http://bura.brunel.ac.uk/handle/2438/8608 2026-07-05T22:35:53Z 2026-07-05T22:35:53Z Maashi, A Davies, J http://bura.brunel.ac.uk/handle/2438/33536 2026-06-30T02:00:25Z 2026-06-15T00:00:00Z

Title: Identifying Clinical Managers’ Leadership Competencies: A Systematic Review and Cross-Frameworks Mapping Using the CLCF Authors: Maashi, A; Davies, J Abstract: Background/Objectives: Effective clinical leadership is a critical driver of healthcare quality, patient safety, and organisational performance. However, evidence on the leadership competencies of healthcare professionals in formal management roles remains fragmented. It is dispersed across professional groups, healthcare contexts, and conceptual frameworks, limiting opportunities for synthesis and cumulative knowledge development. This systematic review examined three questions: how clinical managers perceive their leadership competency; what challenges they encounter in exercising leadership roles; and what development mechanisms the literature identifies. Methods: A systematic review was conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD420261305279). Four databases were searched: Ovid MEDLINE, CINAHL, EMCARE, and Web of Science from January 2010 to February 2026. Two reviewers independently screened studies; methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Reported competencies were mapped to the five domains of the Clinical Leadership Competency Framework (CLCF) using narrative integrative synthesis. Results: Forty-nine studies were included across quantitative, qualitative, and mixed-methods designs from 24 countries. Competencies in the Working with Others and Demonstrating Personal Qualities domains were reported as strengths across the largest number of included studies. Competencies in Managing Services, Improving Services, and Setting Direction were reported as areas of weakness or developmental need across multiple studies. Leadership challenges included inadequate preparation, role ambiguity, limited authority, and organisational constraints. Development needs spanned formal training, strategic competency building, mentoring, and sustained organisational support. Conclusions: Clinical leadership competency is unevenly distributed across CLCF domains. This pattern reflects not only individual developmental gaps but also the organisational and contextual conditions that shape how leadership is enacted in practice. The findings support a contextual-relational model of clinical leadership. Both individual capability and enabling organisational conditions must be addressed to strengthen leadership effectiveness across healthcare systems. Description: Data Availability Statement: No new data were created or analysed in this study.; Supplementary Materials: The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/healthcare14121720/s1, Table S1. Search strategy for four databases. Table S2. Quality assessment for qualitative studies. Table S3. Characteristics of included studies. Table S4. Mapping of reported leadership competencies from included studies to the domains of the CLCF.

2026-06-15T00:00:00Z Truong, T Radin, JM Li, L Ordóñez-mena, JM Hoang, U Balogh, O Araujo, AB Nicodemo, C Lusignan, SD Madia, JE http://bura.brunel.ac.uk/handle/2438/33527 2026-06-28T02:00:25Z 2026-06-10T00:00:00Z

Title: Burden and economic impact of RSV hospitalisations among English adults, 2023/24 Authors: Truong, T; Radin, JM; Li, L; Ordóñez-mena, JM; Hoang, U; Balogh, O; Araujo, AB; Nicodemo, C; Lusignan, SD; Madia, JE Abstract: Objectives: To provide updated, national estimates of the burden and secondary-care costs of respiratory syncytial virus (RSV) hospitalisations among adults aged ≥40 years in England, using data from 2023/24, the last season before the UK implemented its adult RSV vaccination programme, given that, while the burden of RSV is well established in young children and older adults, it remains less well characterised in working-age adults. Methods: We analysed adults admitted to hospital with an acute respiratory infection (ARI) using aggregated Hospital Episode Statistics (HES) data for England, 2023/24. RSV, influenza, and COVID-19 hospitalisations were identified using validated International Classification of Diseases, Tenth Revision (ICD-10) codes. Incidence proportion was calculated per 100,000 population by age group. To adjust for potential under-recognition of RSV among ARI admissions without an identified pathogen, proportional-redistribution methods were applied. Hospital costs were estimated using Healthcare Resource Group (HRG) emergency tariffs weighted by clinical presentation. Results: In 2023/24, 803,088 ARI admissions occurred among adults ≥40 years; 18% had a viral and 79% an unspecified aetiology recorded. RSV accounted for 4836 admissions (16 per 100,000 population) based on primary diagnosis. After proportional redistribution to account for under-recognition, this increased to an estimated 23,407 admissions (75.9 per 100,000 population; £68.5 million), which we consider the base estimate. In an expanded scenario including all recorded diagnoses, RSV admissions were estimated at 25,264 (82 per 100,000 population; £74 million), of which approximately £54 million may be attributable to unrecognised cases. Around one-third of total estimated RSV-related costs occurred in adults aged 40–74 years. RSV incidence increased steeply with age, reaching its highest levels in adults aged ≥85 years. Conclusions: RSV poses a substantial, under-recognised hospital burden in English adults and associated healthcare costs. Increased testing and improved coding and surveillance, particularly for adults aged 40–74 years, are needed to accurately measure potential impact of vaccination and guide prevention policy. Description: Data availability: All data used in this study are publicly available administrative and costing datasets. Hospital admission data were obtained from Hospital Episode Statistics (HES) Admitted Patient Care, published by NHS England: https://digital.nhs.uk/data-and-information/publications/statistical/hospital-admitted-patient-care-activity. Hospital cost data were obtained from the National Cost Collection (NCC), published by NHS England: https://www.england.nhs.uk/publication/2024–25-national-cost-collection-data-publication/. Population denominators were obtained from the Office for National Statistics (ONS) mid-year population estimates: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates. All datasets are accessible without restriction via the respective public websites.; Supplementary materials are available online at: https://www.journalofinfection.com/article/S0163-4453(26)00117-9/fulltext#supplementary-material .

2026-06-10T00:00:00Z Kerr, S Madia, JE Nicodemo, C Sheikh, A http://bura.brunel.ac.uk/handle/2438/33526 2026-06-28T02:00:24Z 2026-04-21T00:00:00Z

Title: The economic burden of COVID-19 undervaccination: costs of hospitalisation, ICU admission, and death in Scotland Authors: Kerr, S; Madia, JE; Nicodemo, C; Sheikh, A Abstract: The COVID-19 pandemic has imposed substantial financial and operational pressures on healthcare systems globally. While vaccines were known to reduce severe outcomes, their broader economic impacts, especially in publicly funded health systems, requires clearer quantification. This study evaluates the direct healthcare costs associated with COVID-19 outcomes in relation to vaccination status, using linked individual-level data from Scotland’s EAVE II cohort (June to September 2022). We defined undervaccination as the shortfall between recommended and received COVID-19 vaccine doses, stratified by age group. Retrospective cohort analysis employing Cox proportional hazards and linear regression models was used to assess the associations between undervaccination and the risk, frequency, and duration of hospitalisation, intensive care unit (ICU) admission, and death. We also conducted a counterfactual analysis to estimate averted costs and quality-adjusted life years gained (QALYs) under a full vaccination scenario. Findings demonstrate a strong dose–response relationship between undervaccination and severe COVID-19 outcomes. Among individuals aged 75+, those with higher undervaccination levels showed significantly increased hazard ratios for hospitalisation (up to 3.92 for sub-optimal level 2), ICU admission (up to 12.53 for sub-optimal level 2), and mortality (up to 6.63 for sub-optimal level 3). These elevated risks translated into substantial direct healthcare costs. Hospitalisation costs reached £4.7 million for the 75+ group and £2.6 million for the 16–74 group, while ICU costs totalled £70,489 and £246,486, respectively. Under a counterfactual full vaccination scenario, potentially avertable hospital costs were estimated at £1.4 million for the 75+ group and £0.5 million for the 16–74 group. Vaccination rates were lower among younger individuals, ethnic minorities, and residents in more deprived areas, highlighting persistent health inequalities. Of the total cohort of 4,992,498 individuals, 65.8% were fully vaccinated on 1 June 2022, while 34.2% were undervaccinated. These inequalities were not only clinically consequential but also economically costly: undervaccinated individuals generated more than five-fold the COVID-19 healthcare spend of their fully vaccinated peers. Universal full vaccination could have averted approximately £1.4 million (75+) and £0.5 million (16–74) in hospital costs, and a further £38,000 in ICU costs, during summer 2022. Description: Data availability: The data utilized in this study consist of sensitive, individual-level, linked health records from the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) platform in Scotland. Due to the highly confidential nature of these data and to protect patient privacy, they are not publicly available. Access to the EAVE II platform is strictly controlled and granted only to approved researchers operating within secure trusted research environments in accordance with stringent ethical and data governance protocols. Researchers interested in accessing similar data for future studies may submit a formal application to Public Health Scotland, following their established data access procedures and subject to ethical approval. This ensures adherence to national guidelines for the use of health data for research purposes.; Supplementary Information is available online at: https://link.springer.com/article/10.1186/s13561-026-00775-3#Sec17 .

2026-04-21T00:00:00Z Bolbocean, C Coomarasamy, A Hippisley-Cox, J Nicodemo, C Quenby, S Petrou, S http://bura.brunel.ac.uk/handle/2438/33525 2026-06-28T02:00:20Z 2026-06-12T00:00:00Z

Title: Miscarriage, self-harm, and psychiatric disorders in first-time pregnant women: Evidence from a linkage study Authors: Bolbocean, C; Coomarasamy, A; Hippisley-Cox, J; Nicodemo, C; Quenby, S; Petrou, S Abstract: We leveraged the biological evidence that a first pregnancy ending in miscarriage is considered a quasi-exogenous shock to fertility and linked electronic health records to estimate adjusted associations between miscarriage and self-harm and psychiatric outcomes. In a random cohort of 1.2 million women aged 16 to 50, all first recorded pregnancies between 01/01/2004 and 31/12/2017 were identified using data linked from health registries in England, UK. Each first pregnancy was subsequently categorized into one of two mutually-exclusive groups: miscarriage vs continued pregnancy using valid medical definitions. For each outcome-specific model, we excluded women with a prior recorded diagnosis of the same outcome before first pregnancy. Our empirical strategy relied upon methods under the selection on observables assumption (logistic regression, the augmented-inverse probability weighting estimator, and entropy balancing) to estimate the effects of miscarriage. Miscarriage was associated with higher adjusted odds of self-harm at 6 months (OR 2.30), depression at 6 months (OR 1.50), and anxiety at 6 months (OR 1.25), with the self-harm association persisting up to three years (OR 1.60). Associations with self-harm differed by area-level deprivation: no statistically significant association was observed in the least deprived quintile, whereas elevated odds were observed in more deprived quintiles. Targeted interventions such as counselling aimed at ensuring that women who miscarry have access to healthcare services are required to mitigate possible harms caused by early pregnancy losses. Description: Data availability: The authors do not have permission to share data.; Supplementary data are available online at: https://www.sciencedirect.com/science/article/pii/S0277953626005575#sec26 .

2026-06-12T00:00:00Z