University roles and responsibilities
- Project Manager
Affiliations and memberships
Contrast-enhanced digital mammography (CEDM) is an alternative to conventional X-ray mammography for imaging dense breasts. However, conventional approaches to CEDM require a double exposure of the patient, implying higher dose, and risk of incorrect image registration due to motion artifacts. A novel approach is presented, based on hyperspectral imaging, where a detector combining positional and high-resolution spectral information (in this case based on Cadmium Telluride) is used. This allows simultaneous acquisition of the two images required for CEDM. The approach was tested on a custom breast-equivalent phantom containing iodinated contrast agent (Niopam 150®). Two algorithms were used to obtain images of the contrast agent distribution: K-edge subtraction (KES), providing images of the distribution of the contrast agent with the background structures removed, and a dual-energy (DE) algorithm, providing an iodine-equivalent image and a water-equivalent image. The high energy resolution of the detector allowed the selection of two close-by energies, maximising the signal in KES images, and enhancing the visibility of details with the low surface concentration of contrast agent. DE performed consistently better than KES in terms of contrast-to-noise ratio of the details; moreover, it allowed a correct reconstruction of the surface concentration of the contrast agent in the iodine image. Comparison with CEDM with a conventional detector proved the superior performance of hyperspectral CEDM in terms of the image quality/dose tradeoff.
Computerised medical record (CMR) system data can be used to compare different models of health care for children. We identified sources of data from the Models of Child Health Appraised (MOCHA) project that compares family doctor led with paediatrician led and mixed models of child care using index conditions. Asthma and immunisation coverage are the first of these. We explored the extent to which an established Patient Registries Initiative (PARENT); MOCHA's own survey (MIROI); the European Centre for Disease Control (ECDC) immunisation information system survey and the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) registry of data sources provided data to make comparisons of child health care. Five countries had data repositories for our index conditions from paediatrician lead services, compared with 14 for mixed, and 11 for family doctor led services. PARENT identified 212 sources, MIROI 148 sources, ECDC 17 sources and ENCePP 42; with immunisation related data sources found in all four but asthma in only three. There are less sources of electronic data available to study paediatrician led systems than other models; this risks unequal sample size bias.
To pilot enhanced safety surveillance of seasonal influenza vaccine meeting the European Medicines Agency (EMA) requirement to rapidly detect a significant increase in the frequency or severity of adverse events of interest (AEIs), which may indicate risk from the new season's vaccine.
A prospective passive enhanced safety surveillance combining data collection from adverse drug reaction (ADR) cards with automated collection of pseudonymised routinely collected electronic health record (EHR) data. This study builds on a feasibility study carried out at the start of the 2015/2016 influenza season. We will report influenza vaccine exposure and any AEIs reported via ADR card or recorded directly into the EHR, from the commencement of influenza vaccination and ends as specified by EMA (30 November 2016).
Ten volunteer English general practices, primarily using the GSK influenza vaccines. They had selected this vaccine in advance of the study.
People who receive a seasonal influenza vaccine, in each age group defined in EMA interim guidance: 6 months to 5 years, 6-12 years, 13-17 years, 18-65 years and >65 years.
The primary outcome measure is the rate of AEIs occurring within 7 days postvaccination, using passive surveillance of general practitioner (GP) EHR systems enhanced by a card-based ADR reporting system. Extracted data will be presented overall by brand (Fluarix Tetra vs others), by age strata and risk groups. The secondary outcome measure is the vaccine uptake among the subjects registered in the enrolled general practices.
ETHICS AND DISSEMINATION:
Ethical approval was granted by the Proportionate Review Sub-committee of the North East-Newcastle & North Tyneside 2 on 5 August 2016. The study received approval from the Health Research Authority on 1 September 2016. We will produce an interim analysis within 8 weeks, and an end-of-study report, which will be submitted to peer-reviewed journals.