What We Do
Our ethos is
to generate insight and find practical solutions to real problems. We use mathematical modelling, computer simulation and quantitative
analysis to tackle a range of problems in health and health
care, choosing whatever approach is most suited to the problem at hand.
Key to our success is that we work very
closely with clinicians and other experts to ensure our work is
informed by and relevant to
their experience. It is
our
flexibility in methodological approach, our ability to spot opportunities for
cross-fertilisation and our extensive collaborative network that enables CORU to
undertake projects across a very broad range of disciplines and
problems.
Some of our current and recent projects
| LOCAL |
NATIONAL |
GLOBAL |
LOCAL
Modelling concerning the use of bridging technologies in heart transplantation programmes
It is possible to prolong the life of some children
awaiting heart transplantation using “bridging” technologies. We are
working with surgeons, cardiologists and intensivists at Great Ormond
Street Hospital to address a number of questions raised by the
availability of this expensive resource. Bridging may increase the
chance of an individual patient receiving a transplant and of a donated
organ being used. However, these benefits need to be considered
alongside the opportunity costs associated with the prolonged use of
intensive care beds and the fact that for some patients this burdensome
intervention will prove unavailing.
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Organisation of hospital pharmacies
CORU has an ongoing collaboration with colleagues from the School of
Pharmacy and Imperial College Healthcare NHS Trust in work related to
the operation of in hospital pharmacy dispensers and the provision of
feedback to physicians on prescribing errors.
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Workforce planning in a cardiac intensive care unit
In a short exercise working with consultant intensivists, we compared
patterns of admission to cardiac intensive care to staffing levels by
time of day and day of week. This work informed decisions regarding
future staffing of the unit concerned.
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The monitoring and reporting of surgical wound infections
Hospital acquired infections such as MRSA are a
major concern for clinicians and for the public. As part of our work in
the area of improving patient safety, we are working with
microbiologists at University College London Hospital to develop
practical tools to assist with the monitoring and reporting of surgical
wound infections. We aim to provide clinicians with an early-warning
system that will help identify, in a timely fashion, trends in infection
rates and also to standardise and automate the reporting of the
occurrence of surgical wound infections to clinical teams. By alerting
clinicians to potential problems, the hope is that this work will result
in a reduction in the number of surgical wound infections and,
consequently, save many lives and reduce post-operative morbidity.
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NATIONAL
Risk modelling in congenital heart surgery
Audit and clinical governance in adult cardiac surgery have
benefited greatly from the existence of a widely accepted model for the
risk of peri-operative death and tools developed within CORU for
monitoring risk-adjusted outcomes.
No widely accepted risk model exists for use in congenital heart
surgery, partly due to the great diversity in diagnoses, co-morbidities
and surgical procedures. CORU is working with surgeons and intensivists
at Great Ormond Street Hospital for Children and the Central Cardiac
Audit Database to establish whether the routine adjustment of surgical
outcomes for case mix is feasible.
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Evaluating the role of pneumococcal vaccine in an influenza pandemic
We
developed a mathematical model for estimating the number of deaths
and hospitalisations that could be avoided by use of a vaccine against
pneumonia in the advent of an influenza pandemic. This work directly
informed the policy process within Department of Health.
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Modelling the effectiveness of triage to intensive care
Working with consultant intensivists from Great
Ormond Street Hospital, we developed simple analytical models to inform
thinking concerning processes of triage to determine access to critical
care during a pandemic. Our work focussed attention on the need to be
clear as to the objectives of triage and explored the nature and scale
of differences that would have to exist between different patient groups
for triage to have the intended benefits.
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CORU is working with colleagues at the Thames
Cancer Registry to build mathematical models for estimating cancer
prevalence over the coming decades. Ultimately, our aim is to provide
estimates as to the number of people at each of a number of stages of
their disease or recovery with a view to informing the provision of
health care and other services for this growing section of the
population. Image courtesy of King's College London.
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GLOBAL
Navigating the Evidence of Health Financing
We have been working with colleagues at the UCL
Centre for International Health and Development and Save the Children to
review the published evidence on the impact and feasibility of
different models of health financing. The second part of the project
involved developing a web based tool that will allow policy makers to
explore and navigate the evidence generated by the literature review
with respect to their own contexts and concerns. This tool is due to be
launched in the spring of 2011.
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Insufficient progress had been made towards meeting
the Millennium Development Goals of reducing maternal mortality rates. We built a mathematical model of the key steps during and after childbirth which can lead to maternal death from haemorrhage or sepsis. We used this model to estimate the potential impact of a range of interventions aimed at increasing women's access to life-saving medicines.
The scale of unattended deliveries in Asia and Africa
A key step to reducing maternal mortality in Asia and Africa is to increase access to skilled attendance at birth. In 2008, less than half of women gave birth with a skilled attendant in many parts of Asia and Africa. However, access cannot be increased overnight, and many women will continue to give birth without skilled attendance in the years to come. In such contexts, policy makers might choose to implement policies aimed at preventing death in unattended births, alongside policies aimed at increase access to skilled attendance.
We used existing data and simple mathematics to estimate a plausible range for the absolute number of women giving birth without a skilled attendant in each county in South Asia and sub-Saharan Africa over the next five years, to help inform short-term policy. Graphic from WHO.
We assisted
in the analysis of two trials published in the Lancet in 2010 on the effect of community women’s
groups on neonatal deaths in India and Bangladesh. Following up on this work, CORU
contributed to UCL consultancy work for the Department of International
Development to examine the potential for extending community
interventions in India to address malnutrition.
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