NHS Digital Data Release Register - reformatted

Society of Endocrinology

Project 1 — DARS-NIC-148364-RHMHS

Opt outs honoured: No - consent provided by participants of research study, No - data flow is not identifiable (Consent (Reasonable Expectation))

Sensitive: Sensitive

When: 2018/03 — 2020/12.

Repeats: Ongoing, One-Off

Legal basis: Informed Patient consent to permit the receipt, processing and release of data by the HSCIC, Health and Social Care Act 2012 – s261(2)(c)

Categories: Identifiable, Anonymised - ICO code compliant

Datasets:

  • MRIS - Members and Postings Report
  • MRIS - Cause of Death Report
  • Cancer Registration Data
  • Demographics
  • Civil Registration - Deaths

Objectives:

The data supplied by the NHS IC to Royal Hallamshire Hospital will be used only for the approved Medical Research Project identified above.

Yielded Benefits:

The impact of the CaHASE study was acknowledged in an independent review published in the Journal of Clinical Endocrinology & Metabolism (December 2011) and presented at Endo 2011. The review identified the results of CaHASE published in November 2010 as one of the eleven most significant papers published in the field of adrenal endocrinology that year (Carey. 2011. Adrenal disease update 2011. JCEM, 96:3583–3591). The significance of CaHASE is highlighted by the number of publications, invited talks and presentations at conferences and patient support events and the reported improvement in patient services (listed below). The project has been invited to join the Euro-DSD registry and as a direct result of the project, the Society is preparing clinical guidance on the management of the adult patient with congenital adrenal hyperplasia. No NHS Digital has or will flow to the Euro-DSD registry. International Impact Leverage funding - Data from CaHASE was used to support a successful bid for 4,200,000 Euros of EU funding and the establishment of a spin out campaign using higher level results not including NHS Digital data. Establishment of the CAH-specific arm, i-CAH (www.i-cah.org) of an international registry for disorders of sexual development. Development of guidelines for Adults with CAH are being developed by the Society for endocrinology. • 2015 Professor Arlt, Symposium talk, 2nd Endocrinology and Global exchange (EDGE) meeting for paediatric endocrinology, Berlin, Germany • 2014 Abstract presented at ECE 2014 • 2014 Abstract presented at ENDO 2014 • 2014 Professor Arlt, Symposium talk, 53rd Annual Meeting of the European Society of Paediatric Endocrinology (ESPE), Dublin, Ireland • 2013 Poster ENDO 2013 (selected for featured poster session) • 2013 Professor Ross, Chair of CaHASE invited speaker at ICE/ECE 2013 Nurse Session, • 2013 Poster ECE 2013 • 2012 Oral ENDO 2012 • 2012 Professor Ross, Chair of CaHASE invited speaker at ICE/ECE 2012, Florence • 2012 Poster ICE/ECE 2012, Florence • 2012 Oral genetics ICE/ECE 2012, Florence • 2011 Dr Mooij presented novel mutation analysis results at ESPE, Glasgow • 2010 CaHASE published results in American Journal– JCEM • 2010 Professor Ross, Chair of CaHASE invited speaker at ICE, Japan • 2009 Dr Krone presented genetic results at LWPES/ESPE, New York, USA • 2009 Professor Arlt , Oral communication at Endo, Washington, USA • 2009 Dr Krone presented genetic results at Endo, Washington, USA National impact • 2014 Editorial submitted to Clinical Endocrinology • 2014 Manuscript in JCEM • 2014 Poster at SfE BES 2014 • 2013 Professor Ross, Chair of CaHASE, invited speaker at BSPED 2013 • 2013 Poster at SfE BES 2013 • 2012 Oral SfE BES 2012 • 2012 Poster SfE BES genetics • 2011 Dr Steve Ball. Annual North East Endocrine Research and Audit meeting • 2011 Dr Steve Ball Northern Paediatric Endocrine group meeting • 2010 Professor Ross, Chair of CaHASE, invited speaker at SfE BES 2010 • 2009 Dr Doherty presented fertility aspects at SfE BES • 2009 Dr Thang Han presented bone and body composition aspects at SfE BES • 2009 Dr Krone presented quality of life aspects at SfE BES Interaction with Patient support groups. • 2011 Professor Ross invited speaker at UK patient support group annual meeting, Manchester • 2008 Article in patient support group (living with CAH) newsletter • 2007 Professor Ross invited speaker at UK patient support group annual meeting, Stevenage • 2006 Professor Ross invited speaker at USA patient support group (CARES) Effect on clinical practice at participating centres, Centres report finding patients lost to follow up and improved transition from paediatric to adult endocrine care. Specifically; • Oxford - identified patients lost to follow-up and set up a designated CAH clinic in 2007-2008 after having comments from CAH patients that they would like consistency of care. This clinic is held jointly with a consultant in Clinical Genetics. They have managed to bring back the majority of patients who had been lost to follow-up and also to expand further the number of patients they see. Based on data of the last 8 months, their DNA (did not attend) rate is down to 3% from approximately 20% before the set up of the clinic • Edinburgh - presented the CaHASE data locally, resulting in increased collaboration with local paediatric team to improve transitional care. They report wider effects to include most of the rest of Scotland. • Spin out company - underpinned formation of Diurnal LTD spin out from Sheffield http://www.diurnal.co.uk/ Publications Full papers 1. Han TS, Conway GS, Willis DS, Krone NP, Rees DA, Stimson RH, Arlt W, Walker BR, Ross RJ and the United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE). Relationship between final height and health outcomes in adults with congenital adrenal hyperplasia. J Clin Endocrinol Metab. 2014; 99:E1547-E1555. doi: 10.1210/jc.2014-1486 2. Han TS, Walker BR, Arlt W, Ross RJ 2013. Treatment and health outcomes in adult patients with congenital adrenal hyperplasia; perspectives from the UK CaHASE study investigators. Nat Rev Endocrinol. 2014;10(2):115-24 3. Ross RJ. CaHASE: a Specialist Society Led Academic Collaboration to improve the management of CAH. Clin Endocrinol (Oxf). 2014;81(3):334-5. 4. Han TS, Krone N, Willis DS, Conway GS, Hahner S, Rees DA, Stimson RH, Walker BR, Arlt W, Ross RJ; United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE) 2013. Quality of life in adults with congenital adrenal hyperplasia relates to glucocorticoid treatment, adiposity and insulin resistance: United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE). Eur J Endocrinol. 2013 May 3;168(6):887-93. doi: 10.1530/EJE-13-0128. Print 2013 June 5. Krone N, Rose IT, Willis DS, Hodson J, Wild SH, Doherty EJ, Hahner S, Parajes S, Stimson RH, Han TS, Carroll PV, Conway GS, Walker BR, MacDonald F, Ross RJ, Arlt W; United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE). Genotype-phenotype correlation in 153 adult patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency: analysis of the United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE) cohort. J Clin Endocrinol Metab. 2013 Feb;98(2):E346-54. doi: 10.1210/jc.2012-3343. Epub 2013 Jan 21. 6. Han TS, Stimson RH, Rees DA, Krone N, Willis DS, Conway GS, Arlt W, Walker BR, Ross RJ; United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE) 2013. Glucocorticoid treatment regimen and health outcomes in adults with congenital adrenal hyperplasia. Clin Endocrinol (Oxf). 2013 Feb;78(2):197-203. doi: 10.1111/cen.12045. 7. Arlt W, Willis DS, Wild SH, Krone N, Doherty EJ, Hahner S, Han TS, Carroll PV, Conway GS, Rees DA, Stimson RH, Walker BR, Connell JM, Ross RJ; United Kingdom Congenital Adrenal Hyperplasia Adult Study Executive (CaHASE) 2010 Health status of adults with congenital adrenal hyperplasia: a cohort study of 203 patients. J Clin Endocrinol Metab. 2010 Nov;95(11):5110-21. doi: 10.1210/jc.2010-0917. Epub 2010 Aug 18. Abstracts presented at meetings 1. Han TS, Krone N, Willis DS, Conway GS, Hahner S, Rees DA, Stimson RH, Walker BR, Arlt W, Ross RJ and the United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE). Quality of Life in Adults With Congenital Adrenal Hyperplasia Relates to Glucocorticoid Treatment, Adiposity and Insulin Resistance: United Kingdom Congenital Adrenal Hyperplasia Adult Study Executive (CaHASE). ENDO 2013 P 5428. 2. Han TS, Krone N, Willis DS, Conway GS, Hahner S, Rees DA, Stimson RH, Walker BR, Arlt W, Ross RJ and the United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE). Impaired quality of life in CAH adults is associated with adiposity and insulin resistance. ECE 2013 Poster 3. Ross RJM. Management of CAH in Adults. ECE 2013 Oral 4. Han TS, Krone N, Willis DS, Conway GS, Rees DA, Stimson RH, Walker BR, Arlt W, Ross RJ and the United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE). Quality of life relates to glucocorticoid treatment regimen, and adiposity and insulin resistance in adults with congenital adrenal hyperplasia: United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE). SfE BES 2013 poster 5. Han TS, Stimson RH, Rees A, Krone N, Willis DS, Wild SH, Conway GS, Arlt W, Walker BR, Ross RJ and the United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE) 2012. Glucocorticoid dose in adults with CAH; association with clinical and biochemical variables – analysis of the United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE) cohort. ENDO 2012 Oral. 6. Han TS, Stimson RH, Rees A, Krone N, Willis DS, Wild SH, Conway GS, Arlt W, Walker BR, Ross RJ and the United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE) 2012. Relationship of current glucocorticoid dose with metabolic outcomes in CAH – analysis of the United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE) cohort ICE/ECE 2012; P 53. 7. Ross RJ. CAH and adulthood. Invited talk at ICE/ECE 2012. 8. Krone N, Rose IT, Crosby C, Willis DS, Wild SH, Doherty EJ, Hahner S, Parajes S, Han TS, Carrol PV, Conway GS, Walker BR, MacDonald F, Ross RJ, Arlt W and the United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE) 2012 (submitted) Genotype-phenotype correlation in 153 adult patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency – analysis of the United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE) cohort. BES 2012; P306. 9. Christiaan F. Mooij, Silvia Parajes, Ian T. Rose, Angela Taylor, Taner Bayraktaroglu, John Wass, John Connell, David Ray, Wiebke Arlt, Nils Krone (2011) In vitro analysis of five CYP11B1 gene mutations detected in patients with classic and nonclassic 11β-hydroxylase deficiency. 50th Annual ESPE Meeting

Expected Benefits:

Due to its comparative rarity, no one UK centre could observe sufficient numbers of patients to enable analysis of potential influences on mortality and morbidity of pre-existing co-morbidities and different treatment modalities. CAH is relatively rare (though one of the most common of the inherited diseases) and therefore the study results will not be of interest to the majority of the general public. Ensuring data is disseminated to all involved in the care of these patients, the patients themselves and their families, and the scientific community interested in researching CAH will help achieve the study aim of improving healthcare provision and informing day to day management of the condition. Improving day to day management might help to prolong life and enable earlier detection/better surveillance of certain morbidities/causes of mortality. The data is being processed as a legitimate interest with the added provision that participants must consent to having their data collected and processed in order to take part. Purpose, necessity and balance has been considered in the Legitimate Interest Assessment. The data received from NHS Digital will provide information on the number of deaths in the cohort, number of deaths in each cause subgroup, the distribution of age at death, number of cancers reported in the study cohort and frequency of cancer sub types. This data will be reviewed alongside wider project information on morbidity and different treatment modalities. The NHS Digital information is only a small part of the wider project aim which is to improve healthcare provision for CAH patients in general. This project has been running for a number of years and this agreement is for a renewal to collect longer term data on death and cancer. All other data collection ceased some time ago. This means that there have already been a number of dissemination events and publications and the benefits of the study are already apparent. A comprehensive list describing all yielded benefits to date is provided below. Management of CAH conditions has already been improved and longer term data regarding death and cancer might impact on future care advice. The final manuscript is expected to be published in 2021 and this will be disseminated to the policy makers. The Society for Endocrinology publishes its own Clinical Guidance and will create a new guideline should the results show one is needed.

Outputs:

As a result of data processing the study expects to obtain useful information on the causes of morbidity and mortality in patients with CAH. This information (along with other study results) needs to be disseminated to help inform the day to day management of conditions. Improving day to day management is expected to prolong life and enable earlier detection/better surveillance of certain morbidities/causes of mortality. The intention is publication in peer-reviewed journals, presentation at national and international meetings (to include The Society for Endocrinology BES annual conference) and a summary of the results (using lay terminology) will be available on the Society for Endocrinology’s website. The data disseminated will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide. The aim is to disseminate the results to key stakeholders including participants, the public, and health care professionals responsible for caring for CAH patients. The results will be available to all Society members including scientists, nurses, clinicians and patient groups. If strong enough evidence is found for a change in current care strategies, the Society for Endocrinology will release a Clinical Guideline or Position Statement. This will be shared with NHS Trusts and policy decision makers. The dissemination strategy will facilitate engagement with the scientific and policy-making communities and will ensure that knowledge developed by the research can benefit these communities. Dissemination channels Channels include a peer reviewed journal, the Society’s public facing website and member website. The Society has a number of social media channels and these will be utilised if appropriate. The study group confirm that dissemination of the results will be done proactively to ensure all interested groups are engaged. Communication channels The Society will provide a link to any significant results in the member newsletters. If strong evidence is found the Press Office will engage with the media. A talk will be given by the study Chief Investigator at The Society for Endocrinology’s annual conference. Exploitation of results/outputs The Society for Endocrinology will ensure the data is made available in an open access journal. If this research leads to further research questions a steering group will be convened to discuss a new application to the HRA and REC. Under current approvals the main study data will need to be archived with access and use restricted until destruction. The data provided by this agreement will be destroyed when the agreement expires, as per NHS Digital policy. The final study manuscript describing mortality will be published in 2021 after a further 2 years of data collection.

Processing:

The Society for Endocrinology provided the following fields (as required by NHS digital): NHS number, forename, surname, date of birth and sex. These identifiers are held by NHS Digital and the cohort recruitment was completed in 2013. NHS Digital return an identifiable report to the Society for Endocrinology. Data includes: Event type, Event date, Latest posting location, Death district or cancer registration number, Death sub district or cancer anniversary year, Register number or cancer site, Entry number or cancer type, Cancer behaviour, Cause of death. Record level data is stored securely at the Society for Endocrinology, on a server within a locked room. The office itself is also secure • Only identifiable data necessary for the analysis is made visible to the statistician in Sheffield they do not receive identifiers such as names, addresses, place of death etc. Each individual is given a study ID instead of sharing NHS number, forename and surname. Date of Birth, Date of Death, Cause of death and cancer registrations are provided to Sheffield who undertake the analyses. • The statistician pools the data in to aggregated tabular form with small numbers suppressed inline with the HES Analysis Guide, for publication in peer-reviewed journals, presentation at national and international meetings. A lay summary of the information is provided to participants and patient support groups. The purpose of collecting this data is to learn about the causes of morbidity and mortality in CAH patients. Requesting fact and cause of death and cancer registration data over an extended period of time is therefore helping to achieve this aim. The data is stored in its raw form at the Society for Endocrinology. Data includes Event type, Event date, Latest posting location, Death district or cancer registration number, Death sub district or cancer anniversary year, Register number or cancer site, Entry number or cancer type, Cancer behaviour and Cause of death. The patients identifiers are replaced with a study ID and the following fields are shared with the statistician at Sheffield University: Patient ID, date of death, date of birth, cause of death and cancer information. The statistician uses this data to provide aggregated tables with small numbers suppressed to show number of deaths in the cohort, number of deaths in each cause subgroup, the distribution of age at death, number of cancers reported in the study cohort and frequency of cancer sub types. The study only link the cause of death/cancer data to the information already held for the patients (age, sex, other morbidities, medication use etc.). Linkage is made via a unique study ID. Only the participating site, the central study coordination office, including the study statistician based at The University of Sheffield have access to identifiable information about participants. Every attempt is made to mitigate risk of identification by use of participant IDs when collecting, recording, storing and analysing data. Date of Birth, Date of Death, Cause of death and cancer registrations are provided to The University of Sheffield as these are necessary for the study to analyse the data. Any published study results will always be anonymous. Recruitment and data collection for this study ended a long time ago. At that time, a number of high quality manuscripts were published and patients were informed of the main study outcomes. They were also informed that the study planned to collect a further 2 years of data from NHS Digital, to gain a better understanding of mortality and cancer related morbidity. There is a fair processing notice for this study on the website and a page describing the study outputs so far. Patients are expecting a further data collection and the study team will notify them should enough data be gained to submit another manuscript for publication. This study will close completely early next year. There will be no requirement/attempt to re-identify individuals beyond the study. The study team confirm that data processing is only carried out by substantive employees of the University of Sheffield or Society for Endocrinology. Data is stored on a secure server within the Society for Endocrinology. This server is in a locked room and access to data is restricted to named individuals only. Data is sent to the University of Sheffield, either as a password protected document via email or on an encrypted USB stick by recorded post.


Project 2 — DARS-NIC-147893-ZFLWG

Opt outs honoured: No - consent provided by participants of research study (Reasonable Expectation, Consent (Reasonable Expectation))

Sensitive: Sensitive

When: 2016/04 (or before) — 2018/12.

Repeats: Ongoing, One-Off

Legal basis: Informed Patient consent to permit the receipt, processing and release of data by the HSCIC, Health and Social Care Act 2012 – s261(2)(c)

Categories: Identifiable

Datasets:

  • MRIS - Members and Postings Report
  • MRIS - Cause of Death Report
  • MRIS - Cohort Event Notification Report

Objectives:

Acromegaly is associated with increased morbidity and mortality, due largely to cardiovascular, cerebrovascular and probably malignant disease. The incidence of acromegaly is reported to be between 4-6 new cases per million per year with a prevalence of approximately 40-60 per million. This equates in the UK to around 2,500 patients with acromegaly. Due to its comparative rarity no one centre can provide sufficient numbers of patients to enable analysis with sufficient statistical power. Therefore the UK Acromegaly register was established in 1997.

Yielded Benefits:

The study has already greatly enhanced the studies clinical understanding of Acromegaly and has informed best practice. Patients across the UK will already be benefiting from positive changes to their treatment pathways. Some examples of the findings are given below: • An assessment of control & responses to certain medications gave a greater understanding of which were adequate and in what proportion of patients. • Radiosurgery data showed Gamma knife radiosurgery after neurosurgery to be a safe and effective long-term adjunctive treatment for pituitary tumours that cause acromegaly. • Radiotherapy data concluded conventional pituitary irradiation to be an effective and safe means of reducing growth hormone levels. • Unsuccessful surgery for acromegaly has major consequences for the patient and financially for the NHS. A study of the surgical data collected showed surgeon experience to be an important determinant of surgical success. Recent improvements in success rates coincide with the trend to now concentrate pituitary surgery amongst a smaller number of specialist surgeons.

Expected Benefits:

Due to its comparative rarity, no one centre can provide sufficient numbers of patients to enable analysis of potential influences on mortality and morbidity of, for example a) Pre-existing co-morbidities, e.g., diabetes mellitus and hypertension, b) Different treatment modalities, e.g., pituitary radiotherapy and different growth hormone levels. In particular, there is only one publication relating mortality to IGF1 data. The benefit of being able to obtain the data from NHS Digital to support the study aim will inform the day to day management of patients with acromegaly and to encourage centres to audit their practice against the national dataset.

Outputs:

PRIMARY MEASURE OF OUTCOME: To provide epidemiological evidence about long-term mortality and morbidity and the results of treatment by surgery, radiotherapy and medical therapy in acromegaly. SECONDARY OUTCOME MEASURES: To inform on the day to day management of patients with acromegaly and to encourage centres to audit their own practice against the national dataset. Outputs will be published in peer-reviewed journals, presentated at national and international meetings (to include The Society for Endocrinology BES annual conference) and a summary of the results will also be sent to the patient support group, The Pituitary Foundation. www.pituitary.org.uk. Outputs are due in 2018 and all outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide.

Processing:

Local hospital staffs add patient details and clinical data to the UK Acromegaly Register remotely. Data is stored at the Society for Endocrinology Office in Bristol. The data needed by NHS Digital to return death/cancer registration information is collated within the Society for Endocrinology Office in Bristol by those named as ONS users only. Data is submitted to NHS Digital – DARS. This includes: NHS number, forename, surname, date of birth and sex. NHS Digital -DARS process and release data to Society for Endocrinology. The person receiving the data has been approved by NHS Digital. Data is uploaded to the UK Acromegaly Register and stored at the Society for Endocrinology Office in Bristol. All data analysis of record-level data is undertaken at the Society for Endocrinology office in Bristol. Only identifiable data necessary for the analysis is made visible to the statistician e.g. it is not possible to report the distribution of age at death without providing date of birth and date of death for each individual. Where an identifiable field is absolutely necessary, this is pseudonymised e.g. each participant is given a unique identifying number in place of their NHS number, forename and surname. Once data has been pooled in to aggregated tabular form with small numbers suppressed, the data will be further processed at Newcastle University for publication in peer-reviewed journals, presented at national and international meetings and lay information provided to patient support groups. The Society for Endocrinology confirm that no record level data will be accessed or processed outside of the Society for Endocrinology office in Bristol. ONS Terms and Conditions will be adhered to. There will be no data linkage undertaken with NHS Digital data provided under this agreement that is not already noted in the agreement. All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data).