Browsing by Author "Richardson S"

Now showing 1 - 3 of 3
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    An informatics consult approach for generating clinical evidence for treatment decisions
    (BioMed Central Ltd, 2021-12) Lai AG; Chang WH; Parisinos CA; Katsoulis M; Blackburn RM; Shah AD; Nguyen V; Denaxas S; Davey Smith G; Gaunt TR; Nirantharakumar K; Cox MP; Forde D; Asselbergs FW; Harris S; Richardson S; Sofat R; Dobson RJB; Hingorani A; Patel R; Sterne J; Banerjee A; Denniston AK; Ball S; Sebire NJ; Shah NH; Foster GR; Williams B; Hemingway H
    BACKGROUND: An Informatics Consult has been proposed in which clinicians request novel evidence from large scale health data resources, tailored to the treatment of a specific patient. However, the availability of such consultations is lacking. We seek to provide an Informatics Consult for a situation where a treatment indication and contraindication coexist in the same patient, i.e., anti-coagulation use for stroke prevention in a patient with both atrial fibrillation (AF) and liver cirrhosis. METHODS: We examined four sources of evidence for the effect of warfarin on stroke risk or all-cause mortality from: (1) randomised controlled trials (RCTs), (2) meta-analysis of prior observational studies, (3) trial emulation (using population electronic health records (N = 3,854,710) and (4) genetic evidence (Mendelian randomisation). We developed prototype forms to request an Informatics Consult and return of results in electronic health record systems. RESULTS: We found 0 RCT reports and 0 trials recruiting for patients with AF and cirrhosis. We found broad concordance across the three new sources of evidence we generated. Meta-analysis of prior observational studies showed that warfarin use was associated with lower stroke risk (hazard ratio [HR] = 0.71, CI 0.39-1.29). In a target trial emulation, warfarin was associated with lower all-cause mortality (HR = 0.61, CI 0.49-0.76) and ischaemic stroke (HR = 0.27, CI 0.08-0.91). Mendelian randomisation served as a drug target validation where we found that lower levels of vitamin K1 (warfarin is a vitamin K1 antagonist) are associated with lower stroke risk. A pilot survey with an independent sample of 34 clinicians revealed that 85% of clinicians found information on prognosis useful and that 79% thought that they should have access to the Informatics Consult as a service within their healthcare systems. We identified candidate steps for automation to scale evidence generation and to accelerate the return of results. CONCLUSION: We performed a proof-of-concept Informatics Consult for evidence generation, which may inform treatment decisions in situations where there is dearth of randomised trials. Patients are surprised to know that their clinicians are currently not able to learn in clinic from data on 'patients like me'. We identify the key challenges in offering such an Informatics Consult as a service.
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    Food for people in place: reimagining resilient food systems for economic recovery
    (MDPI (Basel, Switzerland), 2020-11-11) Dombroski K; Diprose G; Sharp E; Graham R; Lee L; Scobie M; Richardson S; Watkins A; Martin-Neuninger R
    The COVID-19 pandemic and associated response have brought food security into sharp focus for many New Zealanders. The requirement to “shelter in place” for eight weeks nationwide, with only “essential services” operating, affected all parts of the New Zealand food system. The nationwide full lockdown highlighted existing inequities and created new challenges to food access, availability, affordability, distribution, transportation, and waste management. While Aotearoa New Zealand is a food producer, there remains uncertainty surrounding the future of local food systems, particularly as the long-term effects of the pandemic emerge. In this article we draw on interviews with food rescue groups, urban farms, community organisations, supermarket management, and local and central government staff to highlight the diverse, rapid, community-based responses to the COVID-19 pandemic. Our findings reveal shifts at both the local scale, where existing relationships and short supply chains have been leveraged quickly, and national scale, where funding has been mobilised towards a different food strategy. We use these findings to re-imagine where and how responsibility might be taken up differently to enhance resilience and care in diverse food systems in New Zealand.
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    Regional destination attributes that attract domestic tourists: the role of man-made venues for leisure and recreation.
    (2021-06) Camacho-Murillo A; Gounder R; Richardson S
    This paper examines the influence of man-made attractions for leisure and recreation on domestic tourists' preferences amongst regional destinations, and the moderating role of these attractions on the negative effect of distance on tourists' choices. A mixed multinomial logit model is employed for 368 cities in Colombia grouped into 28 provinces. Factor analysis is utilised to identify the latent variable that groups several man-made attractions for leisure and recreation. Results show that domestic tourists' choices of a regional destination increase as the number of man-made attractions for leisure and recreation rises, although there is taste heterogeneity between tourists explained by their city of origin. Findings also show that the decline in domestic tourists' preferences for a regional destination due to increases in travel distance can be lessened through the construction and/or enhancement of man-made venues for leisure and recreation in the destination; a strategy that can serve to reduce monetary poverty in distant destinations that have attributes to attract tourists.