, a respiratory doctor who is currently one of the National Medical Director’s Clinical Fellows. Below we set our new measure on inhalers and the environment and Nicola explains its importance for all inhaler prescribers.

  6. Posted
    Categories
    • OpenPrescribing

    New Measure: Seven Day Prescribing for Long-term Conditions

    This week we launched a new measure of seven day prescription for medicines used to treat long-term conditions. There is no current consensus on duration of prescription across the NHS and prescribers are advised that they should write a prescription for a duration that is clinically appropriate. For medicines that are for stable long-term conditions many areas have policies in place recommending one, two, or three month prescriptions.

    What are Medicines Compliance Aids?

    Medicines Compliance Aids (MCAs), sometimes known as dosette boxes or pill organisers, are plastic boxes with small compartments that show which pills need to be taken at what time of day. The British Medical Association reports growing requests to prescribe seven day quantities of medicines to fund supply of medicine compliance aids (MCAs). We propose this measure of seven day prescriptions for long-term conditions as a surrogate measure for MCAs.

  7. Posted
    Categories
    • OpenPrescribing

    Zuclopenthixol Acetate: a new kind of measure on OpenPrescribing

    Zuclopenthixol is an antipsychotic used for schizophrenia and other psychoses. In the UK, there are two injectable forms of zuclopenthixol:

    • zuclopenthixol acetate : a short acting treatment used for acute episodes
    • zuclopenthixol decanoate : a long acting treatment used for maintenance

    This week we launched a new measure to support a new type of alert to identify any prescriptions of zuclopenthixol acetate for further investigation. It is not recommended to be prescribed in primary care, so prescriptions may have been prescribed in error.

  8. Posted
    Categories
    • Open Working

    OpenPrescribing Newsletter September 2019

    New Feature! Measures linked to Analyse page

    Following many requests from users, we have created links from our measures to the corresponding search on the Analyse page. This is particularly useful if you want to see multiple practices or CCGs on one chart, view the results on a map, or see exactly which products are included in the measure.

    You will notice this is not yet available for all of our measures (which now number close to 100), due to the complex way some measures are constructed. This currently affects just 12 of our standard measures and 4 of the Low-Priority prescribing measures, and we hope to keep increasing the options in the coming months.

  9. Posted
    Categories
    • OpenPathology

    OpenPathology: getting population sizes right

    At OpenPathology, we’ve already found interesting variation in test request rates between practices, but we’d also like to compare whole laboratories.

    The number of tests per patient is an important measure for understanding variation in test requesting across the country. For example, the Getting It Right First Time (GIRFT) initiative uses this measurement to shine a light on clinically important variation and promote improvements in cost-effective care.

    For GIRFT, laboratories in England were asked to provide an estimate of their primary care populations. North Devon reported this as 160,000 patients, and Cornwall reported 473,637.

  10. Posted
    Categories
    • OpenPathology

    Validating pathology data against known shifts in clinical practice

    OpenPathology is our project exploring and feeding back to clinicians on their test requesting rates.

    Having established that patient counts are subject to some inaccuracy in existing analyses (see our previous blog), it’s important to sense check the accuracy of our own list size data.

    Because two members of our OpenPathology team are also clinicians in North Devon, we have the opportunity to compare our data with known changes in practice.

  11. Posted
    Categories
    • OpenPathology

    Examining variation in test request rates

    We are excited to reveal some of the data for our new OpenPathology.net project. Similar to our previous project for NHS prescribing data openprescribing.net, we are developing free, open dashboards for analysing NHS pathology data. So far we have data from two laboratories (North Devon and Cornwall), and have started to analyse it.

    What have we found so far?

    Lots. This blog post is one in a series highlighting some initial insights we have noted.

  12. Posted
    Categories
    • Open Working

    OpenPrescribing Newsletter Summer 2019

    New Feature! DM+D browser

    This week we have launched a new browser for the NHS Dictionary of Medicines and Devices, better known as dm+d. dm+d is the standard dictionary for the medicines and devices used across the NHS. At last count there were over 150,000 packs of medicines and devices described. You can read more about the dm+d in [this detailed blog]/blog/2019/08/what-is-the-dm-d-the-nhs-dictionary-of-medicines-and-devices/).

    We have been using the dm+d browser internally for a while, and having found it very useful we believe it will come in handy for others too, so we have now made it available publicly for anyone to use. Read more about the tool here.

  13. Posted
    Categories
    • OpenPrescribing

    NHS dm+d browser — A New Feature on OpenPrescribing

    This week we have launched a new browser for the NHS Dictionary of Medicines and Devices, better known as dm+d. dm+d is the standard dictionary for the medicines and devices used across the NHS. It contains codes and descriptions for all these medicines and devices; at last count there were over 150,000 packs of medicines and devices described. You can read more about the dm+d in this detailed blog.

    What is the dm+d browser?

    Our dm+d browser allows anyone to search and identify any product in the NHS. For example, you can see all the paracetamol products available in the dm+d here. We’ve previously written about how the dm+d can be useful, like using user-friendly names on the website, or identifying all dry powdered inhalers for analysis. As we have found our dm+d browser so useful, we believe others will find it useful too, and have now made it available publicly for anyone to use.

  14. Posted
    Categories
    • OpenCodelists

    What is the dm+d? The NHS Dictionary of Medicines and Devices

    Over the past year we have been increasingly using NHS Dictionary of Medicines and Devices (dm+d). This blog post sets out to describe dm+d for the benefit of the wider prescribing analytics community and others.

    What is the NHS Dictionary of Medicines and Devices (dm+d)?

    dm+d is the standard dictionary for the medicines and devices used across the NHS. It contains standardised codes, descriptions, and metadata (such as price and pack size) for every entry. At last count it contained over 150,000 packs of medicines and devices.

  15. Posted
    Categories
    • Policy Insights

    UK Trials and Brexit — An Update

    Earlier this year we noticed a disturbing trend among UK trials registered on the EUCTR. The amount of newly approved and registered trials on the EUCTR dropped drastically following the 2016 Brexit vote. The chart from that blog post (from May 2019) is included below.

    When we reached out to the MHRA to ask about this, they stated that there was actually no decline in UK trials post-Brexit but rather administrative delays that kept trials from appearing on the public-facing EUCTR website. They noted this issue was being addressed and updates would be completed by the end of Q2 2019.

  16. Posted
    Categories
    • Open Working

    OpenPrescribing Newsletter June 2019

    New low-priority measures approved

    Yesterday (27 June), NHS England completed its consultation on an additional proposed set of products being considered for a recommendation against regular use in primary care. Therefore, on the site we have now included these new items in the set of low-priority measures. The newly added products include bath and shower emollients, higher cost insulin pen needles and dronedarone. See how your practice or CCG is performing on these measures here, or navigate to the Low Priority measures from your favourite organisation’s dashboard.

  17. Posted
    Categories
    • OpenPrescribing

    Additional Functions on Analyse page - multi-level searching and STP/NHS England regions

    Our technical team are busy improving how the engine room of OpenPrescribing. When they’ve finished we’ll get them to write a blog on exactly what they’ve done. In the meantime, as the work progresses we are able to add some additional exciting new features to the site.

    Multi-level analysis

    One of the limitations of how our Analyse page worked was the ability to only search at one BNF level at a time. For example, you couldn’t search for products and presentations together. However, now you are able to add any combinations you want, making this tool much more powerful. For example, it’s helpful when looking at broad-spectrum antibiotics: previously you could only include either cephalosporins and quinolones (BNF paragraphs), OR co-amoxiclav (a BNF chemical). Now you can include all of them at the same time.

  18. Posted
    Categories
    • OpenPrescribing

    Custom Organisation Groupings: OpenPrescribing Plan for Organisations like Primary Care Networks

    Update November 2019: Our NHS PCN dashboards are now live at https://openprescribing.net/pcn/ and you can read more on our launch blog.

    Update August 2019: Our amazing developers have written all the code necessary to display all prescribing measures and data for all PCNs in England on OpenPrescribing. Unfortunately there is no national list of PCNs and their membership available, as soon as this is published we will bring you our prescribing dashboards.