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2. 'Starting to think that way from the start': approaching deprescribing decision-making for people accessing palliative care - a qualitative exploration of healthcare professionals views

Author

Anna Robinson-Barella, Charlotte Lucy Richardson, Zana Bayley, Andy Husband, Andy Bojke, Rona Bojke, Catherine Exley, Barbara Hanratty, Joanna Elverson, Jesse Jansen, and Adam Todd

Subjects
Deprescribing, Life-limiting illness, Medicines, Palliative care, Polypharmacy, Qualitative, Special situations and conditions, RC952-1245
Abstract

Abstract Background Deprescribing has been defined as the planned process of reducing or stopping medications that may no longer be beneficial or are causing harm, with the goal of reducing medication burden while improving patient quality of life. At present, little is known about the specific challenges of decision-making to support deprescribing for patients who are accessing palliative care. By exploring the perspectives of healthcare professionals, this qualitative study aimed to address this gap, and explore the challenges of, and potential solutions to, making decisions about deprescribing in a palliative care context. Methods Semi-structured interviews were conducted with healthcare professionals in-person or via video call, between August 2022 – January 2023. Perspectives on approaches to deprescribing in palliative care; when and how they might deprescribe; and the role of carers and family members within this process were discussed. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the NHS Health Research Authority (ref 305394). Results Twenty healthcare professionals were interviewed, including: medical consultants, nurses, specialist pharmacists, and general practitioners (GPs). Participants described the importance of deprescribing decision-making, and that it should be a considered, proactive, and planned process. Three themes were developed from the data, which centred on: (1) professional attitudes, competency and responsibility towards deprescribing; (2) changing the culture of deprescribing; and (3) involving the patient and family/caregivers in deprescribing decision-making. Conclusions This study sought to explore the perspectives of healthcare professionals with responsibility for making deprescribing decisions with people accessing palliative care services. A range of healthcare professionals identified the importance of supporting decision-making in deprescribing, so it becomes a proactive process within a patient’s care journey, rather than a reactive consequence. Future work should explore how healthcare professionals, patients and their family can be supported in the shared decision-making processes of deprescribing. Trial registration Ethical approval was obtained from the NHS Health Research Authority (ref 305394).

Published
2024
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7. Assessment of TROP2, CEACAM5 and DLL3 in metastatic prostate cancer: Expression landscape and molecular correlates

Author

Ajkunic, Azra, Sayar, Erolcan, Roudier, Martine P., Patel, Radhika A., Coleman, Ilsa M., De Sarkar, Navonil, Hanratty, Brian, Adil, Mohamed, Zhao, Jimmy, Zaidi, Samir, True, Lawrence D., Sperger, Jamie M., Cheng, Heather H., Yu, Evan Y., Montgomery, Robert B., Hawley, Jessica E., Ha, Gavin, Persse, Thomas, Galipeau, Patricia, Lee, John K., Harmon, Stephanie A., Corey, Eva, Lang, Joshua M., Sawyers, Charles L., Morrissey, Colm, Schweizer, Michael T., Gulati, Roman, Nelson, Peter S., and Haffner, Michael C.

Published
2024
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10. New models of health and social care for people in later life: mapping of innovation in services in two regions of the United Kingdom using a mixed method approach

Author

Helen Frost, Tricia R. Tooman, Navneet Aujla, Bruce Guthrie, Barbara Hanratty, Eileen Kaner, Amy O’Donnell, Margaret E. Ogden, Helen G. Pain, Susan D. Shenkin, and Stewart W. Mercer

Subjects
Innovation, Health and social care reform, Models of care, Older people, Technology, Health inequalities, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Innovation for reforming health and social care is high on the policy agenda in the United Kingdom in response to the growing needs of an ageing population. However, information about new innovations of care being implemented is sparse. Methods We mapped innovations for people in later life in two regions, North East England and South East Scotland. Data collection included discussions with stakeholders (n = 51), semi-structured interviews (n = 14) and website searches that focused on technology, evaluation and health inequalities. We analysed qualitative data using framework and thematic analyses. Quantitative data were analysed descriptively. Results One hundred eleven innovations were identified across the two regions. Interviewees reported a wide range of technologies that had been rapidly introduced during the COVID-19 pandemic and many remained in use. Digital exclusion of certain groups of older people was an ongoing concern. Innovations fell into two groups; system-level ones that aimed to alleviate systems pressures such as preventing hospital (re)admissions, and patient-level ones which sought to enhance health and wellbeing directly. Interviewees were aware of the importance of health inequalities but lacked data to monitor the impact of innovations on these, and evaluation was challenging due to lack of time, training, and support. Quantitative findings revealed that two thirds of innovations (n = 74, 67%) primarily focused on the system level, whilst a third (n = 37, 33%) primarily focused on the patient-level. Overall, over half (n = 65, 59%) of innovations involved technologies although relatively few (n = 12, 11%) utilised advanced technologies. Very few (n = 16, 14%) focused on reducing health inequalities, and only a minority of innovations (n = 43, 39%) had undergone evaluation (most of which were conducted by the service providers themselves). Conclusions We found a wide range of innovative care services being developed for people in later life, yet alignment with key policy priorities, such as addressing health inequalities, was limited. There was a strong focus on technology, with little consideration for the potential to widen the health inequality gap. The absence of robust evaluation was also a concern as most innovations were implemented without support to monitor effectiveness and/or without plans for sustainability and spread.

Published
2024
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11. Using 42 CFR part 2 revisions to integrate substance use disorder treatment information into electronic health records at a safety net health system

Author

Alexandra R. Tillman, Emily Bacon, Brooke Bender, Dean McEwen, Joshua Blum, Matthew Hoag, Kenneth A. Scott, Rachel Everhart, Rebecca Hanratty, Laura J. Podewils, Carolina Close, John Mills, and Arthur J. Davidson

Subjects
Substance use disorder treatment, Electronic health record, Hub-and-spoke, Data integration, 42 CFR Part 2, Medicine (General), R5-920, Social pathology. Social and public welfare. Criminology, HV1-9960
Abstract

Abstract Background Regulations put in place to protect the privacy of individuals receiving substance use disorder (SUD) treatment have resulted in an unintended consequence of siloed SUD treatment and referral information outside of the integrated electronic health record (EHR). Recent revisions to these regulations have opened the door to data integration, which creates opportunities for enhanced patient care and more efficient workflows. We report on the experience of one safety-net hospital system integrating SUD treatment data into the EHR. Methods SUD treatment and referral information was integrated from siloed systems into the EHR through the implementation of a referral order, treatment episode definition, and referral and episode-related tools for addiction therapists and other clinicians. Integration was evaluated by monitoring SUD treatment episode characteristics, patient characteristics, referral linkage, and treatment episode retention before and after integration. Satisfaction of end-users with the new tools was evaluated through a survey of addiction therapists. Results After integration, three more SUD treatment programs were represented in the EHR. This increased the number of patients that could be tracked as initiating SUD treatment by 250%, from 562 before to 1,411 after integration. After integration, overall referral linkage declined (74% vs. 48%) and treatment episode retention at 90-days was higher (45% vs. 74%). Addiction therapists appreciated the efficiency of having all SUD treatment information in the EHR but did not find that the tools provided a large time savings shortly after integration. Conclusions Integration of SUD treatment program data into the EHR facilitated both care coordination in patient treatment and quality improvement initiatives for treatment programs. Referral linkage and retention rates were likely modified by a broader capture of patients and changed outcome definition criteria. Greater preparatory workflow analysis may decrease initial end-user burden. Integration of siloed data, made possible given revised regulations, is essential to an efficient hub-and-spoke model of care, which must standardize and coordinate patient care across multiple clinics and departments.

Published
2024
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12. UPDATED PROTOCOL: Universal School-Based Programmes for Improving Social and Emotional Outcomes in Children Aged 3-11 Years: An Evidence and Gap Map

Author

Hanratty, Jennifer, Miller, Sarah, Rodriguez, Leonor, Connolly, Paul, Roberts, Jennifer, Sloan, Seaneen, Brennan-Wilson, Aoibheann, Bradshaw, Daragh, Coughlan, Christopher, Gleghorne, Nicole, Dunne, Laura, Millen, Sharon, Smith, Aimee, and O'Sullivan, Cadhla

Abstract

This is the protocol for an evidence and gap map. The objective of this EGM is to identify and map all primary studies (including randomised and cluster randomised trials) and systematic reviews on universal, school-based social and emotional learning programmes for young children (3-11 years) to create a live, searchable, and publicly available evidence and gap map.

Published
2023
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13. Stratified analyses refine association between TLR7 rare variants and severe COVID-19

Author

Jannik Boos, Caspar I. van der Made, Gayatri Ramakrishnan, Eamon Coughlan, Rosanna Asselta, Britt-Sabina Löscher, Luca V.C. Valenti, Rafael de Cid, Luis Bujanda, Antonio Julià, Erola Pairo-Castineira, J. Kenneth Baillie, Sandra May, Berina Zametica, Julia Heggemann, Agustín Albillos, Jesus M. Banales, Jordi Barretina, Natalia Blay, Paolo Bonfanti, Maria Buti, Javier Fernandez, Sara Marsal, Daniele Prati, Luisa Ronzoni, Nicoletta Sacchi, Joachim L. Schultze, Olaf Riess, Andre Franke, Konrad Rawlik, David Ellinghaus, Alexander Hoischen, Axel Schmidt, Kerstin U. Ludwig, Valeria Rimoldi, Elvezia M. Paraboschi, Alessandra Bandera, Flora Peyvandi, Giacomo Grasselli, Francesco Blasi, Francesco Malvestiti, Serena Pelusi, Cristiana Bianco, Lorenzo Miano, Angela Lombardi, Pietro Invernizzi, Alessio Gerussi, Giuseppe Citerio, Andrea Biondi, Maria Grazia Valsecchi, Marina Elena Cazzaniga, Giuseppe Foti, Ilaria Beretta, Mariella D'Angiò, Laura Rachele Bettini, Xavier Farré, Susana Iraola-Guzmán, Manolis Kogevinas, Gemma Castaño-Vinyals, Koldo Garcia-Etxebarria, Beatriz Nafria, Mauro D'Amato, Adriana Palom, Colin Begg, Sara Clohisey, Charles Hinds, Peter Horby, Julian Knight, Lowell Ling, David Maslove, Danny McAuley, Johnny Millar, Hugh Montgomery, Alistair Nichol, Peter J.M. Openshaw, Alexandre C. Pereira, Chris P. Ponting, Kathy Rowan, Malcolm G. Semple, Manu Shankar-Hari, Charlotte Summers, Timothy Walsh, Latha Aravindan, Ruth Armstrong, Heather Biggs, Ceilia Boz, Adam Brown, Richard Clark, Audrey Coutts, Judy Coyle, Louise Cullum, Sukamal Das, Nicky Day, Lorna Donnelly, Esther Duncan, Angie Fawkes, Paul Fineran, Max Head Fourman, Anita Furlong, James Furniss, Bernadette Gallagher, Tammy Gilchrist, Ailsa Golightly, Fiona Griffiths, Katarzyna Hafezi, Debbie Hamilton, Ross Hendry, Andy Law, Dawn Law, Rachel Law, Sarah Law, Rebecca Lidstone-Scott, Louise Macgillivray, Alan Maclean, Hanning Mal, Sarah McCafferty, Ellie Mcmaster, Jen Meikle, Shona C. Moore, Kirstie Morrice, Lee Murphy, Sheena Murphy, Mybaya Hellen, Wilna Oosthuyzen, Chenqing Zheng, Jiantao Chen, Nick Parkinson, Trevor Paterson, Katherine Schon, Andrew Stenhouse, Mihaela Das, Maaike Swets, Helen Szoor-McElhinney, Filip Taneski, Lance Turtle, Tony Wackett, Mairi Ward, Jane Weaver, Nicola Wrobel, Marie Zechner, Gill Arbane, Aneta Bociek, Sara Campos, Neus Grau, Tim Owen Jones, Rosario Lim, Martina Marotti, Marlies Ostermann, Christopher Whitton, Zoe Alldis, Raine Astin-Chamberlain, Fatima Bibi, Jack Biddle, Sarah Blow, Matthew Bolton, Catherine Borra, Ruth Bowles, Maudrian Burton, Yasmin Choudhury, David Collier, Amber Cox, Amy Easthope, Patrizia Ebano, Stavros Fotiadis, Jana Gurasashvili, Rosslyn Halls, Pippa Hartridge, Delordson Kallon, Jamila Kassam, Ivone Lancoma-Malcolm, Maninderpal Matharu, Peter May, Oliver Mitchelmore, Tabitha Newman, Mital Patel, Jane Pheby, Irene Pinzuti, Zoe Prime, Oleksandra Prysyazhna, Julian Shiel, Melanie Taylor, Carey Tierney, Suzanne Wood, Anne Zak, Olivier Zongo, Stephen Bonner, Keith Hugill, Jessica Jones, Steven Liggett, Evie Headlam, Nageswar Bandla, Minnie Gellamucho, Michelle Davies, Christopher Thompson, Marwa Abdelrazik, Dhanalakshmi Bakthavatsalam, Munzir Elhassan, Arunkumar Ganesan, Anne Haldeos, Jeronimo Moreno-Cuesta, Dharam Purohit, Rachel Vincent, Kugan Xavier, Kumar Rohit, Frater Alasdair, Malik Saleem, Carter David, Jenkins Samuel, Zoe Lamond, Wall Alanna, Jaime Fernandez-Roman, David O. Hamilton, Emily Johnson, Brian Johnston, Maria Lopez Martinez, Suleman Mulla, David Shaw, Alicia A.C. Waite, Victoria Waugh, Ingeborg D. Welters, Karen Williams, Anna Cavazza, Maeve Cockrell, Eleanor Corcoran, Maria Depante, Clare Finney, Ellen Jerome, Mark McPhail, Monalisa Nayak, Harriet Noble, Kevin O'Reilly, Evita Pappa, Rohit Saha, Sian Saha, John Smith, Abigail Knighton, David Antcliffe, Dorota Banach, Stephen Brett, Phoebe Coghlan, Ziortza Fernandez, Anthony Gordon, Roceld Rojo, Sonia Sousa Arias, Maie Templeton, Megan Meredith, Lucy Morris, Lucy Ryan, Amy Clark, Julia Sampson, Cecilia Peters, Martin Dent, Margaret Langley, Saima Ashraf, Shuying Wei, Angela Andrew, Archana Bashyal, Neil Davidson, Paula Hutton, Stuart McKechnie, Jean Wilson, David Baptista, Rebecca Crowe, Rita Fernandes, Rosaleen Herdman-Grant, Anna Joseph, Denise O'Connor, Meryem Allen, Adam Loveridge, India McKenley, Eriko Morino, Andres Naranjo, Richard Simms, Kathryn Sollesta, Andrew Swain, Harish Venkatesh, Jacyntha Khera, Jonathan Fox, Gillian Andrew, Lucy Barclay, Marie Callaghan, Rachael Campbell, Sarah Clark, Dave Hope, Lucy Marshall, Corrienne McCulloch, Kate Briton, Jo Singleton, Sohphie Birch, Lutece Brimfield, Zoe Daly, David Pogson, Steve Rose, Ceri Battle, Elaine Brinkworth, Rachel Harford, Carl Murphy, Luke Newey, Tabitha Rees, Marie Williams, Sophie Arnold, Petra Polgarova, Katerina Stroud, Eoghan Meaney, Megan Jones, Anthony Ng, Shruti Agrawal, Nazima Pathan, Deborah White, Esther Daubney, Kay Elston, Lina Grauslyte, Musarat Hussain, Mandeep Phull, Tatiana Pogreban, Lace Rosaroso, Erika Salciute, George Franke, Joanna Wong, Aparna George, Laura Ortiz-Ruiz de Gordoa, Emily Peasgood, Claire Phillips, Michelle Bates, Jo Dasgin, Jaspret Gill, Annette Nilsson, James Scriven, Carlos Castro Delgado, Deborah Dawson, Lijun Ding, Georgia Durrant, Obiageri Ezeobu, Sarah Farnell-Ward, Abiola Harrison, Rebecca Kanu, Susannah Leaver, Elena Maccacari, Soumendu Manna, Romina Pepermans Saluzzio, Joana Queiroz, Tinashe Samakomva, Christine Sicat, Joana Texeira, Edna Fernandes Da Gloria, Ana Lisboa, John Rawlins, Jisha Mathew, Ashley Kinch, William James Hurt, Nirav Shah, Victoria Clark, Maria Thanasi, Nikki Yun, Kamal Patel, Sara Bennett, Emma Goodwin, Matthew Jackson, Alissa Kent, Clare Tibke, Wiesia Woodyatt, Ahmed Zaki, Azmerelda Abraheem, Peter Bamford, Kathryn Cawley, Charlie Dunmore, Maria Faulkner, Rumanah Girach, Helen Jeffrey, Rhianna Jones, Emily London, Imrun Nagra, Farah Nasir, Hannah Sainsbury, Clare Smedley, Tahera Patel, Matthew Smith, Srikanth Chukkambotla, Aayesha Kazi, Janice Hartley, Joseph Dykes, Muhammad Hijazi, Sarah Keith, Meherunnisa Khan, Janet Ryan-Smith, Philippa Springle, Jacqueline Thomas, Nick Truman, Samuel Saad, Dabheoc Coleman, Christopher Fine, Roseanna Matt, Bethan Gay, Jack Dalziel, Syamlan Ali, Drew Goodchild, Rhiannan Harling, Ravi Bhatterjee, Wendy Goddard, Chloe Davison, Stephen Duberly, Jeanette Hargreaves, Rachel Bolton, Miriam Davey, David Golden, Rebecca Seaman, Shiney Cherian, Sean Cutler, Anne Emma Heron, Anna Roynon-Reed, Tamas Szakmany, Gemma Williams, Owen Richards, Yusuf Cheema, Hollie Brooke, Sarah Buckley, Jose Cebrian Suarez, Ruth Charlesworth, Karen Hansson, John Norris, Alice Poole, Alastair Rose, Rajdeep Sandhu, Brendan Sloan, Elizabeth Smithson, Muthu Thirumaran, Veronica Wagstaff, Alexandra Metcalfe, Mark Brunton, Jess Caterson, Holly Coles, Matthew Frise, Sabi Gurung Rai, Nicola Jacques, Liza Keating, Emma Tilney, Shauna Bartley, Parminder Bhuie, Sian Gibson, Amanda Lyle, Fiona McNeela, Jayachandran Radhakrishnan, Alistair Hughes, Bryan Yates, Jessica Reynolds, Helen Campbell, Maria Thompsom, Steve Dodds, Stacey Duffy, Sandra Greer, Karen Shuker, Ascanio Tridente, Reena Khade, Ashok Sundar, George Tsinaslanidis, Isobel Birkinshaw, Joseph Carter, Kate Howard, Joanne Ingham, Rosie Joy, Harriet Pearson, Samantha Roche, Zoe Scott, Hollie Bancroft, Mary Bellamy, Margaret Carmody, Jacqueline Daglish, Faye Moore, Joanne Rhodes, Mirriam Sangombe, Salma Kadiri, Maria Croft, Ian White, Victoria Frost, Maia Aquino, Rajeev Jha, Vinodh Krishnamurthy, Lai Lim, Li Lim, Edward Combes, Teishel Joefield, Sonja Monnery, Valerie Beech, Sallyanne Trotman, Christine Almaden-Boyle, Pauline Austin, Louise Cabrelli, Stephen Cole, Matt Casey, Susan Chapman, Clare Whyte, Yolanda Baird, Aaron Butler, Indra Chadbourn, Linda Folkes, Heather Fox, Amy Gardner, Raquel Gomez, Gillian Hobden, Luke Hodgson, Kirsten King, Michael Margarson, Tim Martindale, Emma Meadows, Dana Raynard, Yvette Thirlwall, David Helm, Jordi Margalef, Kristine Criste, Rebecca Cusack, Kim Golder, Hannah Golding, Oliver Jones, Samantha Leggett, Michelle Male, Martyna Marani, Kirsty Prager, Toran Williams, Belinda Roberts, Karen Salmon, Peter Anderson, Katie Archer, Karen Austin, Caroline Davis, Alison Durie, Olivia Kelsall, Jessica Thrush, Charlie Vigurs, Laura Wild, Hannah-Louise Wood, Helen Tranter, Alison Harrison, Nicholas Cowley, Michael McAlindon, Andrew Burtenshaw, Stephen Digby, Emma Low, Aled Morgan, Naiara Cother, Tobias Rankin, Sarah Clayton, Alex McCurdy, Cecilia Ahmed, Balvinder Baines, Sarah Clamp, Julie Colley, Risna Haq, Anne Hayes, Jonathan Hulme, Samia Hussain, Sibet Joseph, Rita Kumar, Zahira Maqsood, Manjit Purewal, Leonie Benham, Zena Bradshaw, Joanna Brown, Melanie Caswell, Jason Cupitt, Sarah Melling, Stephen Preston, Nicola Slawson, Emma Stoddard, Scott Warden, Bethan Deacon, Ceri Lynch, Carla Pothecary, Lisa Roche, Gwenllian Sera Howe, Jayaprakash Singh, Keri Turner, Hannah Ellis, Natalie Stroud, Jodie Hunt, Joy Dearden, Emma Dobson, Andy Drummond, Michelle Mulcahy, Sheila Munt, Grainne O'Connor, Jennifer Philbin, Chloe Rishton, Redmond Tully, Sarah Winnard, Susanne Cathcart, Katharine Duffy, Alex Puxty, Kathryn Puxty, Lynne Turner, Jane Ireland, Gary Semple, Kate Long, Simon Whiteley, Elizabeth Wilby, Bethan Ogg, Amanda Cowton, Andrea Kay, Melanie Kent, Kathryn Potts, Ami Wilkinson, Suzanne Campbell, Ellen Brown, Julie Melville, Jay Naisbitt, Rosane Joseph, Maria Lazo, Olivia Walton, Alan Neal, Peter Alexander, Schvearn Allen, Joanne Bradley-Potts, Craig Brantwood, Jasmine Egan, Timothy Felton, Grace Padden, Luke Ward, Stuart Moss, Susannah Glasgow, Lynn Abel, Michael Brett, Brian Digby, Lisa Gemmell, James Hornsby, Patrick MacGoey, Pauline O'Neil, Richard Price, Natalie Rodden, Kevin Rooney, Radha Sundaram, Nicola Thomson, Bridget Hopkins, Laura Thrasyvoulou, Heather Willis, Martyn Clark, Martina Coulding, Edward Jude, Jacqueline McCormick, Oliver Mercer, Darsh Potla, Hafiz Rehman, Heather Savill, Victoria Turner, Charlotte Downes, Kathleen Holding, Katie Riches, Mary Hilton, Mel Hayman, Deepak Subramanian, Priya Daniel, Oluronke Adanini, Nikhil Bhatia, Maines Msiska, Rebecca Collins, Ian Clement, Bijal Patel, A. Gulati, Carole Hays, K. Webster, Anne Hudson, Andrea Webster, Elaine Stephenson, Louise McCormack, Victoria Slater, Rachel Nixon, Helen Hanson, Maggie Fearby, Sinead Kelly, Victoria Bridgett, Philip Robinson, Julie Camsooksai, Charlotte Humphrey, Sarah Jenkins, Henrik Reschreiter, Beverley Wadams, Yasmin Death, Victoria Bastion, Daphene Clarke, Beena David, Harriet Kent, Rachel Lorusso, Gamu Lubimbi, Sophie Murdoch, Melchizedek Penacerrada, Alastair Thomas, Jennifer Valentine, Ana Vochin, Retno Wulandari, Brice Djeugam, Gillian Bell, Katy English, Amro Katary, Louise Wilcox, Michelle Bruce, Karen Connolly, Tracy Duncan, Helen T-Michael, Gabriella Lindergard, Samuel Hey, Claire Fox, Jordan Alfonso, Laura Jayne Durrans, Jacinta Guerin, Bethan Blackledge, Jade Harris, Martin Hruska, Ayaa Eltayeb, Thomas Lamb, Tracey Hodgkiss, Lisa Cooper, Joanne Rothwell, Angela Allan, Felicity Anderson, Callum Kaye, Jade Liew, Jasmine Medhora, Teresa Scott, Erin Trumper, Adriana Botello, Liana Lankester, Nikitas Nikitas, Colin Wells, Bethan Stowe, Kayleigh Spencer, Craig Brandwood, Lara Smith, Katie Birchall, Laurel Kolakaluri, Deborah Baines, Anila Sukumaran, Elena Apetri, Cathrine Basikolo, Laura Catlow, Bethan Charles, Paul Dark, Reece Doonan, Alice Harvey, Daniel Horner, Karen Knowles, Stephanie Lee, Diane Lomas, Chloe Lyons, Tracy Marsden, Danielle McLaughlan, Liam McMorrow, Jessica Pendlebury, Jane Perez, Maria Poulaka, Nicola Proudfoot, Melanie Slaughter, Kathryn Slevin, Vicky Thomas, Danielle Walker, Angiy Michael, Matthew Collis, Tracey Cosier, Gemma Millen, Neil Richardson, Natasha Schumacher, Heather Weston, James Rand, Nicola Baxter, Steven Henderson, Sophie Kennedy-Hay, Christopher McParland, Laura Rooney, Malcolm Sim, Gordan McCreath, Louise Akeroyd, Shereen Bano, Matt Bromley, Lucy Gurr, Tom Lawton, James Morgan, Kirsten Sellick, Deborah Warren, Brian Wilkinson, Janet McGowan, Camilla Ledgard, Amelia Stacey, Kate Pye, Ruth Bellwood, Michael Bentley, Jeremy Bewley, Zoe Garland, Lisa Grimmer, Bethany Gumbrill, Rebekah Johnson, Katie Sweet, Denise Webster, Georgia Efford, Karen Convery, Deirdre Fottrell-Gould, Lisa Hudig, Jocelyn Keshet-Price, Georgina Randell, Katie Stammers, Maria Bokhari, Vanessa Linnett, Rachael Lucas, Wendy McCormick, Jenny Ritzema, Amanda Sanderson, Helen Wild, Anthony Rostron, Alistair Roy, Lindsey Woods, Sarah Cornell, Fiona Wakinshaw, Kimberley Rogerson, Jordan Jarmain, Robert Parker, Amie Reddy, Ian Turner-Bone, Laura Wilding, Peter Harding, Caroline Abernathy, Louise Foster, Andrew Gratrix, Vicky Martinson, Priyai Parkinson, Elizabeth Stones, Llucia Carbral-Ortega, Georgia Bercades, David Brealey, Ingrid Hass, Niall MacCallum, Gladys Martir, Eamon Raith, Anna Reyes, Deborah Smyth, Letizia Zitter, Sarah Benyon, Suzie Marriott, Linda Park, Samantha Keenan, Elizabeth Gordon, Helen Quinn, Kizzy Baines, Lenka Cagova, Adama Fofano, Lucie Garner, Helen Holcombe, Sue Mepham, Alice Michael Mitchell, Lucy Mwaura, Krithivasan Praman, Alain Vuylsteke, Julie Zamikula, Bally Purewal, Vanessa Rivers, Stephanie Bell, Hayley Blakemore, Borislava Borislavova, Beverley Faulkner, Emma Gendall, Elizabeth Goff, Kati Hayes, Matt Thomas, Ruth Worner, Kerry Smith, Deanna Stephens, Louise Mew, Esther Mwaura, Richard Stewart, Felicity Williams, Lynn Wren, Sara-Beth Sutherland, Emily Bevan, Jane Martin, Dawn Trodd, Geoff Watson, Caroline Wrey Brown, Amy Collins, Waqas Khaliq, Estefania Treus Gude, Olugbenga Akinkugbe, Alasdair Bamford, Emily Beech, Holly Belfield, Michael Bell, Charlene Davies, Gareth A.L. Jones, Tara McHugh, Hamza Meghari, Lauran O'Neill, Mark J. Peters, Samiran Ray, Ana Luisa Tomas, Iona Burn, Geraldine Hambrook, Katarina Manso, Ruth Penn, Pradeep Shanmugasundaram, Julie Tebbutt, Danielle Thornton, Jade Cole, Rhys Davies, Donna Duffin, Helen Hill, Ben Player, Emma Thomas, Angharad Williams, Denise Griffin, Nycola Muchenje, Mcdonald Mupudzi, Richard Partridge, Jo-Anna Conyngham, Rachel Thomas, Mary Wright, Maria Alvarez Corral, Reni Jacob, Cathy Jones, Craig Denmade, Sarah Beavis, Katie Dale, Rachel Gascoyne, Joanne Hawes, Kelly Pritchard, Lesley Stevenson, Amanda Whileman, Patricia Doble, Joanne Hutter, Corinne Pawley, Charmaine Shovelton, Marius Vaida, Deborah Butcher, Susie O'Sullivan, Nicola Butterworth-Cowin, Norfaizan Ahmad, Joann Barker, Kris Bauchmuller, Sarah Bird, Kay Cawthron, Kate Harrington, Yvonne Jackson, Faith Kibutu, Becky Lenagh, Shamiso Masuko, Gary H. Mills, Ajay Raithatha, Matthew Wiles, Jayne Willson, Helen Newell, Alison Lye, Lorenza Nwafor, Claire Jarman, Sarah Rowland-Jones, David Foote, Joby Cole, Roger Thompson, James Watson, Lisa Hesseldon, Irene Macharia, Luke Chetam, Jacqui Smith, Amber Ford, Samantha Anderson, Kathryn Birchall, Kay Housley, Sara Walker, Leanne Milner, Helena Hanratty, Helen Trower, Patrick Phillips, Simon Oxspring, Ben Donne, Catherine Jardine, Dewi Williams, Alasdair Hay, Rebecca Flanagan, Gareth Hughes, Scott Latham, Emma McKenna, Jennifer Anderson, Robert Hull, Kat Rhead, Carina Cruz, Natalie Pattison, Rob Charnock, Denise McFarland, Denise Cosgrove, Ashar Ahmed, Anna Morris, Srinivas Jakkula, Asifa Ali, Megan Brady, Sam Dale, Annalisa Dance, Lisa Gledhill, Jill Greig, Kathryn Hanson, Kelly Holdroyd, Marie Home, Diane Kelly, Ross Kitson, Lear Matapure, Deborah Melia, Samantha Mellor, Tonicha Nortcliffe, Jez Pinnell, Matthew Robinson, Lisa Shaw, Ryan Shaw, Lesley Thomis, Alison Wilson, Tracy Wood, Lee-Ann Bayo, Ekta Merwaha, Tahira Ishaq, Sarah Hanley, Meg Hibbert, Dariusz Tetla, Chrsitopher Woodford, Latha Durga, Gareth Kennard-Holden, Debbie Branney, Jordan Frankham, Sally Pitts, Nigel White, Shondipon Laha, Mark Verlander, Alexandra Williams, Abdelhakim Altabaibeh, Ana Alvaro, Kayleigh Gilbert, Louise Ma, Loreta Mostoles, Chetan Parmar, Kathryn Simpson, Champa Jetha, Lauren Booker, Anezka Pratley, Colene Adams, Anita Agasou, Tracie Arden, Amy Bowes, Pauline Boyle, Mandy Beekes, Heather Button, Nigel Capps, Mandy Carnahan, Anne Carter, Danielle Childs, Denise Donaldson, Kelly Hard, Fran Hurford, Yasmin Hussain, Ayesha Javaid, James Jones, Sanal Jose, Michael Leigh, Terry Martin, Helen Millward, Nichola Motherwell, Rachel Rikunenko, Jo Stickley, Julie Summers, Louise Ting, Helen Tivenan, Louise Tonks, Rebecca Wilcox, Maureen Holland, Natalie Keenan, Marc Lyons, Helen Wassall, Chris Marsh, Mervin Mahenthran, Emma Carter, Thomas Kong, Helen Blackman, Ben Creagh-Brown, Sinead Donlon, Natalia Michalak-Glinska, Sheila Mtuwa, Veronika Pristopan, Armorel Salberg, Eleanor Smith, Sarah Stone, Charles Piercy, Jerik Verula, Dorota Burda, Rugia Montaser, Lesley Harden, Irving Mayangao, Cheryl Marriott, Paul Bradley, Celia Harris, Susan Anderson, Eleanor Andrews, Janine Birch, Emma Collins, Kate Hammerton, Ryan O'Leary, Michele Clark, Sarah Purvis, Russell Barber, Claire Hewitt, Annette Hilldrith, Karen Jackson-Lawrence, Sarah Shepardson, Maryanne Wills, Susan Butler, Silvia Tavares, Amy Cunningham, Julia Hindale, Sarwat Arif, Sarah Bean, Karen Burt, Michael Spivey, Carrie Demetriou, Charlotte Eckbad, Sarah Hierons, Lucy Howie, Sarah Mitchard, Lidia Ramos, Alfredo Serrano-Ruiz, Katie White, Fiona Kelly, Daniele Cristiano, Natalie Dormand, Zohreh Farzad, Mahitha Gummadi, Kamal Liyanage, Brijesh Patel, Sara Salmi, Geraldine Sloane, Vicky Thwaites, Mathew Varghese, Anelise C. Zborowski, John Allan, Tim Geary, Gordon Houston, Alistair Meikle, Peter O'Brien, Miranda Forsey, Agilan Kaliappan, Anne Nicholson, Joanne Riches, Mark Vertue, Elizabeth Allan, Kate Darlington, Ffyon Davies, Jack Easton, Sumit Kumar, Richard Lean, Daniel Menzies, Richard Pugh, Xinyi Qiu, Llinos Davies, Hannah Williams, Jeremy Scanlon, Gwyneth Davies, Callum Mackay, Joannne Lewis, Stephanie Rees, Metod Oblak, Monica Popescu, Mini Thankachen, Andrew Higham, Kerry Simpson, Jayne Craig, Rosie Baruah, Sheila Morris, Susie Ferguson, Amy Shepherd, Luke Stephen Prockter Moore, Marcela Paola Vizcaychipi, Laura Gomes de Almeida Martins, Jaime Carungcong, Inthakab Ali Mohamed Ali, Karen Beaumont, Mark Blunt, Zoe Coton, Hollie Curgenven, Mohamed Elsaadany, Kay Fernandes, Sameena Mohamed Ally, Harini Rangarajan, Varun Sarathy, Sivarupan Selvanayagam, Dave Vedage, Matthew White, Mandy Gill, Paul Paul, Valli Ratnam, Sarah Shelton, Inez Wynter, Siobhain Carmody, Valerie Joan Page, Claire Marie Beith, Karen Black, Suzanne Clements, Alan Morrison, Dominic Strachan, Margaret Taylor, Michelle Clarkson, Stuart D'Sylva, Kathryn Norman, Fiona Auld, Joanne Donnachie, Ian Edmond, Lynn Prentice, Nikole Runciman, Dario Salutous, Lesley Symon, Anne Todd, Patricia Turner, Abigail Short, Laura Sweeney, Euan Murdoch, Dhaneesha Senaratne, Michaela Hill, Thogulava Kannan, Wild Laura, Rikki Crawley, Abigail Crew, Mishell Cunningham, Allison Daniels, Laura Harrison, Susan Hope, Ken Inweregbu, Sian Jones, Nicola Lancaster, Jamie Matthews, Alice Nicholson, Gemma Wray, Helen Langton, Rachel Prout, Malcolm Watters, Catherine Novis, Anthony Barron, Ciara Collins, Sundeep Kaul, Heather Passmore, Claire Prendergast, Anna Reed, Paula Rogers, Rajvinder Shokkar, Meriel Woodruff, Hayley Middleton, Oliver Polgar, Claire Nolan, Kanta Mahay, Dawn Collier, Anil Hormis, Victoria Maynard, Cheryl Graham, Rachel Walker, Ellen Knights, Alicia Price, Alice Thomas, Chris Thorpe, Teresa Behan, Caroline Burnett, Jonathan Hatton, Elaine Heeney, Atideb Mitra, Maria Newton, Rachel Pollard, Rachael Stead, Vishal Amin, Elena Anastasescu, Vikram Anumakonda, Komala Karthik, Rizwana Kausar, Karen Reid, Jacqueline Smith, Janet Imeson-Wood, Denise Skinner, Jane Gaylard, Dee Mullan, Julie Newman, Alison Brown, Vikki Crickmore, Gabor Debreceni, Joy Wilkins, Liz Nicol, Rosie Reece-Anthony, Mark Birt, Alison Ghosh, Emma Williams, Louise Allen, Eva Beranova, Nikki Crisp, Joanne Deery, Tracy Hazelton, Alicia Knight, Carly Price, Sorrell Tilbey, Salah Turki, Sharon Turney, Joshua Cooper, Cheryl Finch, Sarah Liderth, Alison Quinn, Natalia Waddington, Tina Coventry, Susan Fowler, Michael MacMahon, Amanda McGregor, Anne Cowley, Judith Highgate, Jane Gregory, Susan O'Connell, Tim Smith, Luigi Barberis, Shameer Gopal, Nichola Harris, Victoria Lake, Stella Metherell, Elizabeth Radford, Amelia Daniel, Joanne Finn, Rajnish Saha, Nikki White, Phil Donnison, Fiona Trim, Beena Eapen, Jenny Birch, Laura Bough, Josie Goodsell, Rebecca Tutton, Patricia Williams, Sarah Williams, Barbara Winter-Goodwin, Ailstair Nichol, Kathy Brickell, Michelle Smyth, Lorna Murphy, Samantha Coetzee, Alistair Gales, Igor Otahal, Meena Raj, Craig Sell, Paula Hilltout, Jayne Evitts, Amanda Tyler, Joanne Waldron, Kate Beesley, Sarah Board, Agnieszka Kubisz-Pudelko, Alison Lewis, Jess Perry, Lucy Pippard, Di Wood, Clare Buckley, Peter Barry, Neil Flint, Patel Rekha, Dawn Hales, Lara Bunni, Claire Jennings, Monica Latif, Rebecca Marshall, Gayathri Subramanian, Peter J. McGuigan, Christopher Wasson, Stephanie Finn, Jackie Green, Erin Collins, Bernadette King, Andy Campbell, Sara Smuts, Joseph Duffield, Oliver Smith, Lewis Mallon, Watkins Claire, Liam Botfield, Joanna Butler, Catherine Dexter, Jo Fletcher, Atul Garg, Aditya Kuravi, Poonam Ranga, Emma Virgilio, Zakaula Belagodu, Bridget Fuller, Anca Gherman, Olumide Olufuwa, Remi Paramsothy, Carmel Stuart, Naomi Oakley, Charlotte Kamundi, David Tyl, Katy Collins, Pedro Silva, June Taylor, Laura King, Charlotte Coates, Maria Crowley, Phillipa Wakefield, Jane Beadle, Laura Johnson, Janet Sargeant, Madeleine Anderson, Ailbhe Brady, Rebekah Chan, Jeff Little, Shane McIvor, Helena Prady, Helen Whittle, Bijoy Mathew, Ben Attwood, Penny Parsons, Geraldine Ward, Pamela Bremmer, West Joe, Baird Tracy, Ruddy Jim, Ellie Davies, Sonia Sathe, Catherine Dennis, Alastair McGregor, Victoria Parris, Sinduya Srikaran, Anisha Sukha, Noreen Clarke, Jonathan Whiteside, Mairi Mascarenhas, Avril Donaldson, Joanna Matheson, Fiona Barrett, Marianne O'Hara, Laura Okeefe, Clare Bradley, Christine Eastgate-Jackson, Helder Filipe, Daniel Martin, Amitaa Maharajh, Sara Mingo Garcia, Glykeria Pakou, Mark De Neef, Kathy Dent, Elizabeth Horsley, Muhmmad Nauman Akhtar, Sandra Pearson, Dorota Potoczna, Sue Spencer, Melanie Clapham, Rosemary Harper, Una Poultney, Polly Rice, Rachel Mutch, Lisa Armstrong, Hayley Bates, Emma Dooks, Fiona Farquhar, Brigid Hairsine, Chantal McParland, Sophie Packham, Rehana Bi, Barney Scholefield, Lydia Ashton, Linsha George, Sophie Twiss, David Wright, Manish Chablani, Amy Kirkby, Kimberley Netherton, Kim Davies, Linda O'Brien, Zohra Omar, Emma Perkins, Tracy Lewis, Isobel Sutherland, Karen Burns, Dr Ben Chandler, Kerry Elliott, Janine Mallinson, Alison Turnbull, Prisca Gondo, Bernard Hadebe, Abdul Kayani, Bridgett Masunda, Taya Anderson, Dan Hawcutt, Laura O'Malley, Laura Rad, Naomi Rogers, Paula Saunderson, Kathryn Sian Allison, Deborah Afolabi, Jennifer Whitbread, Dawn Jones, Rachael Dore, Matthew Halkes, Pauline Mercer, Lorraine Thornton, Joy Dawson, Sweyn Garrioch, Melanie Tolson, Jonathan Aldridge, Ritoo Kapoor, David Loader, Karen Castle, Sally Humphreys, Ruth Tampsett, Katherine Mackintosh, Amanda Ayers, Wendy Harrison, Julie North, Suzanne Allibone, Roman Genetu, Vidya Kasipandian, Amit Patel, Ainhi Mac, Anthony Murphy, Parisa Mahjoob, Roonak Nazari, Lucy Worsley, Andrew Fagan, Thomas Bemand, Ethel Black, Arnold Dela Rosa, Ryan Howle, Shaman Jhanji, Ravishankar Rao Baikady, Kate Colette Tatham, Benjamin Thomas, Dina Bell, Rosalind Boyle, Katie Douglas, Lynn Glass, Emma Lee, Liz Lennon, Austin Rattray, Abigail Taylor, Rachel Anne Hughes, Helen Thomas, Alun Rees, Michaela Duskova, Janet Phipps, Suzanne Brooks, Michelle Edwards, Sheena Quaid, Ekaterina Watson, Adam Brayne, Emma Fisher, Jane Hunt, Peter Jackson, Duncan Kaye, Nicholas Love, Juliet Parkin, Victoria Tuckey, Lynne Van Koutrik, Sasha Carter, Benedict Andrew, Louise Findlay, Katie Adams, Jen Service, Alison Williams, Claire Cheyne, Anne Saunderson, Sam Moultrie, Miranda Odam, Kathryn Hall, Isheunesu Mapfunde, Charlotte Willis, Alex Lyon, Chunda Sri-Chandana, Joslan Scherewode, Lorraine Stephenson, Sarah Marsh, John Hardy, Henry Houlden, Eleanor Moncur, Ambreen Tariq, Arianna Tucci, Maria Hobrok, Ronda Loosley, Heather McGuinness, Helen Tench, Rebecca Wolf-Roberts, Val Irvine, Benjamin Shelley, Claire Gorman, Abhinav Gupta, Elizabeth Timlick, Rebecca Brady, Barry Milligan, Arianna Bellini, Jade Bryant, Anton Mayer, Amy Pickard, Nicholas Roe, Jason Sowter, Alex Howlett, Katy Fidler, Emma Tagliavini, and Kevin Donnelly

Subjects
SARS-CoV-2, host genetics, toll-like receptor 7, targeted sequencing, rare variants, variant collapsing analysis, Genetics, QH426-470
Abstract

Summary: Despite extensive global research into genetic predisposition for severe COVID-19, knowledge on the role of rare host genetic variants and their relation to other risk factors remains limited. Here, 52 genes with prior etiological evidence were sequenced in 1,772 severe COVID-19 cases and 5,347 population-based controls from Spain/Italy. Rare deleterious TLR7 variants were present in 2.4% of young (

Published
2024
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14. Psychological and psychosocial determinants of COVID‐related handwashing behaviours: A systematic review

Author

Rachel Leonard, Sean R. O'Connor, Jennifer Hanratty, Ciara Keenan, Yuan Chi, Jenny Ferguson, Ariana Axiaq, Anna Volz, Ceri Welsh, Kerry Campbell, Victoria Hawkins, Sarah Miller, Declan Bradley, and Martin Dempster

Subjects
anxiety, COVID‐19, handwashing, social norms, Social Sciences
Abstract

Abstract Background The COVID‐19 pandemic, caused by the SARS‐CoV‐2 virus, has resulted in illness, deaths and societal disruption on a global scale. Societies have implemented various control measures to reduce transmission of the virus and mitigate its impact. Individual behavioural changes are crucial to the successful implementation of these measures. One commonly recommended measure to limit risk of infection is frequent handwashing. It is important to identify those factors that can predict the uptake and maintenance of handwashing. Objectives We aimed to identify and synthesise the evidence on malleable psychological and psychosocial factors that determine uptake and adherence to handwashing aimed at reducing the risk of infection or transmission of COVID‐19. Search Methods We searched various literature sources including electronic databases (Medline ALL, Child Development & Adolescent Studies, ERIC, PsycInfo, CINAHL and Web of Science), web searches, conference proceedings, government reports, other repositories of literature and grey literature. The search strategy was built around three concepts of interest including (1) context (terms relating to COVID‐19), (2) behaviour of interest and (3) terms related to psychological and psychosocial determinants of COVID Health‐Related Behaviours and adherence or compliance with handwashing, to capture malleable determines. Searches capture studies up until October 2021. Selection Criteria Eligibility criteria included observational studies (both retrospective and prospective) and experimental studies that measure and report malleable psychological and psychosocial determinants and handwashing at an individual level, amongst the general public. Screening was supported by the Cochrane Crowd. Titles and abstracts were screened against the eligibility criteria by three independent screeners. Following this, all potentially relevant studies were screened at full‐text level by the research team. All conflicts between screeners were resolved by discussion between the core research team. Data Collection and Analysis All data extraction was managed in EPPI‐Reviewer software. All eligible studies, identified through full‐text screening were extracted by one author. We extracted data on study information, population, determinant, behaviour and effects. A second author checked data extraction on 20% of all included papers. All conflicts were discussed by the two authors until consensus was reached. We assessed methodological quality of all included studies using an adapted version of the Joanna Briggs Institute Quality appraisal tool for cross‐sectional studies. Main Results Our initial searches yielded 23,587 results, of which 56 studies were included in this review. The included studies were cross sectional in design, came from 22 countries and had a combined sample of 199,376 participants. The vast majority of studies had samples from the general public, with eight of the studies focusing on specific samples. All included studies considered people over the age of 18. The quality of the majority of the studies was good (n = 30 rated low risk of bias), with 8 rated high risk of bias, predominately due to lack of reporting of recruitment, sample characteristics and methodology. Thirty‐four studies were included in the narrative synthesis and 28 in the meta‐analysis. Findings indicated that emotions about COVID‐19 (worry [0.381, confidence interval [CI] = 0.270–0.482, I2 = 92%) and anxiety (0.308, CI = 0.154–0.448, I2 = 91%]), knowledge of COVID‐19 (0.323, CI = 0.223–0.417, I2 = 94%), and perceived social norms (0.303, CI = 0.184–0.413, I2 = 92%) were among the malleable determinants most associated with handwashing. Perceived severity (0.006, CI = ‐0.011–0.023) and susceptibility of COVID‐19 (0.041, CI = −0.034 to 0.115) had little to no effect on handwashing behaviour. Authors' Conclusions Understanding the effects of various malleable determinants on COVID‐related handwashing can aid in the development and implementation of interventions and public health campaigns to promote handwashing behaviour in potential new waves of COVID‐19 or other respiratory infections. Emotions about COVID, knowledge of COVID and perceived social norms warrant further consideration in future research and policy.

Published
2024
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15. Psychological and psychosocial determinants of COVID related face covering behaviours: A systematic review

Author

Rachel Leonard, Sean R. O'Connor, Jennifer Hanratty, Ciara Keenan, Yuan Chi, Jenny Ferguson, Ariana Axiaq, Anna Volz, Ceri Welsh, Kerry Campbell, Victoria Hawkins, Sarah Miller, Declan Bradley, and Martin Dempster

Subjects
COVID‐19, face coverings, knowledge, masks, Social Sciences
Abstract

Abstract Background The COVID‐19 pandemic, caused by the SARS‐CoV‐2 virus, has resulted in illness, deaths and societal disruption on a global scale. Societies have implemented various control measures to reduce transmission of the virus and mitigate its impact. Individual behavioural changes are crucial to the successful implementation of these measures. One commonly recommended measure to limit risk of infection is face covering. It is important to identify those factors that can predict the uptake and maintenance of face covering. Objectives We aimed to identify and synthesise the evidence on malleable psychological and psychosocial factors that determine uptake and adherence to face covering aimed at reducing the risk of infection or transmission of COVID‐19. Search Methods We searched various literature sources including electronic databases (Medline ALL, Child Development & Adolescent Studies, ERIC, PsycInfo, CINAHL & Web of Science), web searches, conference proceedings, government reports, other repositories of literature and grey literature. The search strategy was built around three concepts of interest including (1) context (terms relating to COVID19), (2) behaviour of interest and (3) terms related to psychological and psychosocial determinants of COVID Health‐Related Behaviours and adherence or compliance with face covering, to capture malleable determines. Searches capture studies up until October 2021. Selection Criteria Eligibility criteria included observational studies (both retrospective and prospective) and experimental studies that measure and report malleable psychological and psychosocial determinants and handwashing at an individual level, amongst the general public. Screening was supported by the Cochrane Crowd. Studies titles and abstracts were screened against the eligibility criteria by three independent screeners. Following this, all potentially relevant studies were screened at full‐text level by the research team. All conflicts between screeners were resolved by discussion between the core research team. Data Collection and Analysis All data extraction was managed in EPPI‐Reviewer software. All eligible studies, identified through full‐text screening were extracted by one author. We extracted data on study information, population, determinant, behaviour and effects. A second author checked data extraction on 20% of all included papers. All conflicts were discussed by the two authors until consensus was reached. We assessed methodological quality of all included studies using an adapted version of the Joanna Briggs Institute Quality appraisal tool for cross‐sectional studies. Main Results Our initial searches yielded 23,587 results, of which 23 were included in this review. The included studies were cross‐sectional in design, came from nine countries and had a combined sample of 54,401 participants. The vast majority of studies had samples from the general public, with five of the studies focusing on specific samples. All included studies considered people over the age of 18. The quality of 10 of the studies was rated as unclear, 10 were rated as low, and 3 rated high risk of bias, predominately due to lack of reporting of recruitment, sample characteristics and methodology. Ten studies were included in the meta‐analysis and 16 in the narrative synthesis. Findings from the meta‐analysis indicated that knowledge of COVID‐19 (0.341, 95% confidence interval [CI] = 0.06, 0.530, I2 = 100%) was the malleable determinant most associated with face covering behaviour. Perceived susceptibility of COVID‐19 (r = 0.088, 95% CI = −0.004, 0.180, I2 = 80%) and COVID‐related worry and anxiety (r = 0.064, 95% CI = −0.066, 0.191, I2 = 93% had little to no effect on face covering behaviour. In the narrative synthesis, the strongest association was found between perceived benefits and effectiveness of behaviours and mask wearing behaviour. Authors' Conclusions Understanding the effects of various malleable determinants on COVID‐related face covering can aid in the development and implementation of interventions and public health campaigns to promote face covering behaviour in potential new waves of COVID‐19 or other respiratory infections. Knowledge of COVID and perceived benefits of face coverings warrant further consideration in future research and policy.

Published
2024
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16. Understanding health service utilisation patterns for care home residents during the COVID-19 pandemic using routinely collected healthcare data

Author

Alex Garner, Nancy Preston, Camila C S Caiado, Emma Stubington, Barbara Hanratty, James Limb, Suzanne M Mason, and Jo Knight

Subjects
Geriatrics, RC952-954.6
Abstract

Abstract Background Healthcare in care homes during the COVID-19 pandemic required a balance, providing treatment while minimising exposure risk. Policy for how residents should receive care changed rapidly throughout the pandemic. A lack of accessible data on care home residents over this time meant policy decisions were difficult to make and verify. This study investigates common patterns of healthcare utilisation for care home residents in relation to COVID-19 testing events, and associations between utilisation patterns and resident characteristics. Methods Datasets from County Durham and Darlington NHS Foundation Trust including secondary care, community care and a care home telehealth app are linked by NHS number used to define daily healthcare utilisation sequences for care home residents. We derive four 10-day sets of sequences related to Pillar 1 COVID-19 testing; before [1] and after [2] a resident’s first positive test and before [3] and after [4] a resident’s first test. These sequences are clustered, grouping residents with similar healthcare patterns in each set. Association of individual characteristics (e.g. health conditions such as diabetes and dementia) with healthcare patterns are investigated. Results We demonstrate how routinely collected health data can be used to produce longitudinal descriptions of patient care. Clustered sequences [1,2,3,4] are produced for 3,471 care home residents tested between 01/03/2020–01/09/2021. Clusters characterised by higher levels of utilisation were significantly associated with higher prevalence of diabetes. Dementia is associated with higher levels of care after a testing event and appears to be correlated with a hospital discharge after a first test. Residents discharged from inpatient care within 10 days of their first test had the same mortality rate as those who stayed in hospital. Conclusion We provide longitudinal, resident-level data on care home resident healthcare during the COVID-19 pandemic. We find that vulnerable residents were associated with higher levels of healthcare usage despite the additional risks. Implications of findings are limited by the challenges of routinely collected data. However, this study demonstrates the potential for further research into healthcare pathways using linked, routinely collected datasets.

Published
2024
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17. Assessment of TROP2, CEACAM5 and DLL3 in metastatic prostate cancer: Expression landscape and molecular correlates

Author

Azra Ajkunic, Erolcan Sayar, Martine P. Roudier, Radhika A. Patel, Ilsa M. Coleman, Navonil De Sarkar, Brian Hanratty, Mohamed Adil, Jimmy Zhao, Samir Zaidi, Lawrence D. True, Jamie M. Sperger, Heather H. Cheng, Evan Y. Yu, Robert B. Montgomery, Jessica E. Hawley, Gavin Ha, Thomas Persse, Patricia Galipeau, John K. Lee, Stephanie A. Harmon, Eva Corey, Joshua M. Lang, Charles L. Sawyers, Colm Morrissey, Michael T. Schweizer, Roman Gulati, Peter S. Nelson, and Michael C. Haffner

Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Therapeutic approaches targeting proteins on the surface of cancer cells have emerged as an important strategy for precision oncology. To capitalize on the potential impact of drugs targeting surface proteins, detailed knowledge about the expression patterns of the target proteins in tumor tissues is required. In castration-resistant prostate cancer (CRPC), agents targeting prostate-specific membrane antigen (PSMA) have demonstrated clinical activity. However, PSMA expression is lost in a significant number of CRPC tumors. The identification of additional cell surface targets is necessary to develop new therapeutic approaches. Here, we performed a comprehensive analysis of the expression heterogeneity and co-expression patterns of trophoblast cell-surface antigen 2 (TROP2), delta-like ligand 3 (DLL3), and carcinoembryonic antigen-related cell adhesion molecule 5 (CEACAM5) in CRPC samples from a rapid autopsy cohort. We show that DLL3 and CEACAM5 exhibit the highest expression in neuroendocrine prostate cancer (NEPC), while TROP2 is expressed across different CRPC molecular subtypes, except for NEPC. We further demonstrated that AR alterations were associated with higher expression of PSMA and TROP2. Conversely, PSMA and TROP2 expression was lower in RB1-altered tumors. In addition to genomic alterations, we show a tight correlation between epigenetic states, particularly histone H3 lysine 27 methylation (H3K27me3) at the transcriptional start site and gene body of TACSTD2 (encoding TROP2), DLL3, and CEACAM5, and their respective protein expression in CRPC patient-derived xenografts. Collectively, these findings provide insights into patterns and determinants of expression of TROP2, DLL3, and CEACAM5 with implications for the clinical development of cell surface targeting agents in CRPC.

Published
2024
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18. What works to support carers of older people and older carers? an international evidence map of interventions and outcomes

Author

Gemma Spiers, Michelle M.C. Tan, Jayne L Astbury, Alex Hall, Nisar Ahmed, Kate Lanyi, Oleta Williams, Fiona Beyer, Dawn Craig, and Barbara Hanratty

Subjects
Carers, Older people, Interventions, Outcomes, Evidence gap maps, Geriatrics, RC952-954.6
Abstract

Abstract Background Unpaid carers of older people, and older unpaid carers, experience a range of adverse outcomes. Supporting carers should therefore be a public health priority. Our understanding of what works to support carers could be enhanced if future evaluations prioritise under-researched interventions and outcomes. To support this, we aimed to: map evidence about interventions to support carers, and the outcomes evaluated; and identify key gaps in current evidence. Methods Evidence gap map review methods were used. Searches were carried out in three bibliographic databases for quantitative evaluations of carer interventions published in OECD high-income countries between 2013 and 2023. Interventions were eligible if they supported older carers (50 + years) of any aged recipient, or any aged carers of older people (50 + years). Findings 205 studies reported across 208 publications were included in the evidence map. The majority evaluated the impact of therapeutic and educational interventions on carer burden and carers’ mental health. Some studies reported evidence about physical exercise interventions and befriending and peer support for carers, but these considered a limited range of outcomes. Few studies evaluated interventions that focused on delivering financial information and advice, pain management, and physical skills training for carers. Evaluations rarely considered the impact of interventions on carers’ physical health, quality of life, and social and financial wellbeing. Very few studies considered whether interventions delivered equitable outcomes. Conclusion Evidence on what works best to support carers is extensive but limited in scope. A disproportionate focus on mental health and burden outcomes neglects other important areas where carers may need support. Given the impact of caring on carers’ physical health, financial and social wellbeing, future research could evaluate interventions that aim to support these outcomes. Appraisal of whether interventions deliver equitable outcomes across diverse carer populations is critical.

Published
2024
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19. ‘In the shower crying…but we came back in the following day and did it all again’. Distress and resilience in care home staff during the COVID-19 pandemic– A qualitative interview study

Author

Zoë Cockshott, Siân Russell, Rachel Stocker, Jo Knight, Suzanne Mason, Barbara Hanratty, and Nancy Preston

Subjects
Care homes, Long-term care facilities, Nursing homes, COVID-19, Staff well-being, Staff mental health, Geriatrics, RC952-954.6
Abstract

Abstract Background Care homes (long-term care facilities) were profoundly impacted early in the COVID-19 pandemic, both in terms of resident mortality and restrictions for infection control. This study investigated the impact on the emotional well-being of care home staff of challenges faced at this time, and the strategies used to manage them. Methods Semi-structured interviews conducted October 2020-June 2021 with care home staff and health service staff working with them explored the impact of the early waves of the COVID-19 pandemic (March 2020-June 2021). Interview data were analysed using reflexive thematic analysis. Results Interview participants were 16 care home staff and 10 health service staff. Analysis generated four key themes: 1)Anxiety and distress, 2)Overwhelming workload, 3)Pulling through; and 4)Resilience in a time of crisis. Care home staff experienced Anxiety and distress due to uncertainty of what to expect; witnessing illness and deaths of residents; concerns regarding their own health, and sometimes feeling their work was under-recognised. They also experienced an Overwhelming workload due to infection control measures, caring for sick residents and reduction in external healthcare support. Our theme of Pulling through reflects the peer support and problem-solving strategies with which care home staff managed the impact of the pandemic, along with a sense of responsibility and meaning towards their work. An overarching theme of Resilience in a time of crisis drew on the other three themes and describes how many staff managed, maintained, and often increased their work despite the challenges of the pandemic. Participants also described increasing emotional fatigue as the pandemic continued. Conclusions This paper builds on literature on the emotional impact of the pandemic on care home staff, also exploring ways that staff responded to this impact. These findings can help inform planning for future crises including disease outbreaks, and raise important questions for further work to develop pandemic preparedness in care homes and beyond. They also raise wider questions about the current cultural status of care work, which may have exposed care home staff to greater risk of distress, and which contrasts with the professionalism and responsibility shown by staff in response to pandemic challenges.

Published
2024
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20. ‘I just felt either I’m going to kill someone or I’m going to end up killing myself’. How does it feel to be burnt out as a practicing UK GP?

Author

Ishbel Orla Whitehead, Suzanne Moffatt, and Barbara Hanratty

Subjects
Burnout, primary care, general practice, Medicine (General), R5-920
Abstract

Objective To explore how it feels to be a burnt out GP in the NHS.Design In depth qualitative interviews with 16 UK GPs with self-declared ‘lived experience’ of burnout.Setting United Kingdom Primary Care.Results Seven male and nine female GPs described their experiences of burnout to a peer researcher. Themes identified were exhaustion and depersonalisation, mental and physical illness, identity and existential crises, and finally tenacity and resilience. Participants were self-reflective and described distress, shame, stigma, and guilt, including times of suicidal behaviour and isolation due to their burnout.Conclusions Burnout threatens a GP’s sense of identity, purpose, and functioning in their lives, and ultimately can be life-threatening. Active listening to GP distress and a system wide approach to managing distress and burnout is urgently required.

Published
2024
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21. Using Palliative Care Needs Rounds in the UK for care home staff and residents: an implementation science study

Author

Liz Forbat, Aisha Macgregor, Karen Spilsbury, Brendan McCormack, Alasdair Rutherford, Barbara Hanratty, Jo Hockley, Lisa Davison, Margaret Ogden, Irene Soulsby, and Maisie McKenzie

Subjects
end-of-life care, palliative, care homes, hospice, ageing, dying, patient and public involvement and engagement, implementation science, Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract

Background Care home residents often lack access to end-of-life care from specialist palliative care providers. Palliative Care Needs Rounds, developed and tested in Australia, is a novel approach to addressing this. Objective To co-design and implement a scalable UK model of Needs Rounds. Design A pragmatic implementation study using the integrated Promoting Action on Research Implementation in Health Services framework. Setting Implementation was conducted in six case study sites (England, n = 4, and Scotland, n = 2) encompassing specialist palliative care service working with three to six care homes each. Participants Phase 1: interviews (n = 28 care home staff, specialist palliative care staff, relatives, primary care, acute care and allied health practitioners) and four workshops (n = 43 care home staff, clinicians and managers from specialist palliative care teams and patient and public involvement and engagement representatives). Phase 2: interviews (n = 58 care home and specialist palliative care staff); family questionnaire (n = 13 relatives); staff questionnaire (n = 171 care home staff); quality of death/dying questionnaire (n = 81); patient and public involvement and engagement evaluation interviews (n = 11); fidelity assessment (n = 14 Needs Rounds recordings). Interventions (1) Monthly hour-long discussions of residents’ physical, psychosocial and spiritual needs, alongside case-based learning, (2) clinical work and (3) relative/multidisciplinary team meetings. Main outcome measures A programme theory describing what works for whom under what circumstances with UK Needs Rounds. Secondary outcomes focus on health service use and cost effectiveness, quality of death and dying, care home staff confidence and capability, and the use of patient and public involvement and engagement. Data sources Semistructured interviews and workshops with key stakeholders from the six sites; capability of adopting a palliative approach, quality of death and dying index, and Canadian Health Care Evaluation Project Lite questionnaires; recordings of Needs Rounds; care home data on resident demographics/health service use; assessments and interventions triggered by Needs Rounds; semistructured interviews with academic and patient and public involvement and engagement members. Results The programme theory: while care home staff experience workforce challenges such as high turnover, variable skills and confidence, Needs Rounds can provide care home and specialist palliative care staff the opportunity to collaborate during a protected time, to plan for residents’ last months of life. Needs Rounds build care home staff confidence and can strengthen relationships and trust, while harnessing services’ complementary expertise. Needs Rounds strengthen understandings of dying, symptom management, advance/anticipatory care planning and communication. This can improve resident care, enabling residents to be cared for and die in their preferred place, and may benefit relatives by increasing their confidence in care quality. Limitations COVID-19 restricted intervention and data collection. Due to an insufficient sample size, it was not possible to conduct a cost–benefit analysis of Needs Rounds or calculate the treatment effect or family perceptions of care. Conclusions Our work suggests that Needs Rounds can improve the quality of life and death for care home residents, by enhancing staff skills and confidence, including symptom management, communications with general practitioners and relatives, and strengthen relationships between care home and specialist palliative care staff. Future work Conduct analysis of costs–benefits and treatment effects. Engagement with commissioners and policy-makers could examine integration of Needs Rounds into care homes and primary care across the UK to ensure equitable access to specialist care. Study registration This study is registered as ISRCTN15863801. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128799) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 19. See the NIHR Funding and Awards website for further award information. Plain language summary Care home residents often lack access to end-of-life care from hospice teams and so may experience distressing symptoms at end of life if care home staff cannot fully meet their needs. We examined how an approach which worked well in Australia called ‘Palliative Care Needs Rounds’ (or ‘Needs Rounds’) could be used in the United Kingdom. We interviewed 28 people (care home staff, hospice staff and other National Health Service/social care professionals in the community) about their understanding of the United Kingdom setting, what might help trigger change and what results they would want. We discussed these interviews at online workshops with 43 people, where we started to develop a theory of ‘what would work, for whom, under what circumstances’ and determine what United Kingdom Needs Rounds would look like. Six specialist palliative care services, each partnered with three to six local care homes, used Needs Rounds for a year. We collected information on care home residents, staff experiences of using Needs Rounds, relatives’ perceptions of care quality, staff views of residents’ quality of death, and on their ability to provide a palliative approach to residents. We found that Needs Rounds can provide care home staff and specialist palliative care staff the opportunity to work together during a protected time, to plan for residents’ last months of life. Needs Rounds build care home staff confidence and can strengthen relationships and trust, while using each services’ expertise. Needs Rounds strengthen understandings of dying, symptom management, advance/anticipatory care planning and communication between care home staff, families, specialist palliative care staff and primary care. This improves the quality of resident care, enabling residents to be cared for and die in their preferred place, and also benefits relatives by increasing their confidence in care quality. Scientific summary Background Despite high levels of morbidity and mortality, care home (CH) residents do not always have adequate access to specialist palliative care (SPC). Residents can experience uncontrolled symptoms, poor-quality deaths and futile/burdensome hospitalisations. CH staff can feel unprepared and unsupported to look after residents at end of life. Although models exist for improving end-of-life care in CHs, these are primarily focused on education and do not adequately triage residents to focus on those most at risk of dying without a plan in place and rarely integrate clinical care. A clinical innovation in Australia called ‘Palliative Care Needs Rounds’ (hereafter ‘Needs Rounds’) combines triaging, with anticipatory person-centred planning, case-based learning and case conferencing. The approach has been synthesised into a checklist to provide guidance to clinicians running Needs Rounds. In Australia, Needs Rounds reduced length of stay in hospital and number of admissions, increased dying in preferred place, improved symptoms at end of life and normalised death/dying to CH staff. CH staff felt more confident looking after the residents. Preventing hospital admissions saved AUD$1.7 million over a year (nearly £1 million). Aim To co-design and implement a scalable UK model of Needs Rounds, which takes account of the different policy/practice context in the UK. Objectives The implementation objectives were to: co-design a UK version of Needs Rounds, which is responsive to different contextual characteristics of the UK CH sector (Phase 1) implement the adapted model of care, assess feasibility, acceptability and effectiveness and ultimately propose how the model of care can be further refined and adopted in the UK context, to reap the benefits demonstrated in the Australian work (Phase 2). The intervention objectives were to: determine the transferability of the core elements of the Australian Needs Rounds intervention in the UK context (Phase 1 and 2) delineate the mechanisms of action that enable more effective palliative and end-of-life care practices to be applied in UK CHs (Phase 2) identify the relationships between (1) the mechanisms of action embedded in Needs Rounds, (2) how these mechanisms function in different CH contexts and (3) the outcomes arising for different stakeholders and parts of the care system (Phase 2). The process evaluation objectives were to: document the outcomes of UK Needs Rounds on hospitalisations (including costs), quality of death/dying and CH staff capability (Phase 2) assess and report the perspectives of CH residents, relatives, CH staff and palliative care staff on using UK Needs Rounds (Phase 2). Methods A pragmatic critical-realist implementation study using the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. We determined what works, for whom and in what circumstances for the UK Needs Rounds model. Implementation was conducted in six case studies, where a case is defined as a SPC service working with three to six CHs each. Phase 1: development of an initial programme theory Inclusion criteria: SPC or CH staff in one of the six sites; residents or relatives of someone residing in one of the CHs; worked in a role supporting CHs (acute care, the ambulance service or primary care); and had capacity to consent. Participants and methods: stakeholder interviews (n = 28) across the six cases were used to develop an initial programme theory. Subsequently, we ran four online workshops to co-design UK Needs Rounds with key stakeholders (n = 43). Analysis: Inductive thematic analysis was applied to the interview data, using NVivo for coding. Integrated Promoting Action on Research Implementation in Health Services informed subsequent deductive analysis, categorising the data into contexts, mechanisms, outcomes and innovation components. Chains of inference were identified, and context, mechanism, outcome configurations generated. Outputs: Five theories and an initial programme theory to be tested during implementation. Phase 2: implementing, adapting and evaluating United Kingdom Needs Rounds in the six case study sites Inclusion criteria: interviews – SPC clinicians or a CH staff member in one of the sites; research team member for patient and public involvement and engagement (PPIE) evaluation. Capability to adopt a palliative approach (CAPA) – CH staff members in one of the six sites; Quality of Death and Dying Index (QODDI) for all CH-deceased residents; CANHELP Lite – relatives of someone discussed at Needs Rounds. Participants and data: interviews, n = 58 CH and SPC staff; PPIE evaluation, n = 11; CANHELP Lite questionnaire, n = 13 relatives; CAPA, n = 171 CH staff; QODDI, n = 81 CH staff; fidelity, n = 14 Needs Rounds recordings. Interviewees in Phase 2 had not been interviewed in Phase 1, but participating hospices had staff involved in both Phase 1 and Phase 2 interviews. Analysis: Qualitative data were analysed inductively using thematic analysis and coded using NVivo and organised in line with the five theories derived from Phase 1. Deductive and retroductive analysis were used to formulate the data into context, mechanism, outcomes and identify causal forces of generative causation. Data sources were triangulated in analysis to aid development of the theory. Chains of inference and connectors between and within the initial theories were subsequently refined and integrated to produce the final programme theory of implementation for the UK context. Capability of adopting a palliative approach (CAPA) was analysed using generalised least squares random-effects models with robust standard errors; regressions were conducted for overall CAPA scores and for each individual CAPA item, and a paired t-test was conducted using the subset of CH staff members with multiple responses. The QODDI analysis was conducted using QODDI10, a subset of the QODDI questionnaire, which included 10 items. Due to large numbers of missing data, QODDI10 was selected to preserve the largest proportion of the sample with complete responses (92.6%). Family perceptions of care analysis used descriptive statistics for the family perceptions (CANHELP Lite) survey due to the small sample size. Fidelity was assessed through a random sample of 20% of all audio-recorded Needs Rounds to determine adherence to the agreed approach developed in the workshop. A three-tier scoring system, of 1 (high adherence), 2 (moderate) and 3 (low), was adopted. Estimating the treatment effect on health service outcomes was conducted using descriptive statistics for number of hospital admissions and number of hospital bed-days. Estimating the cost effectiveness (cost–benefit analysis) was not possible due to insufficient data. Qualitative interview data were used to describe costs associated with Needs Rounds. Outputs: A programme theory of what works for whom under what circumstances with Needs Rounds in the UK, an implementation translation package, and policy briefing. Patient and public involvement: three lay people were coinvestigators and contributed to protocol development, ethics paperwork, topic guides for Phase 1 and 2 interviews, content development and participation/co-facilitation at the coproduction workshops, data analysis and dissemination outputs including newsletters, blogs, Twitter, journal articles, conference abstracts and this funder report. Training and support were provided to PPIE members. Results Phase 1: five theories were generated focusing on (1) Confidence and competence, (2) reducing hospitalisations, (3) interagency working and collaboration, (4) better-quality lives and deaths and (5) supporting families. These were integrated to produce one initial overarching initial programme theory to be tested during implementation. Phase 2: primary outcome Needs Rounds resulted in increased CH staff confidence and competence to support residents in their last months of life. Sector-wide workforce issues and associated impacts on time and resources, however, shaped the scale of change, with CHs often being limited in the number and type of staff members being able to attend. Improved relationships were forged between CH and SPC staff. The facilitation approach was a key mechanism for this and was based on developing collaborative, reciprocal relationships where complementary expertise was harnessed. Increased confidence improved communications between CH staff and general practitioners (GPs). Better-quality death and dying resulted from proactive discussions and action plans regarding residents’ physical, psychosocial and spiritual needs. CH staff reported that families felt more informed and secure in the care their relatives received. Fidelity to the coproduced UK model of Needs Rounds was variable. An assessment of a random selection identified that many sites achieved low scores despite qualitative interviews providing evidence of managing to achieve important outcomes. Facilitation approaches were collaborative and involved gentle work in determining people’s current knowledge and areas for extending insights as well as which residents were appropriate to discuss. Managers were key facilitators in enabling staff to attend Needs Rounds, through rotas or paid overtime. The programme theory of what works for whom under what circumstances is as follows: While care homes experience workforce challenges, like high turnover and recruitment difficulties, exacerbated by poor pay and conditions, staff have variable skills and confidence and sometimes having insufficient support within the wider healthcare system. Needs Rounds can provide care home staff and specialist palliative care staff with the opportunity to collaborate during a protected time, to plan for residents’ last months and weeks of life. Flexibly arranging Needs Rounds to suit care home needs, having manager buy-in and building collaborative relationships can help to encourage time to be protected. Needs Rounds augment existing practice by building care home staff confidence for those who attend and prompting anticipatory planning and care. A facilitation approach that is responsive to the difficult context in which care homes operate can improve collaboration. Needs Rounds can strengthen relationships and trust and shift power dynamics between care home and hospice services by harnessing complementary expertise. Integrating learning into Needs Rounds strengthens understandings of the dying process, symptom and pain management, advance/anticipatory care planning, and communication mechanisms between care home staff, families, specialist palliative care staff and primary care. This leads to high-quality resident-centred care, enabling residents to be cared for and die in their preferred place. Needs Rounds also benefit relatives by increasing their confidence in care quality and care home staff, by providing timely expert input. Secondary outcomes Capability of adopting a palliative approach: Questionnaires were returned by 171 CH staff members. Questionnaires completed later in the study achieved higher CAPA scores, indicating that CH staff increased their confidence as Needs Rounds progressed. Staff in not-for-profit homes had higher scores than those in private CHs; care staff and other staff had lower capability scores than managerial staff. Working in a larger CH (50 + beds) compared to a medium CH (11–49 beds) was associated with lower CAPA scores. CANHELP Lite: Thirteen surveys were completed. Family members were largely satisfied with the care provided to their relatives and least satisfied with care provided by doctors. Estimating the treatment effect and cost effectiveness: There was an increase in CH bed-days in hospital (from 1.6/1000 to 2.2/1000) and nights in hospital (from 9.9/1000 to 14.9) from baseline to follow-up. The small sample size (n = 5) and confounding nature of COVID-19 meant it was not possible to test for statistical significance. These factors also meant it was not possible to compute the cost effectiveness of Needs Rounds. Qualitative data indicate several costs including the opportunity costs of CH staff time spent in Needs Rounds meetings, travel costs for SPC staff and medicine costs. Patient and public involvement and engagement: PPIE members were fully integrated into the team. They were meaningfully involved from the outset and made key contributions to the study. Relationship building was a core mechanism that made the PPIE members feel valued; this was facilitated through regular communications and monthly debriefs for support and a relationship dynamic based on equality and mutuality. Many of the academic team members also had lived experience of supporting relatives in CHs and/or receiving palliative and end-of-life care. This enriched the team dynamic without invalidating the contributions of the PPIE members. Care home participation: Low data returns were observed for all quantitative measures. A range of factors impacted CH staff ability and desire to return data to the research team. Conducting complex data collection while CHs were in intermittent lockdowns, experiencing extreme staffing shortages, and being asked to complete bespoke tools all acted as barriers to high levels of data collection. Limitations Key contextual factors impacted implementation of Needs Rounds and data collection. Needs Rounds delivery took place during 2021–2 when COVID-19 lockdowns continued to occur both locally and nationally, which significantly impaired implementation. This resulted in core parts of the intervention not working, namely the case conferences with family members and multidisciplinary team meetings. COVID-19 also reduced the amount of data returned for analysis; the resulting small sample sizes limited the power of claims we can draw from the data. Conclusions Needs Rounds improve palliative and end-of-life care for CH residents by enhancing staff skills and confidence, communication between CH staff and GPs and relationships with SPC clinicians. Needs Rounds result in more proactive support for residents and communications with families. These findings complement the robust evidence base on Needs Rounds in Australia. The facilitation approach was central to implementation. Needs Rounds worked well when SPC clinicians and CH staff adopted a collaborative, partnership approach and recognised and used complementary expertise to improve the quality of lives and deaths of residents. Implications for health care Future work should focus on the sustainability of Needs Rounds to ensure equitable access to SPC for CH residents, engaging with commissioners and policy-makers to secure funding to integrate and embed Needs Rounds into CHs across the UK. Increased CAPA scores demonstrate that Needs Rounds improve competence as the intervention progresses. CH managers should ensure that care staff are able to attend Needs Rounds to benefit from the intervention; larger CHs should include a range of staff to improve staff confidence and competence across the workforce. Recommendations for future research Enhancing the UK evidence for Needs Rounds would involve calculating the cost–benefit analysis and treatment effect. Future research could examine how Needs Rounds run alongside primary care. Semistructured interviews exploring families’ and residents’ perspectives of UK Needs Rounds would provide a fully rounded account of the impact of the approach to care, which was not possible given the limitations of COVID-19 during this study. A follow-up study evaluating how much knowledge and learning is retained and applied by those attending Needs Rounds would provide evidence regarding the long-term impact on staff, including staff moving to different CH providers. Study registration This study is registered as ISRCTN15863801. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128799) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 19. See the NIHR Funding and Awards website for further award information.

Published
2024
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22. Pathways of patients with chronic haematological malignancies: a report from the UK’s population-based HMRN

Author

Eve Roman, Debra Howell, Alexandra Smith, Simon Crouch, Timothy Bagguley, Daniel Painter, Rebecca Sheridan, Dorothy McCaughan, John Blase, William Curson, Han-I Wang, Andrea Manca, Alastair Bennett, Vijay S Gc, Carol Miller, Karl Atkin, Richard Thomson, Barbara Hanratty, Cathy Burton, John Ashcroft, and Russell Patmore

Subjects
chronic lymphocytic leukaemia, follicular lymphoma, myeloma, health services, patient care, population-based patient cohort, Public aspects of medicine, RA1-1270
Abstract

Background Arising in blood and lymph-forming tissues, haematological malignancies (leukaemias, lymphomas and myelomas) are the fifth most common group of cancers. Around 60% are currently incurable and follow a chronic, remitting–relapsing pathway often initially managed by ‘watch & wait’. This involves hospital-based monitoring, followed by treatment if the cancer progresses (which not all do) and then further observation, in a process that may continually repeat. New treatments are constantly emerging, survival is improving and prevalence is rising, but population-based data documenting entire care pathway are sparse. Hence, empirically-based incidence and prevalence estimates about various treatment states (watch and wait, first-line treatment, observation, second-line treatment, etc.) and patterns of healthcare activity are lacking. Likewise, despite complex trajectories, anxiety-provoking watch and wait, and therapies that impede quality of life and incur marked healthcare costs, evidence about patient preferences for information sharing and treatment decisions is scant. Objectives Primary – to generate high-quality, evidence-based information about the care pathways of the general population of patients with chronic haematological malignancies. Secondary – to produce information resources suitable for testing in routine National Health Service practice. Design Population-based cohort of ≈ 8000 patients with chronic haematological malignancies, incorporating five nested work packages, each with its own individual design: (1) exploration of patient experiences: information and treatment decisions; (2) population-based analyses; (3) health economics; (4) development of information resources to support decision-making; and (5) patient well-being and decision-making survey. Setting This programme is predicated on the infrastructure of the United Kingdom’s Haematological Malignancy Research Network (www.hmrn.org); which provides ‘real-world’, robust, generalisable data to inform research and clinical practice, nationally and internationally. Set in Yorkshire and Humberside, the Haematological Malignancy Research Network’s catchment population of ≈ 4 million has a comparable sex, age, urban/rural, and area-based deprivation (Index of Multiple Deprivation, income domain) distribution to the United Kingdom as a whole; and in terms of ethnic diversity the region is centrally ranked, with around 80% of residents identifying as White British, 9% as Asian and 2% as black. Within the Haematological Malignancy Research Network, clinical practice adheres to national guidelines, and all patients with blood cancers are centrally diagnosed (≈ 2500 each year), tracked through their treatment pathways and linked to national databases (deaths, cancer registrations and Hospital Episode Statistics). Linked to the same national databases, the Haematological Malignancy Research Network also contains an age- and sex-matched general-population cohort. Participants Patients aged ≥ 18 years, resident in the study region, and diagnosed with chronic lymphocytic leukaemia, follicular lymphoma or myeloma. Methods Core Haematological Malignancy Research Network data were used to compare the hospital activity of patients with chronic lymphocytic leukaemia, follicular lymphoma and myeloma with that of the general population. Following additional linkages to genetic and clinical data, follicular lymphoma prognostic factors were examined. Two self-administered questionnaires addressing (1) quality of life and well-being and (2) decision-making were iteratively developed, piloted and deployed. Linkage to quality of life, clinical information and Hospital Episode Statistics enabled economic (myeloma) model development. In-depth interviews were conducted with 35 patients (10 alongside relatives). Results Trajectories of ≈ 8000 patients were mapped, and patient-pathway visualisations summarising individual and aggregate information were developed. As expected, patients with chronic blood cancers experienced higher levels of hospital activity than their general population counterparts, the largest effects being for myeloma. Following survey deployment, 3153 patients were recruited across 14 hospitals, 1282 with chronic lymphocytic leukaemia, follicular lymphoma or myeloma. Over half of the questionnaires were completed by patients on watch and wait; the remainder were completed during treatment or post-chemotherapy monitoring. Information gathered, coupled with in-depth interviews, demonstrated patients’ marked anxiety and fluctuating preferences for information sharing and decision-making, contingent on complex, inter-related factors. In turn, prognostic and microsimulation economic models were used to predict individual-level trajectories across multiple treatment lines, examining associated overall survival, costs and quality-adjusted life-years. Limitations Survey mapping to individual care pathways could not be completed because the COVID-19 pandemic delayed clinical data collection. Patients who attended clinics and participated in the survey were more likely than non-attenders to have had first-line chemotherapy, be slightly younger and live in more affluent areas. Conclusions This programme collated high-quality, population-based evidence. Previously lacking, this, coupled with new findings on preferences for information sharing and treatment decisions, provides the foundation for future research. Future work The translation of information accrued into resources suitable for testing in routine NHS practice is key. In this regard, COVID-19 has changed the communication landscape. The visualisations developed by this programme require further refinement/testing using participatory co-design with stakeholder groups. Underpinned by a suitable protocol applied within a single multidisciplinary team setting, prior to further evaluation within/outside the region, such outputs require testing in a cluster-randomised trial. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: RP-PG-0613-20002) and is published in full in Programme Grants for Applied Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information. Plain language summary Around half of all blood cancers (leukaemias, lymphomas and myeloma) are chronic and incurable. Management often involves ‘watch and wait’, which begins with hospital-based monitoring and is followed by treatment if the cancer progresses. This typically leads to further observation and treatment in an ongoing process over time. Patients often experience anxiety and distress about not being treated at diagnosis and also because of uncertainty about ‘if’ and ‘when’ chemotherapy might be needed. Information is critical if patients are to (1) understand what may happen to them in the future and (2) be involved treatment decisions. However, evidence about the care pathways most patients follow is lacking. This programme was designed to fill this gap, tracking all patients with chronic blood cancers through their care pathways. We collected information about diagnosis, treatment and outcome on approximately 8000 patients. These data were used to develop models that could be used to examine outcomes and costs. When compared with the general population, patients with blood cancer were confirmed to have more healthcare activity (e.g. hospital appointments and admissions). Computer programs were developed to electronically generate visual care-pathway ‘maps’ that revealed key similarities and differences between patient groups. Two questionnaires exploring quality of life and involvement in treatment decisions were developed and completed by 3153 patients in 14 hospitals. Thirty-five patients were interviewed about their preferences for information sharing and decision-making; needs were found to differ between patients and over time, and treatment recommendations from clinical staff were generally preferred. Emotional difficulties associated with uncertain trajectories were also clearly described. Yielding new information about the pathways of patients with chronic haematological malignancies, findings from this programme can be built on to improve future care. Final information resources could not be developed or tested in practice due to COVID-19, which continues to impact how health care is delivered. Scientific summary Background Population-based data are required to inform aetiological hypotheses, plan healthcare services and monitor the impact of therapeutic change in the general patient population. This need for data is particularly pertinent in fast-moving areas such as haemato-oncology, where treatments change rapidly and ‘gold-standard’ randomised controlled trials are absent or restricted to specific subgroups (often younger patients with fewer comorbidities), to specific time points (commonly first-line treatment) or by factors such as socioeconomic status, gender or ethnicity. Arising in blood and lymph-forming tissues, haematological malignancies (leukaemias, lymphomas and myelomas) are, collectively, the fifth most common cancer. With diverse aetiologies, treatments and outcomes, more than 100 subtypes are currently recognised by the World Health Organization. Although the incidence of these cancers is stable in high-income countries such as the UK, prevalence is increasing due to population ageing and the development of new multifaceted regimens (e.g. chemotherapies, radiotherapy, stem cell transplants, novel targeted agents). However, around 60% of blood cancers remain incurable, with management often beginning with regular hospital-based monitoring, known as ‘watch & wait’ (W&W). While some patients may never need treatment, others often experience a remitting–relapsing care pathway, requiring treatment at progression interspersed with further monitoring. As with many chronic conditions, there are often uncertainties regarding how individual trajectories will progress, and variations are evident in the need for (and response to) treatment; the most effective regimen; the time when treatment is required (if ever); and the impact of treatment (and non-treatment) on quality of life. Despite such complex trajectories, many of which are associated with anxiety-provoking W&W, and therapies that impede quality of life and incur marked healthcare costs, empirically-based incidence and prevalence estimates relating to treatment states (W&W, first-line treatment, second-line treatment, etc.) are lacking, and granular population-based evidence to guide treatment decisions is sparse. Importantly, new data-gathering measures to redress this deficit have been introduced in the UK but are presently insufficiently mature to guide decisions, and the rapidly evolving nature of haemato-oncology means that generic sources may never be adequate for assessing particular therapies and their impact on individuals. Furthermore, most health economic models have been developed to reflect specific (often static) decision problems, despite effective clinical management being dynamic, involving treatment, monitoring and therapy switching, and depending on treatment response and disease evolution. To summarise, there is a dearth of accessible, reliable information to guide clinicians and patients about treatment and associated healthcare activities, physical health (e.g. disruption to daily life), psychosocial well-being, quality of life and life expectancy. This situation, which is particularly difficult for patients who face uncertain pathways and unresolved anxiety about the future, is compounded by the fact that little is known about preferences for information sharing and the desire to engage in treatment decisions. Objectives This programme sought to address the deficits described above, the premise being that the provision of personalised evidence-based information at key decision points would facilitate treatment decisions, support clinical practice and improve patient experiences. The objectives were as follows: primary – to generate high-quality, longitudinal, real-world information about the care pathways of the general population of patients with chronic haematological malignancies, incorporating data on healthcare costs, and patient preferences for information sharing and engagement in treatment decisions secondary – to produce accessible information resources suitable for testing in routine NHS practice. Design This was a population-based cohort of ≈ 8000 patients with chronic haematological malignancies, incorporating 5 distinct, but inter-related, nested work packages with individual designs, including longitudinal studies, cross-sectional surveys, data linkage and qualitative investigation of patient experiences, as follows: in-depth exploration of patient experiences: information and decision-making population-based analyses health economics development of information resources to support decision-making patient well-being and decision-making survey. Setting This programme is predicated on the established expertise and infrastructure of the UK’s Haematological Malignancy Research Network (HMRN; www.hmrn.org), which was initiated in 2004 to provide robust, generalisable data to inform research and clinical practice. Set in Yorkshire and Humberside, HMRN’s population of ≈ 4 million people has a comparable sex, age, urban/rural and area-based deprivation (Index of Multiple Deprivation, income domain) distribution to that of the UK. Within HMRN, clinical practice adheres to national guidelines, and all patients are centrally diagnosed (≈ 2500 each year), tracked through their care pathways and linked to nationwide health administrative databases (deaths, cancer registrations and Hospital Episode Statistics). HMRN also contains a general-population cohort linked to the same nationwide administrative databases as the patient cohort. HMRN has ethics approval (Leeds West Research Ethics Committee 04/Q1205/69) and Section 251 support [NHS Act 2006: Patient Information and Advisory Group 1-05(h)2007], which provides the legal basis for data collection/linkage. Research building on HMRN’s infrastructure requires supplementary approvals, granted for this programme by the London, City and East Committee (Research Ethics Committee 16/LO/0740). Participants Participants were patients aged ≥ 18 years resident in the study area and diagnosed with one of the three commonest chronic haematological malignancies: chronic lymphocytic leukaemia, follicular lymphoma or myeloma. Patient public involvement and engagement Patient and public involvement and engagement is integral to HMRN, and lay individuals are routinely involved in all research activities via the Patient Partnership, which was established in 2009 and is overseen by a Partnership Committee comprising patients, relatives/carers and researchers. The Partnership includes several hundred people who have agreed to further contact for research purposes, including directing HMRN’s activities and participating in surveys and individual/group discussions. HMRN also benefits from a group that act as a ‘sounding board’, ensuring that all our research is patient-centred and relevant. Patients and relatives were involved in the current programme as applicants and participants. Discussions preceding our application identified issues for investigation, based on patient experiences. Information was considered an area requiring improvement because of widespread concern about W&W and the anxiety and distress that this was said to instil due to uncertainty about ‘if’ and ‘when’ treatment may be required, and its likely impact. Such stories underpinned this programme, alongside our ability (via HMRN) to provide information, mapped to pathways. Changes to programme Following piloting, the survey instrument was split and the content expanded. Questionnaire 1 focused on quality of life and was to be completed pre appointment, and questionnaire 2 targeted treatment decisions and was to be completed post appointment. The number of in-depth interviews was finalised at 35 as the purposeful sampling strategy identified ‘information-rich’ sources and high-quality data. Finally, the secondary objective was curtailed by the COVID-19 pandemic (see Conclusions). Results Patient characteristics and treatment pathways With a median diagnostic age of 71 years, chronic lymphocytic leukaemia and myeloma occur more frequently in men than in women. By contrast, with a younger median age of 65.5 years, follicular lymphoma has a slight preponderance among female patients. First-line management varied markedly by subtype; 84.7% of chronic lymphocytic leukaemia patients were monitored via W&W, compared with 40.9% with follicular lymphoma and 20.2% with myeloma. Furthermore, with a 5-year relative survival of 47.7%, patients with myeloma fared less well than those with chronic lymphocytic leukaemia (5-year relative survival 84.1%) or follicular lymphoma (5-year relative survival 88.1%). To quantify/visualise the data, two software applications were developed. First, a tree-based approach aggregated patients into pathway subgroups, beginning with the initial management or event (chemotherapy, observation or death) and ending with the last. Diversity by cancer subtype was clearly evident: among those diagnosed between 2004 and 2010 who were initially managed by W&W, 40.6% (419/1031) with chronic lymphocytic leukaemia, 38.4% (93/242) with follicular lymphoma and 26.5% (90/339) with myeloma were still on W&W at the end of follow-up (5–11 years later). Second, a patient pathway generator was developed in-house from a Data-Driven Documents (D3) JavaScript library (https://d3js.org/), followed by an iterative graphical restructuring algorithm that displayed visualisations of entire pathways that included all diagnoses, investigations, treatments/responses and hospital activity in real time (generation < 1 second). Population-based analysis and prognostic model Facilitating the identification of patients requiring alternative treatment strategies and separating those at high-risk of disease progression and/or transformation from those who are not is important for clinicians and patients. With a view to incorporating genetic data into conventional prognostic models and the future development of novel targeted treatments, we examined the mutational data of patients newly diagnosed with follicular lymphoma. The molecular investigations undertaken determined that aberrant somatic hypermutations played a leading role in the genetic substructure of follicular lymphoma, with a small number of key genetic mutations, including STAT6, having a marked impact on prognosis. These clusters have implications both for understanding pathogenesis and for potential future treatment strategies. However, separation of follicular lymphoma according to mutational status despite being linked to apparent underlying mechanistic differences provides only limited prognostic information in conventionally treated patients. Hospital activity patterns Patients often question the difference their disease, or treatment, is likely to have on their survival, future healthcare needs and quality of life. As expected, inpatient and outpatient Hospital Episode Statistics activity post diagnosis was considerably higher among patients with chronic haematological malignancies than in the general population, the largest differences being for myeloma. For all three diagnoses, hospital activity peaks around the time of diagnosis, outpatient activity remaining high but levelling around 12 months after diagnosis, and inpatient activity around 8 months post diagnosis for chronic lymphocytic leukaemia and 36 months for follicular lymphoma. Health economics A microsimulation model was developed for myeloma to reflect multiple lines of treatment, post-treatment surveillance and overall survival. The model was used to predict long-term costs, and quality-adjusted life-years to enable future assessment of the expected impact of new treatments and policies. Input parameters were estimated by analysing individual-level time-to-event data (to represent patients’ trajectories), the EuroQol-5 Dimensions, five-level version (to derive quality-adjusted life-years), and HMRN treatment data (to model treatment sequences). Healthcare costs were estimated from Hospital Episode Statistics, based on national tariffs. The model is flexible enough to incorporate evidence from other sources, including clinical trials. Results were based on 2687 patients with myeloma, diagnosed 2004–15 and followed up until December 2017. Patient survey Two questionnaires for use in haemato-oncology outpatient clinics were developed in-house and piloted: questionnaire 1 (health-related quality of life) was to be completed before the clinic appointment, and questionnaire 2 (treatment decisions) was to be completed after. The survey was successfully implemented in all 14 HMRN hospitals, 2016–8, with 3153 patients participating, 1282 with chronic lymphocytic leukaemia, follicular lymphoma or myeloma. Providing information across the pathway, over half of patients completed questionnaires while on W&W; the remainder either received chemotherapy or were monitored post treatment. Survey distribution and data collection were found to be simple and effective, and patients said that they appreciated the opportunity to ‘give back’ via taking part in research. Patient preferences for information sharing and engagement in treatment decisions Interviews were conducted with 35 patients who had experienced varying treatment pathways, and 10 relatives. A large, rich data set generated multifaceted findings. The unpredictable nature of chronic haematological malignancies was confirmed, as were the challenges of coping with uncertain pathways. This caused prolonged anxiety, which could be more distressing than any physical symptoms and difficult to resolve because of infrequent clinic visits and an absence of definitive information. Preferences for information (timing, content, depth and format) varied markedly, both between patients and across individual pathways over time. Regarding treatment decisions, most interviewees said that they preferred a discussion about options, but did not wish, or felt ill-equipped, to make choices themselves. Finally, individual access to a support network (e.g. family, friends or clinical staff) was found to impact positively on experiences and preferences. Conclusions Enhancing understanding about the pathways of the general population of patients with chronic haematological malignancies, this programme has accrued an abundance of new evidence. Data collection instruments have been developed, pathway visualisation programmes have been written, and detailed quantitative and qualitative information, to an extent not previously captured, are now available. We have demonstrated that it is possible to distribute questionnaires and collect longitudinal data in hospital settings, and assemble, summarise and visualise longitudinal pathways, including data on diagnostics, prognostics, treatments, transformations/progressions, hospital episodes, outcomes and costs. Regarding health economics, we have shown the utility of using longitudinal data to estimate how many patients are on each treatment line, post treatment after each line, receiving palliative care, and so on, thereby facilitating cost calculations and resource planning. Such models could potentially be used by commissioners and healthcare managers to simulate the impact of novel policies, treatments and pathway changes prior to their introduction. The marked, ongoing anxiety experienced by some patients due to uncertain pathways suggests that benefits could be accrued from increased awareness about the extent and impact of this, alongside interventions to counteract such difficulties. Addressing varied preferences for information (content, depth, format and timing) would require a broad range and depth of material (from a basic overview to detailed options), complexity (from simple terminology to more complicated graphs) and methods for sharing (verbal, written or electronic), thereby enabling patients to access what they want to know, when they want to know it. As most (but not all) people reported a preference for clinicians to make treatment recommendations, this should also be considered. Changing preferences means that strategies for patient engagement with information-sharing and treatment decisions may need to be tailored to individual needs over time, assessed by routine clinician monitoring. Clinicians might also explore the social infrastructure and support network available to patients, so that they are aware of gaps that could be addressed. Based on several thousand patients, and exceeding any evidence previously generated, this programme collated, assessed and successfully mapped high-quality evidence-based information about the pathways of the general population of patients with chronic haematological malignancies. Previously lacking, these data, coupled with new evidence on preferences for information-sharing and treatment decisions garnered directly from patients, provide the foundation to improve clinical practice. Unfortunately, the final part of the programme could not be completed due to the COVID-19 pandemic; hence, the key future priority is the translation of the data accrued into accessible information resources suitable for testing in routine NHS practice. These would need to be responsive to both the rapidly changing haemato-oncology landscape and the varying needs of clinicians and patients at different points on the pathway. Building on the foundations of the present programme, future research, in collaboration with clinicians and patients, could include: co-refinement of electronic visualisations for use in multidisciplinary team settings co-design of resources for use in clinician–patient consultations development of cluster randomised trial protocols to test resources developed in (1) and (2) across a single multidisciplinary team area using the data collection instruments developed, prior to further evaluation within/outside the region. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: RP-PG-0613-20002) and is published in full in Programme Grants for Applied Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information.

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2024
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23. Stratified analyses refine association between TLR7 rare variants and severe COVID-19

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Rimoldi, Valeria, Paraboschi, Elvezia M., Bandera, Alessandra, Peyvandi, Flora, Grasselli, Giacomo, Blasi, Francesco, Malvestiti, Francesco, Pelusi, Serena, Bianco, Cristiana, Miano, Lorenzo, Lombardi, Angela, Invernizzi, Pietro, Gerussi, Alessio, Citerio, Giuseppe, Biondi, Andrea, Valsecchi, Maria Grazia, Cazzaniga, Marina Elena, Foti, Giuseppe, Beretta, Ilaria, D'Angiò, Mariella, Bettini, Laura Rachele, Farré, Xavier, Iraola-Guzmán, Susana, Kogevinas, Manolis, Castaño-Vinyals, Gemma, Garcia-Etxebarria, Koldo, Nafria, Beatriz, D'Amato, Mauro, Palom, Adriana, Begg, Colin, Clohisey, Sara, Hinds, Charles, Horby, Peter, Knight, Julian, Ling, Lowell, Maslove, David, McAuley, Danny, Millar, Johnny, Montgomery, Hugh, Nichol, Alistair, Openshaw, Peter J.M., Pereira, Alexandre C., Ponting, Chris P., Rowan, Kathy, Semple, Malcolm G., Shankar-Hari, Manu, Summers, Charlotte, Walsh, Timothy, Baillie, J. Kenneth, Aravindan, Latha, Armstrong, Ruth, Biggs, Heather, Boz, Ceilia, Brown, Adam, Clark, Richard, Coutts, Audrey, Coyle, Judy, Cullum, Louise, Das, Sukamal, Day, Nicky, Donnelly, Lorna, Duncan, Esther, Fawkes, Angie, Fineran, Paul, Fourman, Max Head, Furlong, Anita, Furniss, James, Gallagher, Bernadette, Gilchrist, Tammy, Golightly, Ailsa, Griffiths, Fiona, Hafezi, Katarzyna, Hamilton, Debbie, Hendry, Ross, Law, Andy, Law, Dawn, Law, Rachel, Law, Sarah, Lidstone-Scott, Rebecca, Macgillivray, Louise, Maclean, Alan, Mal, Hanning, McCafferty, Sarah, Mcmaster, Ellie, Meikle, Jen, Moore, Shona C., Morrice, Kirstie, Murphy, Lee, Murphy, Sheena, Hellen, Mybaya, Oosthuyzen, Wilna, Zheng, Chenqing, Chen, Jiantao, Parkinson, Nick, Paterson, Trevor, Schon, Katherine, Stenhouse, Andrew, Das, Mihaela, Swets, Maaike, Szoor-McElhinney, Helen, Taneski, Filip, Turtle, Lance, Wackett, Tony, Ward, Mairi, Weaver, Jane, Wrobel, Nicola, Zechner, Marie, Arbane, Gill, Bociek, Aneta, Campos, Sara, Grau, Neus, Jones, Tim Owen, Lim, Rosario, Marotti, Martina, Ostermann, Marlies, Whitton, Christopher, Alldis, Zoe, Astin-Chamberlain, Raine, Bibi, Fatima, Biddle, Jack, Blow, Sarah, Bolton, Matthew, Borra, Catherine, Bowles, Ruth, Burton, Maudrian, Choudhury, Yasmin, Collier, David, Cox, Amber, Easthope, Amy, Ebano, Patrizia, Fotiadis, Stavros, Gurasashvili, Jana, Halls, Rosslyn, Hartridge, Pippa, Kallon, Delordson, Kassam, Jamila, Lancoma-Malcolm, Ivone, Matharu, Maninderpal, May, Peter, Mitchelmore, Oliver, Newman, Tabitha, Patel, Mital, Pheby, Jane, Pinzuti, Irene, Prime, Zoe, Prysyazhna, Oleksandra, Shiel, Julian, Taylor, Melanie, Tierney, Carey, Wood, Suzanne, Zak, Anne, Zongo, Olivier, Bonner, Stephen, Hugill, Keith, Jones, Jessica, Liggett, Steven, Headlam, Evie, Bandla, Nageswar, Gellamucho, Minnie, Davies, Michelle, Thompson, Christopher, Abdelrazik, Marwa, Bakthavatsalam, Dhanalakshmi, Elhassan, Munzir, Ganesan, Arunkumar, Haldeos, Anne, Moreno-Cuesta, Jeronimo, Purohit, Dharam, Vincent, Rachel, Xavier, Kugan, Rohit, Kumar, Alasdair, Frater, Saleem, Malik, David, Carter, Samuel, Jenkins, Lamond, Zoe, Alanna, Wall, Fernandez-Roman, Jaime, Hamilton, David O., Johnson, Emily, Johnston, Brian, Martinez, Maria Lopez, Mulla, Suleman, Shaw, David, Waite, Alicia A.C., Waugh, Victoria, Welters, Ingeborg D., Williams, Karen, Cavazza, Anna, Cockrell, Maeve, Corcoran, Eleanor, Depante, Maria, Finney, Clare, Jerome, Ellen, McPhail, Mark, Nayak, Monalisa, Noble, Harriet, O'Reilly, Kevin, Pappa, Evita, Saha, Rohit, Saha, Sian, Smith, John, Knighton, Abigail, Antcliffe, David, Banach, Dorota, Brett, Stephen, Coghlan, Phoebe, Fernandez, Ziortza, Gordon, Anthony, Rojo, Roceld, Arias, Sonia Sousa, Templeton, Maie, Meredith, Megan, Morris, Lucy, Ryan, Lucy, Clark, Amy, Sampson, Julia, Peters, Cecilia, Dent, Martin, Langley, Margaret, Ashraf, Saima, Wei, Shuying, Andrew, Angela, Bashyal, Archana, Davidson, Neil, Hutton, Paula, McKechnie, Stuart, Wilson, Jean, Baptista, David, Crowe, Rebecca, Fernandes, Rita, Herdman-Grant, Rosaleen, Joseph, Anna, O'Connor, Denise, Allen, Meryem, Loveridge, Adam, McKenley, India, Morino, Eriko, Naranjo, Andres, Simms, Richard, Sollesta, Kathryn, Swain, Andrew, Venkatesh, Harish, Khera, Jacyntha, Fox, Jonathan, Andrew, Gillian, Barclay, Lucy, Callaghan, Marie, Campbell, Rachael, Clark, Sarah, Hope, Dave, Marshall, Lucy, McCulloch, Corrienne, Briton, Kate, Singleton, Jo, Birch, Sohphie, Brimfield, Lutece, Daly, Zoe, Pogson, David, Rose, Steve, Battle, Ceri, Brinkworth, Elaine, Harford, Rachel, Murphy, Carl, Newey, Luke, Rees, Tabitha, Williams, Marie, Arnold, Sophie, Polgarova, Petra, Stroud, Katerina, Meaney, Eoghan, Jones, Megan, Ng, Anthony, Agrawal, Shruti, Pathan, Nazima, White, Deborah, Daubney, Esther, Elston, Kay, Grauslyte, Lina, Hussain, Musarat, Phull, Mandeep, Pogreban, Tatiana, Rosaroso, Lace, Salciute, Erika, Franke, George, Wong, Joanna, George, Aparna, Ortiz-Ruiz de Gordoa, Laura, Peasgood, Emily, Phillips, Claire, Bates, Michelle, Dasgin, Jo, Gill, Jaspret, Nilsson, Annette, Scriven, James, Delgado, Carlos Castro, Dawson, Deborah, Ding, Lijun, Durrant, Georgia, Ezeobu, Obiageri, Farnell-Ward, Sarah, Harrison, Abiola, Kanu, Rebecca, Leaver, Susannah, Maccacari, Elena, Manna, Soumendu, Saluzzio, Romina Pepermans, Queiroz, Joana, Samakomva, Tinashe, Sicat, Christine, Texeira, Joana, Da Gloria, Edna Fernandes, Lisboa, Ana, Rawlins, John, Mathew, Jisha, Kinch, Ashley, Hurt, William James, Shah, Nirav, Clark, Victoria, Thanasi, Maria, Yun, Nikki, Patel, Kamal, Bennett, Sara, Goodwin, Emma, Jackson, Matthew, Kent, Alissa, Tibke, Clare, Woodyatt, Wiesia, Zaki, Ahmed, Abraheem, Azmerelda, Bamford, Peter, Cawley, Kathryn, Dunmore, Charlie, Faulkner, Maria, Girach, Rumanah, Jeffrey, Helen, Jones, Rhianna, London, Emily, Nagra, Imrun, Nasir, Farah, Sainsbury, Hannah, Smedley, Clare, Patel, Tahera, Smith, Matthew, Chukkambotla, Srikanth, Kazi, Aayesha, Hartley, Janice, Dykes, Joseph, Hijazi, Muhammad, Keith, Sarah, Khan, Meherunnisa, Ryan-Smith, Janet, Springle, Philippa, Thomas, Jacqueline, Truman, Nick, Saad, Samuel, Coleman, Dabheoc, Fine, Christopher, Matt, Roseanna, Gay, Bethan, Dalziel, Jack, Ali, Syamlan, Goodchild, Drew, Harling, Rhiannan, Bhatterjee, Ravi, Goddard, Wendy, Davison, Chloe, Duberly, Stephen, Hargreaves, Jeanette, Bolton, Rachel, Davey, Miriam, Golden, David, Seaman, Rebecca, Cherian, Shiney, Cutler, Sean, Heron, Anne Emma, Roynon-Reed, Anna, Szakmany, Tamas, Williams, Gemma, Richards, Owen, Cheema, Yusuf, Brooke, Hollie, Buckley, Sarah, Suarez, Jose Cebrian, Charlesworth, Ruth, Hansson, Karen, Norris, John, Poole, Alice, Rose, Alastair, Sandhu, Rajdeep, Sloan, Brendan, Smithson, Elizabeth, Thirumaran, Muthu, Wagstaff, Veronica, Metcalfe, Alexandra, Brunton, Mark, Caterson, Jess, Coles, Holly, Frise, Matthew, Rai, Sabi Gurung, Jacques, Nicola, Keating, Liza, Tilney, Emma, Bartley, Shauna, Bhuie, Parminder, Gibson, Sian, Lyle, Amanda, McNeela, Fiona, Radhakrishnan, Jayachandran, Hughes, Alistair, Yates, Bryan, Reynolds, Jessica, Campbell, Helen, Thompsom, Maria, Dodds, Steve, Duffy, Stacey, Greer, Sandra, Shuker, Karen, Tridente, Ascanio, Khade, Reena, Sundar, Ashok, Tsinaslanidis, George, Birkinshaw, Isobel, Carter, Joseph, Howard, Kate, Ingham, Joanne, Joy, Rosie, Pearson, Harriet, Roche, Samantha, Scott, Zoe, Bancroft, Hollie, Bellamy, Mary, Carmody, Margaret, Daglish, Jacqueline, Moore, Faye, Rhodes, Joanne, Sangombe, Mirriam, Kadiri, Salma, Croft, Maria, White, Ian, Frost, Victoria, Aquino, Maia, Jha, Rajeev, Krishnamurthy, Vinodh, Lim, Lai, Lim, Li, Combes, Edward, Joefield, Teishel, Monnery, Sonja, Beech, Valerie, Trotman, Sallyanne, Almaden-Boyle, Christine, Austin, Pauline, Cabrelli, Louise, Cole, Stephen, Casey, Matt, Chapman, Susan, Whyte, Clare, Baird, Yolanda, Butler, Aaron, Chadbourn, Indra, Folkes, Linda, Fox, Heather, Gardner, Amy, Gomez, Raquel, Hobden, Gillian, Hodgson, Luke, King, Kirsten, Margarson, Michael, Martindale, Tim, Meadows, Emma, Raynard, Dana, Thirlwall, Yvette, Helm, David, Margalef, Jordi, Criste, Kristine, Cusack, Rebecca, Golder, Kim, Golding, Hannah, Jones, Oliver, Leggett, Samantha, Male, Michelle, Marani, Martyna, Prager, Kirsty, Williams, Toran, Roberts, Belinda, Salmon, Karen, Anderson, Peter, Archer, Katie, Austin, Karen, Davis, Caroline, Durie, Alison, Kelsall, Olivia, Thrush, Jessica, Vigurs, Charlie, Wild, Laura, Wood, Hannah-Louise, Tranter, Helen, Harrison, Alison, Cowley, Nicholas, McAlindon, Michael, Burtenshaw, Andrew, Digby, Stephen, Low, Emma, Morgan, Aled, Cother, Naiara, Rankin, Tobias, Clayton, Sarah, McCurdy, Alex, Ahmed, Cecilia, Baines, Balvinder, Clamp, Sarah, Colley, Julie, Haq, Risna, Hayes, Anne, Hulme, Jonathan, Hussain, Samia, Joseph, Sibet, Kumar, Rita, Maqsood, Zahira, Purewal, Manjit, Benham, Leonie, Bradshaw, Zena, Brown, Joanna, Caswell, Melanie, Cupitt, Jason, Melling, Sarah, Preston, Stephen, Slawson, Nicola, Stoddard, Emma, Warden, Scott, Deacon, Bethan, Lynch, Ceri, Pothecary, Carla, Roche, Lisa, Howe, Gwenllian Sera, Singh, Jayaprakash, Turner, Keri, Ellis, Hannah, Stroud, Natalie, Hunt, Jodie, Dearden, Joy, Dobson, Emma, Drummond, Andy, Mulcahy, Michelle, Munt, Sheila, O'Connor, Grainne, Philbin, Jennifer, Rishton, Chloe, Tully, Redmond, Winnard, Sarah, Cathcart, Susanne, Duffy, Katharine, Puxty, Alex, Puxty, Kathryn, Turner, Lynne, Ireland, Jane, Semple, Gary, Long, Kate, Whiteley, Simon, Wilby, Elizabeth, Ogg, Bethan, Cowton, Amanda, Kay, Andrea, Kent, Melanie, Potts, Kathryn, Wilkinson, Ami, Campbell, Suzanne, Brown, Ellen, Melville, Julie, Naisbitt, Jay, Joseph, Rosane, Lazo, Maria, Walton, Olivia, Neal, Alan, Alexander, Peter, Allen, Schvearn, Bradley-Potts, Joanne, Brantwood, Craig, Egan, Jasmine, Felton, Timothy, Padden, Grace, Ward, Luke, Moss, Stuart, Glasgow, Susannah, Abel, Lynn, Brett, Michael, Digby, Brian, Gemmell, Lisa, Hornsby, James, MacGoey, Patrick, O'Neil, Pauline, Price, Richard, Rodden, Natalie, Rooney, Kevin, Sundaram, Radha, Thomson, Nicola, Hopkins, Bridget, Thrasyvoulou, Laura, Willis, Heather, Clark, Martyn, Coulding, Martina, Jude, Edward, McCormick, Jacqueline, Mercer, Oliver, Potla, Darsh, Rehman, Hafiz, Savill, Heather, Turner, Victoria, Downes, Charlotte, Holding, Kathleen, Riches, Katie, Hilton, Mary, Hayman, Mel, Subramanian, Deepak, Daniel, Priya, Adanini, Oluronke, Bhatia, Nikhil, Msiska, Maines, Collins, Rebecca, Clement, Ian, Patel, Bijal, Gulati, A., Hays, Carole, Webster, K., Hudson, Anne, Webster, Andrea, Stephenson, Elaine, McCormack, Louise, Slater, Victoria, Nixon, Rachel, Hanson, Helen, Fearby, Maggie, Kelly, Sinead, Bridgett, Victoria, Robinson, Philip, Camsooksai, Julie, Humphrey, Charlotte, Jenkins, Sarah, Reschreiter, Henrik, Wadams, Beverley, Death, Yasmin, Bastion, Victoria, Clarke, Daphene, David, Beena, Kent, Harriet, Lorusso, Rachel, Lubimbi, Gamu, Murdoch, Sophie, Penacerrada, Melchizedek, Thomas, Alastair, Valentine, Jennifer, Vochin, Ana, Wulandari, Retno, Djeugam, Brice, Bell, Gillian, English, Katy, Katary, Amro, Wilcox, Louise, Bruce, Michelle, Connolly, Karen, Duncan, Tracy, T-Michael, Helen, Lindergard, Gabriella, Hey, Samuel, Fox, Claire, Alfonso, Jordan, Durrans, Laura Jayne, Guerin, Jacinta, Blackledge, Bethan, Harris, Jade, Hruska, Martin, Eltayeb, Ayaa, Lamb, Thomas, Hodgkiss, Tracey, Cooper, Lisa, Rothwell, Joanne, Allan, Angela, Anderson, Felicity, Kaye, Callum, Liew, Jade, Medhora, Jasmine, Scott, Teresa, Trumper, Erin, Botello, Adriana, Lankester, Liana, Nikitas, Nikitas, Wells, Colin, Stowe, Bethan, Spencer, Kayleigh, Brandwood, Craig, Smith, Lara, Birchall, Katie, Kolakaluri, Laurel, Baines, Deborah, Sukumaran, Anila, Apetri, Elena, Basikolo, Cathrine, Catlow, Laura, Charles, Bethan, Dark, Paul, Doonan, Reece, Harvey, Alice, Horner, Daniel, Knowles, Karen, Lee, Stephanie, Lomas, Diane, Lyons, Chloe, Marsden, Tracy, McLaughlan, Danielle, McMorrow, Liam, Pendlebury, Jessica, Perez, Jane, Poulaka, Maria, Proudfoot, Nicola, Slaughter, Melanie, Slevin, Kathryn, Thomas, Vicky, Walker, Danielle, Michael, Angiy, Collis, Matthew, Cosier, Tracey, Millen, Gemma, Richardson, Neil, Schumacher, Natasha, Weston, Heather, Rand, James, Baxter, Nicola, Henderson, Steven, Kennedy-Hay, Sophie, McParland, Christopher, Rooney, Laura, Sim, Malcolm, McCreath, Gordan, Akeroyd, Louise, Bano, Shereen, Bromley, Matt, Gurr, Lucy, Lawton, Tom, Morgan, James, Sellick, Kirsten, Warren, Deborah, Wilkinson, Brian, McGowan, Janet, Ledgard, Camilla, Stacey, Amelia, Pye, Kate, Bellwood, Ruth, Bentley, Michael, Bewley, Jeremy, Garland, Zoe, Grimmer, Lisa, Gumbrill, Bethany, Johnson, Rebekah, Sweet, Katie, Webster, Denise, Efford, Georgia, Convery, Karen, Fottrell-Gould, Deirdre, Hudig, Lisa, Keshet-Price, Jocelyn, Randell, Georgina, Stammers, Katie, Bokhari, Maria, Linnett, Vanessa, Lucas, Rachael, McCormick, Wendy, Ritzema, Jenny, Sanderson, Amanda, Wild, Helen, Rostron, Anthony, Roy, Alistair, Woods, Lindsey, Cornell, Sarah, Wakinshaw, Fiona, Rogerson, Kimberley, Jarmain, Jordan, Parker, Robert, Reddy, Amie, Turner-Bone, Ian, Wilding, Laura, Harding, Peter, Abernathy, Caroline, Foster, Louise, Gratrix, Andrew, Martinson, Vicky, Parkinson, Priyai, Stones, Elizabeth, Carbral-Ortega, Llucia, Bercades, Georgia, Brealey, David, Hass, Ingrid, MacCallum, Niall, Martir, Gladys, Raith, Eamon, Reyes, Anna, Smyth, Deborah, Zitter, Letizia, Benyon, Sarah, Marriott, Suzie, Park, Linda, Keenan, Samantha, Gordon, Elizabeth, Quinn, Helen, Baines, Kizzy, Cagova, Lenka, Fofano, Adama, Garner, Lucie, Holcombe, Helen, Mepham, Sue, Mitchell, Alice Michael, Mwaura, Lucy, Praman, Krithivasan, Vuylsteke, Alain, Zamikula, Julie, Purewal, Bally, Rivers, Vanessa, Bell, Stephanie, Blakemore, Hayley, Borislavova, Borislava, Faulkner, Beverley, Gendall, Emma, Goff, Elizabeth, Hayes, Kati, Thomas, Matt, Worner, Ruth, Smith, Kerry, Stephens, Deanna, Mew, Louise, Mwaura, Esther, Stewart, Richard, Williams, Felicity, Wren, Lynn, Sutherland, Sara-Beth, Bevan, Emily, Martin, Jane, Trodd, Dawn, Watson, Geoff, Brown, Caroline Wrey, Collins, Amy, Khaliq, Waqas, Gude, Estefania Treus, Akinkugbe, Olugbenga, Bamford, Alasdair, Beech, Emily, Belfield, Holly, Bell, Michael, Davies, Charlene, Jones, Gareth A.L., McHugh, Tara, Meghari, Hamza, O'Neill, Lauran, Peters, Mark J., Ray, Samiran, Tomas, Ana Luisa, Burn, Iona, Hambrook, Geraldine, Manso, Katarina, Penn, Ruth, Shanmugasundaram, Pradeep, Tebbutt, Julie, Thornton, Danielle, Cole, Jade, Davies, Rhys, Duffin, Donna, Hill, Helen, Player, Ben, Thomas, Emma, Williams, Angharad, Griffin, Denise, Muchenje, Nycola, Mupudzi, Mcdonald, Partridge, Richard, Conyngham, Jo-Anna, Thomas, Rachel, Wright, Mary, Corral, Maria Alvarez, Jacob, Reni, Jones, Cathy, Denmade, Craig, Beavis, Sarah, Dale, Katie, Gascoyne, Rachel, Hawes, Joanne, Pritchard, Kelly, Stevenson, Lesley, Whileman, Amanda, Doble, Patricia, Hutter, Joanne, Pawley, Corinne, Shovelton, Charmaine, Vaida, Marius, Butcher, Deborah, O'Sullivan, Susie, Butterworth-Cowin, Nicola, Ahmad, Norfaizan, Barker, Joann, Bauchmuller, Kris, Bird, Sarah, Cawthron, Kay, Harrington, Kate, Jackson, Yvonne, Kibutu, Faith, Lenagh, Becky, Masuko, Shamiso, Mills, Gary H., Raithatha, Ajay, Wiles, Matthew, Willson, Jayne, Newell, Helen, Lye, Alison, Nwafor, Lorenza, Jarman, Claire, Rowland-Jones, Sarah, Foote, David, Cole, Joby, Thompson, Roger, Watson, James, Hesseldon, Lisa, Macharia, Irene, Chetam, Luke, Smith, Jacqui, Ford, Amber, Anderson, Samantha, Birchall, Kathryn, Housley, Kay, Walker, Sara, Milner, Leanne, Hanratty, Helena, Trower, Helen, Phillips, Patrick, Oxspring, Simon, Donne, Ben, Jardine, Catherine, Williams, Dewi, Hay, Alasdair, Flanagan, Rebecca, Hughes, Gareth, Latham, Scott, McKenna, Emma, Anderson, Jennifer, Hull, Robert, Rhead, Kat, Cruz, Carina, Pattison, Natalie, Charnock, Rob, McFarland, Denise, Cosgrove, Denise, Ahmed, Ashar, Morris, Anna, Jakkula, Srinivas, Ali, Asifa, Brady, Megan, Dale, Sam, Dance, Annalisa, Gledhill, Lisa, Greig, Jill, Hanson, Kathryn, Holdroyd, Kelly, Home, Marie, Kelly, Diane, Kitson, Ross, Matapure, Lear, Melia, Deborah, Mellor, Samantha, Nortcliffe, Tonicha, Pinnell, Jez, Robinson, Matthew, Shaw, Lisa, Shaw, Ryan, Thomis, Lesley, Wilson, Alison, Wood, Tracy, Bayo, Lee-Ann, Merwaha, Ekta, Ishaq, Tahira, Hanley, Sarah, Hibbert, Meg, Tetla, Dariusz, Woodford, Chrsitopher, Durga, Latha, Kennard-Holden, Gareth, Branney, Debbie, Frankham, Jordan, Pitts, Sally, White, Nigel, Laha, Shondipon, Verlander, Mark, Williams, Alexandra, Altabaibeh, Abdelhakim, Alvaro, Ana, Gilbert, Kayleigh, Ma, Louise, Mostoles, Loreta, Parmar, Chetan, Simpson, Kathryn, Jetha, Champa, Booker, Lauren, Pratley, Anezka, Adams, Colene, Agasou, Anita, Arden, Tracie, Bowes, Amy, Boyle, Pauline, Beekes, Mandy, Button, Heather, Capps, Nigel, Carnahan, Mandy, Carter, Anne, Childs, Danielle, Donaldson, Denise, Hard, Kelly, Hurford, Fran, Hussain, Yasmin, Javaid, Ayesha, Jones, James, Jose, Sanal, Leigh, Michael, Martin, Terry, Millward, Helen, Motherwell, Nichola, Rikunenko, Rachel, Stickley, Jo, Summers, Julie, Ting, Louise, Tivenan, Helen, Tonks, Louise, Wilcox, Rebecca, Holland, Maureen, Keenan, Natalie, Lyons, Marc, Wassall, Helen, Marsh, Chris, Mahenthran, Mervin, Carter, Emma, Kong, Thomas, Blackman, Helen, Creagh-Brown, Ben, Donlon, Sinead, Michalak-Glinska, Natalia, Mtuwa, Sheila, Pristopan, Veronika, Salberg, Armorel, Smith, Eleanor, Stone, Sarah, Piercy, Charles, Verula, Jerik, Burda, Dorota, Montaser, Rugia, Harden, Lesley, Mayangao, Irving, Marriott, Cheryl, Bradley, Paul, Harris, Celia, Anderson, Susan, Andrews, Eleanor, Birch, Janine, Collins, Emma, Hammerton, Kate, O'Leary, Ryan, Clark, Michele, Purvis, Sarah, Barber, Russell, Hewitt, Claire, Hilldrith, Annette, Jackson-Lawrence, Karen, Shepardson, Sarah, Wills, Maryanne, Butler, Susan, Tavares, Silvia, Cunningham, Amy, Hindale, Julia, Arif, Sarwat, Bean, Sarah, Burt, Karen, Spivey, Michael, Demetriou, Carrie, Eckbad, Charlotte, Hierons, Sarah, Howie, Lucy, Mitchard, Sarah, Ramos, Lidia, Serrano-Ruiz, Alfredo, White, Katie, Kelly, Fiona, Cristiano, Daniele, Dormand, Natalie, Farzad, Zohreh, Gummadi, Mahitha, Liyanage, Kamal, Patel, Brijesh, Salmi, Sara, Sloane, Geraldine, Thwaites, Vicky, Varghese, Mathew, Zborowski, Anelise C., Allan, John, Geary, Tim, Houston, Gordon, Meikle, Alistair, O'Brien, Peter, Forsey, Miranda, Kaliappan, Agilan, Nicholson, Anne, Riches, Joanne, Vertue, Mark, Allan, Elizabeth, Darlington, Kate, Davies, Ffyon, Easton, Jack, Kumar, Sumit, Lean, Richard, Menzies, Daniel, Pugh, Richard, Qiu, Xinyi, Davies, Llinos, Williams, Hannah, Scanlon, Jeremy, Davies, Gwyneth, Mackay, Callum, Lewis, Joannne, Rees, Stephanie, Oblak, Metod, Popescu, Monica, Thankachen, Mini, Higham, Andrew, Simpson, Kerry, Craig, Jayne, Baruah, Rosie, Morris, Sheila, Ferguson, Susie, Shepherd, Amy, Prockter Moore, Luke Stephen, Vizcaychipi, Marcela Paola, Gomes de Almeida Martins, Laura, Carungcong, Jaime, Mohamed Ali, Inthakab Ali, Beaumont, Karen, Blunt, Mark, Coton, Zoe, Curgenven, Hollie, Elsaadany, Mohamed, Fernandes, Kay, Ally, Sameena Mohamed, Rangarajan, Harini, Sarathy, Varun, Selvanayagam, Sivarupan, Vedage, Dave, White, Matthew, Gill, Mandy, Paul, Paul, Ratnam, Valli, Shelton, Sarah, Wynter, Inez, Carmody, Siobhain, Page, Valerie Joan, Beith, Claire Marie, Black, Karen, Clements, Suzanne, Morrison, Alan, Strachan, Dominic, Taylor, Margaret, Clarkson, Michelle, D'Sylva, Stuart, Norman, Kathryn, Auld, Fiona, Donnachie, Joanne, Edmond, Ian, Prentice, Lynn, Runciman, Nikole, Salutous, Dario, Symon, Lesley, Todd, Anne, Turner, Patricia, Short, Abigail, Sweeney, Laura, Murdoch, Euan, Senaratne, Dhaneesha, Hill, Michaela, Kannan, Thogulava, Laura, Wild, Crawley, Rikki, Crew, Abigail, Cunningham, Mishell, Daniels, Allison, Harrison, Laura, Hope, Susan, Inweregbu, Ken, Jones, Sian, Lancaster, Nicola, Matthews, Jamie, Nicholson, Alice, Wray, Gemma, Langton, Helen, Prout, Rachel, Watters, Malcolm, Novis, Catherine, Barron, Anthony, Collins, Ciara, Kaul, Sundeep, Passmore, Heather, Prendergast, Claire, Reed, Anna, Rogers, Paula, Shokkar, Rajvinder, Woodruff, Meriel, Middleton, Hayley, Polgar, Oliver, Nolan, Claire, Mahay, Kanta, Collier, Dawn, Hormis, Anil, Maynard, Victoria, Graham, Cheryl, Walker, Rachel, Knights, Ellen, Price, Alicia, Thomas, Alice, Thorpe, Chris, Behan, Teresa, Burnett, Caroline, Hatton, Jonathan, Heeney, Elaine, Mitra, Atideb, Newton, Maria, Pollard, Rachel, Stead, Rachael, Amin, Vishal, Anastasescu, Elena, Anumakonda, Vikram, Karthik, Komala, Kausar, Rizwana, Reid, Karen, Smith, Jacqueline, Imeson-Wood, Janet, Skinner, Denise, Gaylard, Jane, Mullan, Dee, Newman, Julie, Brown, Alison, Crickmore, Vikki, Debreceni, Gabor, Wilkins, Joy, Nicol, Liz, Reece-Anthony, Rosie, Birt, Mark, Ghosh, Alison, Williams, Emma, Allen, Louise, Beranova, Eva, Crisp, Nikki, Deery, Joanne, Hazelton, Tracy, Knight, Alicia, Price, Carly, Tilbey, Sorrell, Turki, Salah, Turney, Sharon, Cooper, Joshua, Finch, Cheryl, Liderth, Sarah, Quinn, Alison, Waddington, Natalia, Coventry, Tina, Fowler, Susan, MacMahon, Michael, McGregor, Amanda, Cowley, Anne, Highgate, Judith, Gregory, Jane, O'Connell, Susan, Smith, Tim, Barberis, Luigi, Gopal, Shameer, Harris, Nichola, Lake, Victoria, Metherell, Stella, Radford, Elizabeth, Daniel, Amelia, Finn, Joanne, Saha, Rajnish, White, Nikki, Donnison, Phil, Trim, Fiona, Eapen, Beena, Birch, Jenny, Bough, Laura, Goodsell, Josie, Tutton, Rebecca, Williams, Patricia, Williams, Sarah, Winter-Goodwin, Barbara, Nichol, Ailstair, Brickell, Kathy, Smyth, Michelle, Murphy, Lorna, Coetzee, Samantha, Gales, Alistair, Otahal, Igor, Raj, Meena, Sell, Craig, Hilltout, Paula, Evitts, Jayne, Tyler, Amanda, Waldron, Joanne, Beesley, Kate, Board, Sarah, Kubisz-Pudelko, Agnieszka, Lewis, Alison, Perry, Jess, Pippard, Lucy, Wood, Di, Buckley, Clare, Barry, Peter, Flint, Neil, Rekha, Patel, Hales, Dawn, Bunni, Lara, Jennings, Claire, Latif, Monica, Marshall, Rebecca, Subramanian, Gayathri, McGuigan, Peter J., Wasson, Christopher, Finn, Stephanie, Green, Jackie, Collins, Erin, King, Bernadette, Campbell, Andy, Smuts, Sara, Duffield, Joseph, Smith, Oliver, Mallon, Lewis, Claire, Watkins, Botfield, Liam, Butler, Joanna, Dexter, Catherine, Fletcher, Jo, Garg, Atul, Kuravi, Aditya, Ranga, Poonam, Virgilio, Emma, Belagodu, Zakaula, Fuller, Bridget, Gherman, Anca, Olufuwa, Olumide, Paramsothy, Remi, Stuart, Carmel, Oakley, Naomi, Kamundi, Charlotte, Tyl, David, Collins, Katy, Silva, Pedro, Taylor, June, King, Laura, Coates, Charlotte, Crowley, Maria, Wakefield, Phillipa, Beadle, Jane, Johnson, Laura, Sargeant, Janet, Anderson, Madeleine, Brady, Ailbhe, Chan, Rebekah, Little, Jeff, McIvor, Shane, Prady, Helena, Whittle, Helen, Mathew, Bijoy, Attwood, Ben, Parsons, Penny, Ward, Geraldine, Bremmer, Pamela, Joe, West, Tracy, Baird, Jim, Ruddy, Davies, Ellie, Sathe, Sonia, Dennis, Catherine, McGregor, Alastair, Parris, Victoria, Srikaran, Sinduya, Sukha, Anisha, Clarke, Noreen, Whiteside, Jonathan, Mascarenhas, Mairi, Donaldson, Avril, Matheson, Joanna, Barrett, Fiona, O'Hara, Marianne, Okeefe, Laura, Bradley, Clare, Eastgate-Jackson, Christine, Filipe, Helder, Martin, Daniel, Maharajh, Amitaa, Garcia, Sara Mingo, Pakou, Glykeria, De Neef, Mark, Dent, Kathy, Horsley, Elizabeth, Akhtar, Muhmmad Nauman, Pearson, Sandra, Potoczna, Dorota, Spencer, Sue, Clapham, Melanie, Harper, Rosemary, Poultney, Una, Rice, Polly, Mutch, Rachel, Armstrong, Lisa, Bates, Hayley, Dooks, Emma, Farquhar, Fiona, Hairsine, Brigid, McParland, Chantal, Packham, Sophie, Bi, Rehana, Scholefield, Barney, Ashton, Lydia, George, Linsha, Twiss, Sophie, Wright, David, Chablani, Manish, Kirkby, Amy, Netherton, Kimberley, Davies, Kim, O'Brien, Linda, Omar, Zohra, Perkins, Emma, Lewis, Tracy, Sutherland, Isobel, Burns, Karen, Ben Chandler, Dr, Elliott, Kerry, Mallinson, Janine, Turnbull, Alison, Gondo, Prisca, Hadebe, Bernard, Kayani, Abdul, Masunda, Bridgett, Anderson, Taya, Hawcutt, Dan, O'Malley, Laura, Rad, Laura, Rogers, Naomi, Saunderson, Paula, Allison, Kathryn Sian, Afolabi, Deborah, Whitbread, Jennifer, Jones, Dawn, Dore, Rachael, Halkes, Matthew, Mercer, Pauline, Thornton, Lorraine, Dawson, Joy, Garrioch, Sweyn, Tolson, Melanie, Aldridge, Jonathan, Kapoor, Ritoo, Loader, David, Castle, Karen, Humphreys, Sally, Tampsett, Ruth, Mackintosh, Katherine, Ayers, Amanda, Harrison, Wendy, North, Julie, Allibone, Suzanne, Genetu, Roman, Kasipandian, Vidya, Patel, Amit, Mac, Ainhi, Murphy, Anthony, Mahjoob, Parisa, Nazari, Roonak, Worsley, Lucy, Fagan, Andrew, Bemand, Thomas, Black, Ethel, Dela Rosa, Arnold, Howle, Ryan, Jhanji, Shaman, Baikady, Ravishankar Rao, Tatham, Kate Colette, Thomas, Benjamin, Bell, Dina, Boyle, Rosalind, Douglas, Katie, Glass, Lynn, Lee, Emma, Lennon, Liz, Rattray, Austin, Taylor, Abigail, Hughes, Rachel Anne, Thomas, Helen, Rees, Alun, Duskova, Michaela, Phipps, Janet, Brooks, Suzanne, Edwards, Michelle, Quaid, Sheena, Watson, Ekaterina, Brayne, Adam, Fisher, Emma, Hunt, Jane, Jackson, Peter, Kaye, Duncan, Love, Nicholas, Parkin, Juliet, Tuckey, Victoria, Van Koutrik, Lynne, Carter, Sasha, Andrew, Benedict, Findlay, Louise, Adams, Katie, Service, Jen, Williams, Alison, Cheyne, Claire, Saunderson, Anne, Moultrie, Sam, Odam, Miranda, Hall, Kathryn, Mapfunde, Isheunesu, Willis, Charlotte, Lyon, Alex, Sri-Chandana, Chunda, Scherewode, Joslan, Stephenson, Lorraine, Marsh, Sarah, Hardy, John, Houlden, Henry, Moncur, Eleanor, Tariq, Ambreen, Tucci, Arianna, Hobrok, Maria, Loosley, Ronda, McGuinness, Heather, Tench, Helen, Wolf-Roberts, Rebecca, Irvine, Val, Shelley, Benjamin, Gorman, Claire, Gupta, Abhinav, Timlick, Elizabeth, Brady, Rebecca, Milligan, Barry, Bellini, Arianna, Bryant, Jade, Mayer, Anton, Pickard, Amy, Roe, Nicholas, Sowter, Jason, Howlett, Alex, Fidler, Katy, Tagliavini, Emma, Donnelly, Kevin, Boos, Jannik, van der Made, Caspar I., Ramakrishnan, Gayatri, Coughlan, Eamon, Asselta, Rosanna, Löscher, Britt-Sabina, Valenti, Luca V.C., de Cid, Rafael, Bujanda, Luis, Julià, Antonio, Pairo-Castineira, Erola, May, Sandra, Zametica, Berina, Heggemann, Julia, Albillos, Agustín, Banales, Jesus M., Barretina, Jordi, Blay, Natalia, Bonfanti, Paolo, Buti, Maria, Fernandez, Javier, Marsal, Sara, Prati, Daniele, Ronzoni, Luisa, Sacchi, Nicoletta, Schultze, Joachim L., Riess, Olaf, Franke, Andre, Rawlik, Konrad, Ellinghaus, David, Hoischen, Alexander, Schmidt, Axel, and Ludwig, Kerstin U.

Published
2024
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24. Designing Units with the Ubd Framework to Teach English as a Foreign Language: Benefits and Challenges

Author

Evrim Eveyik Aydın and Gülşah Çelikman Hanratty

Subjects
understanding by design (ubd), english curriculum design, unit design in efl, anlama odaklı tasarım (ubd), i̇ngilizce müfredat tasarımı, i̇ngilizce ünite tasarımı, Education
Abstract

This study aims to explore English language teachers’ and English department heads’ perspectives on the benefits and challenges of designing and delivering units using Understanding by Design (UbD) framework to teach English as a Foreign Language (EFL). UbD is a unit and curriculum design framework which aims for student understanding and its transfer into real life context through three stages: identifying the desired results, determining the assessment evidence, and planning learning activities. Data was collected through open-ended questionnaires from 39 English language teachers and five department heads, and semi-structured focus group interviews with seven teachers. The content and thematic analysis of the qualitative data revealed that the teachers who implemented UbD within the context of their school perceived it as a design process with benefits on students’ academic achievement and English language skills through its focus on the development of understandings and transfer. The findings also uncovered perceived challenges caused by institutional, instructional, teacher related and learner related factors. Teachers also found UbD implementations challenging due to the characteristics of online education during the global pandemic. These findings suggest that although UbD is not commonly used at schools in the Turkish EFL context, it can be offered as an alternative unit design practice if teachers’ professional knowledge of its underlying principles is increased with regular in-service trainings on its proper implementation.

Published
2023
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27. Global Consensus Recommendations on Improving the Safety of Chronic Total Occlusion Interventions

Author

Rafeh, Nidal Abi, Agostoni, Pierfrancesco, Alaswad, Khaldoon, Araya, Mario, Avran, Alexandre, Ayoub, Mohamed, Azzalini, Lorenzo, Babunashvili, Avtandil M., Bayani, Baktash, Behnes, Michael, Bhindi, Ravinay, Boudou, Nicolas, Boukhris, Marouane, Bozinovic, Nenad Z., Bryniarski, Leszek, Bufe, Alexander, Buller, Christopher E., Burke, M. Nicholas, Buettner, Heinz Joachim, Cardoso, Pedro, Carlino, Mauro, Chan, Chi-Kin, Chen, Jiyan, Christiansen, Evald Hoej, Colombo, Antonio, Croce, Kevin, Damas de los Santos, Felix, de Martini, Tony, Dens, Joseph, di Mario, Carlo, Doshi, Darshan, Dou, Kefei, Egred, Mohaned, Elbarouni, Basem, ElGuindy, Ahmed M., Escaned, Javier, Furkalo, Sergey, Gagnor, Andrea, Galassi, Alfredo R., Garbo, Roberto, L.Gasparini, Gabriele, Ge, Junbo, Ge, Lei, Goel, Pravin Kumar, Goktekin, Omer, Gonzalo, Nieves, Gorgulu, Sevket, Grancini, Luca, Hall, Allison B., Hanratty, Colm, Harb, Stefan, Harding, Scott A., Hatem, Raja, Hellig, Farrel, Henriques, Jose P.S., Hildick-Smith, David, Hill, Jonathan M., Hoye, Angela, Jaber, Wissam, Jaffer, Farouc A., Jang, Yangsoo, Jussila, Risto, Kalnins, Artis, Kalra, Sanjog, Kandzari, David E., Kao, Hsien-Li, Karmpaliotis, Dimitri, Kassem, Hussien Heshmat, Kearney, Kathleen E., Kerrigan, Jimmy, Khatri, Jaikirshan, Khelimskii, Dmitri, Kirtane, Ajay J., Knaapen, Paul, Kornowski, Ran, Krestyaninov, Oleg, Kumar, V. Ganesh, Kumar, Prathap, Lamelas, Pablo Manuel, Lee, Seung-Whan, Lefevre, Thierry, Leibundgut, Gregor, Leung, Raymond, Leung, Sum-Kin, Li, Yu, Li, Yue, Lim, Soo-Teik, Lo, Sidney, Lombardi, William, Maran, Anbukarasi, McEntegart, Margaret, Moses, Jeffrey, Munawar, Muhammad, Nagamatsu, Wataru, Navarro, Andres, Ngo, Hung M., Nicholson, William, Oksnes, Anja, Olivecrona, Goran K., Padilla, Lucio, Patel, Mitul, Pershad, Ashish, Postu, Marin, Pyxaras, Stylianos, Qian, Jie, Quadros, Alexandre, Hanna Quesada, Franklin Leonardo, Råmunddal, Truls, Rao, Vithala Suryaprakasa, Rathore, Sudhir, Reifart, Nicolaus, Riley, Robert F., Rinfret, Stephane, Saghatelyan, Meruzhan, Santiago, Ricardo, Seth, Ashok, Sianos, Georgios, Smith, Elliot, Spaedy, Anthony, Spratt, James, Stone, Gregg W., Strange, Julian W., Tammam, Khalid O., Thompson, Craig A., Toma, Aurel, Tremmel, Jennifer A., Ungi, Imre, Vadalà, Giuseppe, Vo, Minh, Vu, Vu Hoang, Walsh, Simon, Weilenmann, Daniel, Werner, Gerald S., Wojcik, Jaroslaw, Wollmuth, Jason, Wu, Chiung-Jen, Xu, Bo, Yamane, Masahisa, Ybarra, Luiz F., Yeh, Robert W., Zambakides, Chris, Zhang, Qi, Wu, Eugene B., Kalyanasundaram, Arun, Brilakis, Emmanouil S., Mashayekhi, Kambis, and Tsuchikane, Etsuo

Published
2024
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29. Acceptance and Commitment Therapy plus usual care for improving quality of life in people with motor neuron disease (COMMEND): a multicentre, parallel, randomised controlled trial in the UK

Author

Andreou, Penny, Androulaki-Korakaki, Dynameni, Blakeley, Claire, Bridges, Gary, Campbell, Iain, Davenport, Brittany, Dee, Annily, Drewry, Nicola, Flood, John, Fox, Annemieke, Girling, Melissa, Glew, Ruth, Hartley, Nick, Hocking, Sian, Howell, Mark, Keetharuth, Anju, Makin, Selina, Marsh, Jessica, Mayberry, Emily, McDonald, Alexa, McPartland, Roy, Meldrum, Steven, Mobley, Amanda, Murphy, Donnchadh, O'Brien, Marie Claire, Oliver, Mark, Patel, Darshna, Phipps, Emma, Read, Jessica, Roberts, Rhys, Rooney, Natasha, Smith, Carla, Statham, Jo, Thompson, Cara, Varma, Priya, Walker, Anne Marie, Waterhouse, Simon, Gould, Rebecca L, McDermott, Christopher J, Thompson, Benjamin J, Rawlinson, Charlotte V, Bursnall, Matt, Bradburn, Mike, Kumar, Pavithra, Turton, Emily J, White, David A, Serfaty, Marc A, Graham, Christopher D, McCracken, Lance M, Goldstein, Laura H, Al-Chalabi, Ammar, Orrell, Richard W, Williams, Tim, Noad, Rupert, Baker, Idris, Faull, Christina, Lambert, Thomas, Chhetri, Suresh K, Ealing, John, Hanratty, Anthony, Radunovic, Aleksandar, Gunawardana, Nushan, Meadows, Gail, Gorrie, George H, Young, Tracey, Lawrence, Vanessa, Cooper, Cindy, Shaw, Pamela J, and Howard, Robert J

Published
2024
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32. UK homecare providers’ views about, and experiences of, digitalisation: A national survey

Author

Jan Healey, Vanessa Davey, Jennifer Liddle, Gareth O’Rourke, Barbara Hanratty, and Bryony Beresford

Subjects
Computer applications to medicine. Medical informatics, R858-859.7
Abstract

Objective Using digital systems to support the management and delivery of social care is a priority for UK governments. This study explored progress towards, and experiences of, digitalisation in the homecare sector and providers’ views on contributing client data to a national policy/research dataset. Methods Over 150 UK homecare providers completed an on-line survey (October–December 2022). The survey was hosted on Qualtrics and comprised fixed- and free-text response questions. The recruited sample aligned with the profile of UK homecare providers in terms of use of digital systems, organisation type and size. Results Almost all respondents (95.5%) were using digital systems, in part or exclusively, to support care delivery. However, many (42.7%) reported a desire to further digitalise or a dissatisfaction with existing systems. Findings highlight the time and work involved in choosing a a software system, with the decision regarded as relatively high risk. Over 50 different software systems were being used across the sample. Most respondents (72.5%) supported the creation of a national dataset on homecare users. However, support and recompense are likely to needed to secure buy-in from what is a predominantly private sector context. Conclusions Findings suggest a complex and changing situation, with numerous different digital systems being used and the sector at different stages of digitalisation. The high-pressure, low margin context of UK homecare appeared to be exerting an influence on progress towards digitalisation. Evaluations of government strategies to stimulate and support digitalisation in this diverse and predominantly private sector context will be valuable.

Published
2024
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33. Relationship between staff and quality of care in care homes: StaRQ mixed methods study

Author

Karen Spilsbury, Andy Charlwood, Carl Thompson, Kirsty Haunch, Danat Valizade, Reena Devi, Cornell Jackson, David Phillip Alldred, Antony Arthur, Lucy Brown, Paul Edwards, Will Fenton, Heather Gage, Matthew Glover, Barbara Hanratty, Julienne Meyer, and Aileen Waton

Subjects
older people, nursing homes, care homes, long-term care residential care, quality, staffing, workforce, registered nurses, direct care staff, care support workers, mixed methods study, Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract

Background Quality of life and care varies between and within the care homes in which almost half a million older people live and over half a million direct care staff (registered nurses and care assistants) work. The reasons are complex, understudied and sometimes oversimplified, but staff and their work are a significant influence. Objective(s) To explore variations in the care home nursing and support workforce; how resident and relatives’ needs in care homes are linked to care home staffing; how different staffing models impact on care quality, outcomes and costs; how workforce numbers, skill mix and stability meet residents’ needs; the contributions of the care home workforce to enhancing quality of care; staff relationships as a platform for implementation by providers. Design Mixed-method (QUAL-QUANT) parallel design with five work packages. WP1 – two evidence syntheses (one realist); WP2 – cross-sectional survey of routine staffing and rated quality from care home regulator; WP3 – analysis of longitudinal data from a corporate provider of staffing characteristics and quality indicators, including safety; WP4 – secondary analysis of care home regulator reports; WP5 – social network analysis of networks likely to influence quality innovation. We expressed our synthesised findings as a logic model. Setting English care homes, with and without nursing, with various ownership structures, size and location, with varying quality ratings. Participants Managers, residents, families and care home staff. Findings Staffing’s contribution to quality and personalised care requires: managerial and staff stability and consistency; sufficient staff to develop ‘familial’ relationships between staff and residents, and staff–staff reciprocity, ‘knowing’ residents, and skills and competence training beyond induction; supported, well-led staff seeing modelled behaviours from supervisors; autonomy to act. Outcome measures that capture the relationship between staffing and quality include: the extent to which resident needs and preferences are met and culturally appropriate; resident and family satisfaction; extent of residents living with purpose; safe care (including clinical outcomes); staff well-being and job satisfaction were important, but underacknowledged. Limitations Many of our findings stem from self-reported and routine data with known biases – such as under reporting of adverse incidents; our analysis may reflect these biases. COVID-19 required adapting our original protocol to make it feasible. Consequently, the effects of the pandemic are reflected in our research methods and findings. Our findings are based on data from a single care home operator and so may not be generalised to the wider population of care homes. Conclusions Innovative and multiple methods and theory can successfully highlight the nuanced relationship between staffing and quality in care homes. Modifiable characteristics such as visible philosophies of care and high-quality training, reinforced by behavioural and relational role modelling by leaders can make the difference when sufficient amounts of consistent staff are employed. Greater staffing capacity alone is unlikely to enhance quality in a cost-effective manner. Social network analysis can help identify the right people to aid adoption and spread of quality and innovation. Future research should focus on richer, iterative, evaluative testing and development of our logic model using theoretically and empirically defensible – rather than available – inputs and outcomes. Study registration This study is registered as PROSPERO CRD42021241066 and Research Registry registration: 1062. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/144/29) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information. Plain language summary This study was about the relationship between staffing and quality in care homes. Almost half a million older people live in care homes in England. Why quality of care and quality of life for residents vary so much between and within homes is unknown, but staff and the ways they work are likely to be important. Researching staffing and quality is difficult: quality means different things to different people and a lot of things shape how quality feels to residents, families and staff. In the past, researchers have oversimplified the problem to study it and may have missed important influences. We took a more complex view. In five interlinked work packages, we collected and analysed: (1) research journal articles; (2) national data from different care homes; (3) data from a large care organisation to look at what it is about staffing that influences quality; (4) reports and ratings of homes from the Care Quality Commission; and (5) we looked at the networks between staff in homes that shape how quality improvement techniques might spread. We used theories about how our findings might be linked to plan for this data collection and analysis. The results were combined into something called a ‘logic model’ – a diagram and explanation that make it easier for managers, researchers and people interested in care homes to see how staffing influences quality. Staffing considerations that might improve quality include: not swapping managers too much; having sufficient and consistent staff for family-like relationships in homes and putting residents’ needs first; supporting staff and giving them freedom to act; and key staff leading by example. Research examining care home quality should capture those aspects that mean the most to residents, their families and staff. Scientific summary Background An estimated 425,000 older people in England live in 18,000 care homes: with nursing, without nursing, or dual registered homes. They are some of the oldest and the most vulnerable people in society. Resident dependency levels and care needs are often similar in homes with and without nursing – but their workforces differ significantly. In homes with nursing care, registered nurses (RNs) are employed to provide clinical care and supervise care delivery, mainly from a large workforce of non-registered care assistants. Care homes without nursing comprise only social care staff or care assistants. The NHS provides health care – including nursing care – as required; for example, supporting specialist care for residents at the end of life. Staffing profiles and establishments vary between providers and so studying care homes and their workforce is complex. Conceptually, quality is similarly complex; it is contested, contingent, contextualised, dynamic and often deeply personal. Two dimensions of quality require consideration in care homes: quality of care and quality of life. While care home staff and their work are likely determinants of quality, research into the staffing–quality relationship is comparatively scant. Measuring quality often focuses on clinical outcomes, such as pressure ulcer prevalence, falls or medication errors. Many studies are in North American long-term care and the few English studies’ primary focus has been on staff turnover and quality and working conditions and quality. Our mixed-methods study addresses some of the theoretical gaps and methodological challenges associated with understanding staffing’s relationship to quality. Using established theory we focused on the structures, processes and outcomes of quality. Our aim of investigating workforce models of nursing and care support in care homes that effectively benefit residents, relatives and staff was addressed through six objectives, which were the focus of five linked work packages (WP). Objectives Describe variations in the characteristics of the care home nursing and support workforce (WP1). Identify the dependency and needs of residents and relatives in care homes and their association with care home staffing (WP2, WP3). Examine how different care home staffing models (including new roles) impact on quality of care, resident outcomes and NHS resources (WP1, WP2, WP3). Explain how care home workforce (numbers, skill mix and stability) might meet the dependency and needs of residents (WP1, WP2, WP3, WP4). Explore and understand the contributions of the nursing and support workforce (including innovations in nursing and support roles) in care homes to enhance quality of care (WP1, WP4). Translate methods used for modelling the relationships between staffing and quality to provide a platform for sector-wide implementation (WP5). Methods A mixed-method (QUAL-QUANT) parallel design built around Donabedian’s theoretical framework of structures, processes and outcomes was the basis for our exploration of the relationship between care home staffing and quality. The coronavirus disease 2019 (COVID-19) pandemic meant some deviation from our original protocol was necessary. Work package 1 (WP1) was two evidence reviews: a systematic review synthesising 36 studies of care home staff perceptions of their roles and responsibilities in promoting quality; a realist review (n = 66 studies) then developed evidence and theory-based explanations of how care home staff behaviours promote quality of care and quality of life, why and in what circumstances. Work packages 2 and 3 used routinely collected measures of staffing and examined their relationship to quality. WP2 was a cross-sectional observational study, modelling the relationship between care quality – as measured in Care Quality Commission (CQC) inspection reports – and care home workforce characteristics from the National Minimum Data Set for Social Care (NMDS-SC). WP3 analysed routinely collected longitudinal data measures of workforce, nurse-sensitive indicators of care quality, resident characteristics and home characteristics from a large corporate care home provider over 42 months. A cost analysis from a provider perspective was also undertaken. Work package 4 used documentary analysis of 30 purposively sampled, publicly available, inspection reports from the English national quality regulator (CQC) from homes rated as outstanding or inadequate to examine (1) how staffing structures influenced quality and (2) the care processes that explain the relationship between staffing and quality. In WP5, care homes (n = 11) were purposively sampled and social network analysis (SNA) using questionnaires and roster name generation was used to map the self-reported advice and influence relationships present in care homes. To assess homes’ readiness for innovation and work-related barriers to adoption of our (translated) findings, eight managers completed an adapted version of the Normalisation MeAsure Development questionnaire (NoMAD) questionnaire – an operationalised instrument of Normalisation Process Theory. Public and stakeholder involvement and engagement We worked closely with the public and stakeholders throughout, from question formulation through to synthesis. Two advisory groups were formed: (1) a resident and relative group and (2) a care home manager group. The study steering committee (SSC) contained key stakeholders – including relatives – to provide oversight and guidance. These mechanisms ensured perspectives other than the research team informed and improved research design and implementation and prompted wider conversations and learnRNing that benefited the research. Ethics approval Work package 2 and WP3 were approved (2 August 2017) by the Social Care Research Ethics Committee (17/WM/0232). WP5 was approved (21 June 2019) by the University of Leeds, Faculty of Medicine and Health, Ethics and Governance Committee (HREC 18-028). Findings The five linked WP findings were synthesised using a logic model to explain what is likely to work, why and how, and the interactions between structures, processes and outcomes important for the staffing–quality relationship. Managerial stability was important: care homes with a manager in-post in the 12 months prior to a CQC inspection were more likely to be rated as good or outstanding (WP2). Managers made those workforce decisions necessary for meeting residents’ care and safety needs (WP4). Managers of care homes rated good or outstanding had authority and flexibility to secure the workforce they judged necessary (WP4). Cohesive working relationships between managers and their corporate senior management team or owner helped managers enact their decisions (WP4). Higher staff-to-bed ratios were associated with a greater chance of a good or outstanding CQC inspection score (WP2). More care from RNs was associated with fewer falls with fractures, urinary tract infections (UTIs) and medication errors (WP3). Use of agency nurses to cover for staff sickness or unfilled vacancies was not associated with more falls, infections or pressure ulcers, but was associated with more medication errors (WP3). Simply increasing nursing input is unlikely to be a cost-effective way of reducing adverse incidents in care homes (WP3). WP4 (and WP1ii) identified the importance of having ‘sufficient’ staff to meet residents’ needs and preferences and improve outcomes. But detail of how staffing levels were determined by managers and consistent use of tools to support professional judgement about staffing (WP4) was lacking. Staff stability and minimising agency staff use were perceived as necessary conditions for quality (WP4). Having experienced care staff, that is, staff in post for 5 years, was likely to improve quality, as measured by ratings (WP2). A stable workforce was also associated with skills and competence (WP1i, WP1ii, WP4). Opportunities for staff induction, training and continuing professional development, alongside staff supervision, were extensive in care homes rated as outstanding (WP4). High staff turnover reduced opportunities for developing broader staff skills and competence, narrowing it to staff induction and mandatory training (WP4). Staffing consistency was important for organising care and work (WP1i, WP1ii, WP4). Larger homes were less likely to be rated positively (WP2). Other WPs highlighted the importance of team size (not home size) as a lever for promoting quality (WP1i, WP1ii, WP4). Small groups of linked residents and staff (5–15 residents per staff member based on level of resident dependency) promoted familiarity, communication and a family-like environment for cultivating relationships (WP1ii). Establishing these family-like relationships and ‘knowing’ residents promoted personalisation of resident care (WP1i), encouraging staff to go beyond purely assisting residents with physical tasks, towards addressing wider social and emotional needs (WP1ii). The reviews (WP1i, WP1ii) highlight where the requisite roles and responsibilities of the workforce might help achieve this. Developing relationships based on consultation – with families, professionals outside the home and residents – to support residents was a feature of homes rated as outstanding (WP1i, WP1ii, WP4). These relationships informed care planning and personalisation of care (WP1i). Relationships between staff and families also legitimised family involvement in care to support quality (WP1ii). Unit-level supervisors that role modelled relationship building were important levers for realising team ambitions of relationship-based quality (WP1ii, WP4). Staffing consistency was important for teamworking. In care homes rated outstanding, staff reported working together and supporting each other towards a collective vision of care and support (WP4). Staff that felt supported, valued and – with (managerial) ‘permission’ – able to prioritise residents’ needs, adapted and adopted behaviours promoting residents’ expressing preferences for care (WP1ii, WP4). More autonomy in day-to-day work, with associated accountability, led to greater staff engagement and satisfaction (WP1ii, WP4). Team reciprocity was linked to open communication, information exchange, advice and influence (WP1ii, WP5). Reciprocity encouraged teams to draw on each other’s knowledge and skills to promote individualised care and enhance quality (WP1i, WP1ii, WP4). Combining written and verbal staff communication was a feature in homes rated as outstanding and linked to better resident care (WP4). Visible unit-level supervisors – not always managers – fostered teamworking. They also minimised conflicts, enabling team reciprocity and relationships (WP1ii). Social networks can promote or hinder the behavioural mechanisms influencing quality (WP5). Networks that were interconnected, dense or cohesive, built around strong advice and influence relationships, had higher chances of implementing change associated with innovation around quality (WP5). The care home manager – as opinion leader (i.e. providing most advice and influence and receiving most advice and influence) – was pivotal in implementing innovation-related change (WP5). Leadership and management behaviours promoted resident-centred approaches; ensured effective communication; promoted staff confidence; offered practical and emotional support and recognition to staff; and encouraged diversity (WP1ii). Staff feeling valued was linked to greater staff commitment and contribution to quality (WP4). A managerially endorsed philosophy of care (valuing residents and staff) encouraged the staff behaviours needed for individualised resident care (WP1ii, WP4). Based on our analysis, measuring the following resident outcomes would provide a more meaningful picture of the relationship between staffing and quality: the extent to which resident needs and preferences are met (and culturally appropriate) (WP1i, WP1ii, WP4); resident and family satisfaction (WP1i, WP1ii, WP4); residents living with purpose to promote their quality of life and well-being (WP1i, WP1ii, WP4); and safe care for residents (including clinical outcomes) (WP1i, WP1ii, WP2, WP3, WP4). Staff well-being and job satisfaction were important outcomes which influenced quality as experienced by residents. Conclusions Our study makes a novel and important contribution to understanding the importance of the relationship between staff, their work and behaviours and quality in care homes. We have attempted to shift the debate away from a reductionist picture of numbers of staff and their relationship to clinical indicators, towards a more nuanced recognition of the ways in which staff in the right amounts and with the right behaviours can meet resident’s needs and preferences. Staffing needs to be stable, skilled and competent to realise the benefits of person-focused organisation of care, and enhanced teamworking. Leadership, reward and recognition of staff and a shared philosophy of care provide needed context for the relationships required to improve quality as experienced by residents. Our findings will be useful for people and organisations making policy and delivering services that want to work towards the best ways to deploy and support quality in care homes using their most valuable resource: their staff. Implications for social care Understanding that numbers of staff alone are a necessary but not sufficient condition for care home quality. Quality improves in homes when more care is provided by RNs. Simply introducing ‘more’ staff (particularly RNs) is unlikely to be a cost-effective way of reducing adverse incidents in care homes. Quality relies on the who, what and how of staffing arrangements and organisation of work. Leadership is key, influencing how organisational resources are used to promote the environments and cultures needed for quality-promoting relationships to flourish. Realising and supporting the potential of the staffing resource (clinical, care, social and cultural skills and competence) are essential for quality. Opportunities for learning and development demonstrate an organisation values staff and may support staff retention. A focus on the structures that support staffing consistency (stability, skill and competence) is important for influencing processes (the organisation of care and teamworking) and outcomes for residents and staff. Developing transparent approaches that enable care home managers to effectively judge and make decisions about staffing levels is crucial for safe and appropriate care for residents. Reciprocal relationships, beyond the immediate care team and including residents, their families and health and social care professionals promote quality. Leadership and management behaviours influence staff commitment and thus their contribution to quality. A ‘visible’ unit supervisor and staff who ‘connect’ and influence the team are essential for quality and innovation in care homes. Implications for research Future research should: Unpack the contribution of direct care support workforce (including care assistants, senior care assistants and nursing associates) working at different levels of skills and competence to care home quality. Explore how training for care assistants, senior care assistants and nursing associates contributes to improving quality. Consider differences for temporary (i.e. step-up or step-down care) versus permanent (i.e. long-term placement) care home residents. Explore how resident population levels of dependency are related to quality. Use innovative methods to capture quality in ways that recognise individual stakeholder views, values, expectations and preferences and address both quality of care and quality of life. Develop robust social network interventions to change network structures to enhance reciprocity and advice and influence relationships to embed innovations for enhancing quality. Consider machine learning methods for analysis of routine data because these methods are better able to identify non-linear relationships between staffing and care quality indicators than traditional regression analysis in order to better identify minimum adequate staffing levels. Use methods to promote more accurate modelling of the staffing–quality relationship through data linkage. Further test and develop our logic model. Study registration This study is registered as PROSPERO CRD42021241066 and Research Registry registration: 1062. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/144/29) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information.

Published
2024
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35. No health without access: using a retrospective cohort to model a care continuum for people released from prison at an urban, safety net health system

Author

Michael Frank, Ryan Loh, Rachel Everhart, Hermione Hurley, and Rebecca Hanratty

Subjects
Prisons, Prisoners, Continuity of patient care, Community health services, Health services accessibility, Outpatient, Public aspects of medicine, RA1-1270, Social pathology. Social and public welfare. Criminology, HV1-9960
Abstract

Abstract Background Release from prison is characterized by discontinuity of healthcare services and results in poor health outcomes, including an increase in mortality. Institutions capable of addressing this gap in care seldom collaborate in comprehensive, data-driven transition of care planning. This study harnesses information from a data exchange between correctional facilities and community-based healthcare agencies in Colorado to model a care continuum after release from prison. Methods We merged records from Denver Health (DH), an urban safety-net healthcare system, and the Colorado Department of Corrections (CDOC), for people released from January 1 to June 30, 2021. The study population was either (a) released to the Denver metro area (Denver and its five neighboring counties), or (b) assigned to the DH Regional Accountable Entity, or (c) assigned to the DH medical home based on Colorado Department of Healthcare Policy and Financing attribution methods. Outcomes explored were outpatient, acute care, and inpatient utilization in the first 180 days after release. We used Pearson’s chi-squared tests or Fisher exact for univariate comparisons and logistic regression for multivariable analysis. Results The care continuum describes the healthcare utilization at DH by people released from CDOC. From January 1, 2021, to June 30, 2021, 3242 people were released from CDOC and 2848 were included in the data exchange. 905 individuals of the 2848 were released to the Denver metro area or attributed to DH. In the study population of 905, 78.1% had a chronic medical or psychological condition. Within 180 days of release, 31.1% utilized any health service, 24.5% utilized at least one outpatient service, and 17.1% utilized outpatient services two or more times. 10.1% utilized outpatient services within the first 30 days of release. Conclusions This care continuum highlights drop offs in accessing healthcare. It can be used by governmental, correctional, community-based, and healthcare agencies to design and evaluate interventions aimed at improving the health of a population at considerable risk for poor health outcomes and death.

Published
2023
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36. Immunomodulatory therapy in children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS, MIS-C; RECOVERY): a randomised, controlled, open-label, platform trial

Author

Faust, Saul N, Haynes, Richard, Jones, Christine E, Staplin, Natalie, Whittaker, Elizabeth, Jaki, Thomas, Juszczak, Ed, Spata, Enti, Wan, Mandy, Bamford, Alasdair, Dimitri, Paul, Finn, Adam, Furness, John, Ramanan, Athimalaipet V, Gale, Christopher, Cathie, Katrina, Drysdale, Simon, Bernatoniene, Jolanta, Murray, Clare, Roehr, Charles C, Fleming, Paul, Riordan, Andrew, Bandi, Srini, Jyothish, Deepthi, Evans, Jennifer, Emonts, Marieke, Kelly, Dominic, Pathan, Nazima, Davies, Patrick, Hague, Rosie, Pollock, Louisa, Semple, Malcolm G, Peto, Leon, Baillie, J Kenneth, Buch, Maya, Jeffery, Katie, Knight, Marian, Lim, Wei Shen, Montgomery, Alan, Mukherjee, Aparna, Mumford, Andrew, Rowan, Kathryn, Thwaites, Guy, Mafham, Marion, Emberson, Jonathan, Landray, Martin J, Horby, Peter W, Chappell, Lucy, Day, Jeremy, Dung, DV, Quang, NN, Binh, Prof, Burhan, E, Alisjahbana, B, Koirala, J, Basnet, S, Kestelyn, E, Basnyat, B, Gyanwali, P, Hamers, RL, Sandercock, P, Darbyshire, J, DeMets, D, Fowler, R, Lalloo, D, Munavvar, M, Roberts, I, Warris, A, Wittes, J, Craddock-Bamford, A, Barton, J, Basoglu, A, Brown, R, Brudlo, W, Denis, E, Fletcher, L, Howard, S, Musini, S, Taylor, K, Cui, G, Goodenough, B, King, A, Lay, M, Murray, D, Stevens, W, Wallendszus, K, Welsh, R, Crichton, C, Davies, J, Goldacre, R, Harper, C, Knight, F, Nunn, M, Salih, H, Welch, J, Campbell, M, Pessoa-Amorim, G, Zayed, M, Wiles, J, Bagley, G, Cameron, S, Chamberlain, S, Farrell, B, Freeman, H, Kennedy, A, Whitehouse, A, Wilkinson, S, Wood, C, Reith, C, Davies, K, Halls, H, Holland, L, Truell, R, Wilson, K, Lingwood, Emma, Howie, L, Lunn, M, Rodgers, Penelope, Amuasi, J, Baird, K, Bao, T, Bittaye, M, Bonney, J, D'Alessandro, U, Dhimal, M, Huyen, T, Jagne, A, Karkey, A, Maiga, O, Matey, E, Nadjm, B, Nel, J, Pant, S, Puspatriani, K, Rahardjani, M, Raijal, S, Rees, H, Rimainar, A, Roberts, C, Rocca, A, Shrestha, S, Usuf, E, Vidaillic, C, Wulandari, F, Alexander, A, Amezaga, M, Armah, C, Asghar, A, Aubrey, P, Barker-Williams, K, Barnard, A, Bartholomew, J, Beaumont-Jewell, D, Beddows, S, Beety, J, Birch, C, Boyle, P, Brend, M, Brookes, M, Callens, C, Campbell, D, Campbell, H, Cate, H, Chambers, E, Chapman, K, Coe, A, Collins, J, Crawshaw, S, Das, S, De Soyza, A, Denton, E, Dicks, P, Dolman, M, Donaldson, K, Dowden, L, Dowling, S, Drake, C, Duckles-Leech, H, Duffy, H, Gerdes, L, Gibbons, K, Gill, L, Gilmour, K, Goodwin, J, Graham, J, Green, C, Hall, C, Hall, A, Hampshire, K, Hanson, J, Harman, T, Harper, H, Harrison, S, Hicks, J, Hodgson, H, Hough, M, Jackson, S, Johnson, G, Kirk, J, Lemoine, N, Levett, C, Lock, S, Lockett, T, Logan, M, Lomme, K, Luo, J, McMillan, N, Membrey, H, Mguni, N, Minton, J, Monaghan, H, Murphy, S, Muzengi, N, Naz, M, Nickson, I, Odam, M, Ohia, U, Okell, E, Oliver, A, Pearson, K, Pine, K, Pleass, R, Porter, D, Porter, L, Potter, A, Poustie, V, Pratt, S, Price, A, Priest, A, Rodgers, A, Rook, C, Ryan, P, Sam, S, Sharratt, P, Sheffield, J, Shenton, J, Shirley, K, Skinner, T, Slade, H, Sutu, M, Taylor, J, Thomas, E, Tinkler, H, Unsworth, A, Usher, R, van't Hoff, W, Walker, S, Walters, J, Walton, E, Warmington, J, Wayman, E, Williams, P, Williamson, J, Williamson, D, Yelnoorkar, F, Knight, M, Hodson, K, Pavord, S, Williamson, C, Bowman, L, Chen, F, Clarke, R, Goonasekara, M, Herrington, W, Judge, P, Ng, S, Preiss, D, Sammons, E, Zhu, D, Arkley, C, Bowker, P, Bruce, J, Byrne-Watts, V, Chapman, G, Coleman, G, Denwood, T, Gray, J, Harrison, D, Mather, N, Pinches, H, Rees, A, Rees, S, Turner, G, Abani, O, Abbas, A, Abbas, F, Abbas, J, Abbas, K, Abbas, M, Abbasi, S, Abbass, H, Abbott, A, Abdallah, N, Abdelaziz, A, Abdelfattah, M, Abdelqader, B, Abdul, A, Abdul, B, Abdul, S, Abdul Rasheed, A, Abdulakeem, A, Abdul-Kadir, R, Abdullah, A, Abdulmumeen, A, Abdul-Raheem, R, Abdulshukkoor, N, Abdusamad, K, Abed El Khaleq, Y, Abedalla, M, Abeer Ul Amna, A, Abel, L, Abernethy, K, Abeywickrema, M, Abhinaya, C, Aboaba, A, Aboagye-Odei, A, Aboelela, H, Abo-Leyah, H, Abouelela, K, Abou-Haggar, A, Abouibrahim, M, Abousamra, A, Abouzaid, M, Abraham, M, Abraham, T, Abraheem, A, Abrams, J, Abrams, R, Abu, H, Abu-Arafeh, A, Abubacker, S, Abung, A, Abusamra, Y, Aceampong, Y, Achara, A, Acharya, D, Acheampong, S, Acheampong, P, Acheson, J, Achieng, S, Acosta, A, Acquah, R, Acton, C, Adabie-Ankrah, J, Adair, P, Adam, F, Adam, M, Adamali, H, Adamczyk, M, Adams, C, Adams, D, Adams, K, Adams, L, Adams, N, Adams, R, Adams, T, Adamu-Ikeme, L, Adati, K, Adcock, K, Addo, A, Adeagbo, O, Adebiyi, A, Adedeji, O, Adegeye, Y, Adegoke, K, Adell, V, Adenwalla, S, Adeoye, F, Adesemoye, O, Adewunmi, E, Adeyanju, A, Adeyemi, J, Adeyemo, T, Adhikary, R, Aditya, A, Adkins, G, Adnan, A, Aeron-Thomas, J, Affleck, D, Afnan, C, Afridi, M, Aftab, Z, Agarwal, M, Agbeko, R, Agbo, C, Aggarwal, S, Aghababaie, A, Aguilar Jimenez, L, Ahamed Sadiq, S, Ahammed Nazeer, M, Ahmed, A, Ahmed, B, Ahmed, F, Ahmed, H, Ahmed, I, Ahmed, K, Ahmed, L, Ahmad, M, Ahmed, N, Ahmed, O, Ahmed, R, Ahmad, S, Ahmed, S H, Ahmed Ali, R, Ahmed Mohamud, B, Ahmer, S, Ahonia, A, Aiken, C, Ail, D, Ainsworth, M, Aissa, M, Aitken, L, Ajay, B, Ajibode, A, Ajmi, A, Akhtar, N, Akili, S, Akinbiyi, B, Akindolie, O, Akinfenwa, Y, Akinkugbe, O, Akinpelu, I, Akram, M, Aktinade, O, Akudi, U, Al Aaraj, A, Al Balushi, A, Al Dakhola, M, Al Swaifi, A, Al-Abadi, E, Alabi, A, Aladangady, N, Alafifi, M, Alam, A, Alam, S, Al-Asadi, A, Alatzoglou, K, Albert, P, Albon, L, Alcala, A, Alcorn, G, Alcorn, S, Aldana, A, Alderdice, D, Aldesouki, A, Aldouri, R, Aldridge, J, Aldridge, N, Alegria, A, Alexander, C, Alexander, J, Alexander, P, Al-Fori, J, Alghazawi, L, Alhabsha, O, Al-Hakim, B, Alhameed, R, Al-Hayali, M, Al-Hity, S, Ali, A, Ali, F, Ali, J, Ali, M, Ali, N, Ali, O, Ali, R, Ali, S, Aliberti, E, Alin, J, Alina, A, Alipustain, A, Aliyuda, F, Alizaedeh, K, Al-Jibury, M, Al-Juboori, S, Al-Khalil, M, Alkhudhayri, A, Alkhusheh, M, Allan, F, Allan, N, Allanson, A, Allcock, R, Allen, E, Allen, J, Allen, K, Allen, L, Allen, P, Allen, R, Allen, S, Allen, T, Alli, A, Allison, K, Allman, B, Allsup, D, Allsop, H, Allsop, L, Almahroos, A, Al-Moasseb, H, Al-Obaidi, M, Alomari, L, Al-Rabahi, A, Al-Ramadhani, B, Al-Saadi, Z, Al-Sammarraie, R, Alshaer, I, Al-Shahi Salman, R, Al-Shamkhani, W, Alsheikh, F, Al-Sheklly, B, Altaf, S, Alty, A, Alvarez, M, Alvarez Corral, M, Alveyn, E, Alzetani, M, Amamou, S, Amar, N, Ambalavanan, S, Ambrogetti, R, Ambrose, C, Ameen, A, Ames, K, Amin, A, Amin, K, Amin, S, Amin, T, Amit, B, Amjad, A, Amjad, N, Amosun, V, Amsal, M, Amsha, K, Amutio Martin, N, Amy, P, Anada, A, Anand, A, Anandappa, S, Anantapatnaikuni, S, Anderson, E, Anderson, J, Anderson, L, Anderson, M, Anderson, N, Anderson, R, Anderson, S, Anderson, W, Andreou, P, Andrews, A, Andrews, J, Aneke, K, Ang, A, Ang, W, Angel, T, Angela, A, Angelini, P, Anguvaa, L, Anichtchik, O, Anim-Somuah, M, Aniruddhan, K, Annett, J, Anning, L, Anstey, P, Anstey, R, Anthony, A, Anthony-Pillai, A, Antill, P, Antonnia, Z, Anu, V, 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Zulaikha, R, Zulfikar, S, Zullo, C, and Zuriaga-Alvaro, A

Published
2024
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37. The Role of Different Clay Types in Achieving Low-Carbon 3D Printed Concretes

Author

Niall Hanratty, Mehran Khan, and Ciaran McNally

Subjects
concrete, 3D printing, waste, low carbon, clay, compressive strength, Building construction, TH1-9745
Abstract

Concrete 3D printing, an innovative construction technology, offers reduced material waste, increased construction speed, and the ability to create complex and customized shapes that are challenging to achieve with traditional methods. This study delves into the unique fresh-state performance required for 3D printing concrete, discussing buildability, extrudability, and shape retention in terms of concrete rheology, which can be modified using admixtures. Currently most 3D printing concretes feature high cement contents, with little use of secondary cementitious materials. This leads to high embodied carbon, and addressing this is a fundamental objective of this work. The research identifies attapulgite, bentonite, and sepiolite clay as potential concrete admixtures to tailor concrete rheology. Eight low-carbon concrete mixes are designed to incorporate GGBS at a 50% replacement level and are used to measure the influence of each clay on the concrete rheology at varying dosages. A comprehensive rheological test protocol is designed and carried out on all mixes, together with other tests including slump-flow and compression strength. The objective is to determine the applicability of each clay in improving the printability of low-carbon concrete. The findings reveal that at a dosage of 0.5%, sepiolite was seen to improve static yield stress, dynamic yield stress, and rate of re-flocculation, resulting in improved printability. The addition of attapulgite and sepiolite at a dosage of 0.5% by mass of binder increased compressive strength significantly; bentonite had very little influence. These gains are not repeated at 1% clay content, indicating that there may be an optimum clay content. The results are considered encouraging and show the potential of these clays to enhance the performance of low-carbon concrete in 3D printing applications.

Published
2024
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38. Caring for Older People As a Social Determinant of Health: Findings from a Scoping Review of Observational Studies

Author

Melanie Stowell, Gemma Frances Spiers, Patience Kunonga, Fiona Beyer, Catherine Richmond, Dawn Craig, and Barbara Hanratty

Subjects
Cohort studies, caring, caregiving, caregiver burden, carers research, ageing, Medicine, Social Sciences
Abstract

Background: Unpaid care is a critical source of support for people with health and social care needs. Unpaid carers are a group facing increasing demands and are at risk of adverse outcomes. Objectives: To assess the breadth of evidence on older carers/carers of older people in UK cohort studies. Methods: Using scoping review methods, we developed a targeted search strategy in three bibliographic databases (Medline, PsycInfo and CINAHL) for studies reporting carer characteristics and outcomes. Data were mapped using Evidence for Policy and Practice Information (EPPI) Reviewer, a web-based programme for managing and analysing data in reviews. The impacts of caring were explored and synthesised. Findings: Eighty-five studies were included. Where studies examined the impact of caring, outcomes were typically health-related; findings were inconsistent. Fewer studies reported the socioeconomic, disability-related, quality of life, or social impacts of caring. Fewer than half of studies reported subgroup analyses or care recipient information, and only five studies stratified carers’ outcomes by a measure of socioeconomic status. Limitations: Relying on data from observational studies means that key outcomes or caring pathways may be overlooked due to data collection methods. We therefore cannot infer causation/reverse causation regarding caring and carer outcomes. Implications: Our work highlights specific gaps in evidence regarding the social, economic, health and quality of life outcomes for carers. We also suggest methodological considerations to improve our understanding of care recipients, carers’ trajectories, and those at greatest risk of adverse outcomes. This information is vital to the development of research design, policies and interventions to support carers’ wellbeing.

Published
2024
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39. Protocol for the 'Supporting Young Cancer Survivors who Smoke' study (PRISM): Informing the development of a smoking cessation intervention for childhood, adolescent and young adult cancer survivors in England.

Author

Morven C Brown, Vera Araújo-Soares, Roderick Skinner, Jamie Brown, Adam W Glaser, Helena Hanratty, Martin G McCabe, Ana-Ecaterina Amariutei, Sabrina Mauri, and Linda Sharp

Subjects
Medicine, Science
Abstract

BackgroundChildhood, adolescent and young adult (CAYA) cancer survivors are vulnerable to adverse late-effects. For CAYA cancer survivors, tobacco smoking is the most important preventable cause of ill-health and early death. Yet, effective strategies to support smoking cessation in this group are lacking. The PRISM study aims to undertake multi-method formative research to explore the need for, and if appropriate, inform the future development of an evidence-based and theory-informed tobacco smoking cessation intervention for CAYA cancer survivors.Materials and methodsPRISM involves three phases of: 1) an environmental scan using multiple strategies to identify and examine a) smoking cessation interventions for CAYA cancer survivors that are published in the international literature and b) current smoking cessation services in England that may be available to, or tailorable to, CAYA cancer survivors; 2) a qualitative study involving semi-structured interviews with CAYA cancer survivors (aged 16-29 years and who are current or recent ex-smokers and/or current vapers) to explore their views and experiences of smoking, smoking cessation and vaping; and 3) stakeholder workshops with survivors, healthcare professionals and other stakeholders to consider the potential for a smoking cessation intervention for CAYA cancer survivors and what such an intervention would need to target and change. Findings will be disseminated to patient groups, healthcare professionals and researchers, through conference presentations, journal papers, plain English summaries and social media.DiscussionPRISM will explore current delivery of, perceived need for, and barriers and facilitators to, smoking cessation advice and support to CAYA cancer survivors from the perspective of both survivors and healthcare professionals. A key strength of PRISM is the user involvement throughout the study and the additional exploration of survivors' views on vaping, a behaviour which often co-occurs with smoking. PRISM is the first step in the development of a person-centred, evidence- and theory-based smoking cessation intervention for CAYA cancer survivors who smoke, which if effective, will reduce morbidity and mortality in the CAYA cancer survivor population.

Published
2024
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41. Lack of regional pathways impact on surgical delay: Analysis of the Orthopaedic Trauma Hospital Outcomes–Patient Operative Delays (ORTHOPOD) study

Author

Stevenson, Iain, Yoong, Andrel, Rankin, Iain, Dixon, James, Lim, Jun Wei, Sattar, Mariam, McDonald, Stephen, Scott, Sharon, Davies, Helen, Jones, Louise, Nolan, Michelle, McGinty, Rebecca, Stevenson, Helene, Bowe, David, Sim, Francis, Vun, James, Strain, Ritchie, Giannoudis, Vasileios, Talbot, Christopher, Gunn, Christopher, Le, Ha Phuong Do, Bradley, Matthew, Lloyd, William, Hanratty, Brian, Lim, Yizhe, Brookes-Fazakerley, Steven, Varasteh, Amir, Francis, Jonathan, Choudhry, Nameer, Malik, Sheraz, Vats, Amit, Evans, Ashish, Garner, Madeleine, King, Stratton, Zbaeda, Mohamed, Diamond, Owen, Baker, Gavin, Napier, Richard, Guy, Stephen, McCauley, Gordon, King, Samuel, Edwards, Gray, Lin, Benjamin, Davoudi, Kaveh, Haines, Samuel, Raghuvanshi, Manav, Buddhdev, Pranai, Karam, Edward, Nimmyel, Enoch, Ekanem, George, Lateef, Razaq, Jayadeep, JS, Crowther, Ian, Mazur, Karolina, Hafiz, Nauman, Khan, Umair, Chettiar, Krissen, Ibrahim, Amr, Gopal, Prasanth, Tse, Shannon, Lakshmipathy, Raj, Towse, Claudia, Al-Musawi, Hashim, Walmsley, Matthew, Aspinall, Will, Metcalfe, James, Moosa, Aliabbas, Crome, George, Abdelmonem, Mohamed, Lakpriya, Sathya, Hawkins, Amanda, Waugh, Dominic, Kennedy, Matthew, Elsagheir, Mohamed, Kieffer, Will, Oyekan, Adekinte, Collis, Justin, Raad, Marjan, Raut, Pramin, Baker, Markus, Gorvett, Alexander, Gleeson, Hannah, Fahmy, John, Walters, Sam, Tinning, Craig, Chaturvedi, Abhishek, Russell, Heather, Alsawada, Osama, Sinnerton, Robert, Crane, Evan, Warwick, Catherine, Dimascio, Lucia, Ha, Taegyeong Tina, King, Thomas, Engelke, Daniel, Chan, Matthew, Gopireddy, Rajesh, Deo, Sunny, Vasarhelyi, Ferenc, Jhaj, Jasmeet, Dogramatzis, Kostas, McCartney, Sarah, Ardolino, Toni, Fraig, Hossam, Hiller-Smith, Ryan, Haughton, Benjamin, Greenwood, Heather, Stephenson, Nicola, Chong, Yuki, Sleat, Graham, Saedi, Farid, Gouda, Joe, Ravi, Sanjeev Musuvathy, Henari, Shwan, Imam, Sam, Howell, Charles, Theobald, Emma, Wright, Jan, Cormack, Jonathan, Borja, Karlou, Wood, Sandy, Khatri, Amulya, Bretherton, Chris, Tunstall, Charlotte, Lowery, Kathryn, Holmes, Benjamin, Nichols, Jennifer, Bashabayev, Beibit, Wildin, Clare, Sofat, Rajesh, Thiagarajan, Aarthi, Abdelghafour, Karim, Nicholl, James, Abdulhameed, Ahmed, Duke, Kathryn, Maling, Lucy, McCann, Matthew, Masud, Saqib, Marshman, James, Moreau, Joshua, Cheema, Kanwalnaini, Rageeb, Peter Morad, Mirza, Yusuf, Kelly, Andrew, Hassan, Abdul, Christie, Alexander, Davies, Angharad, Tang, Cary, Frostick, Rhiannon, Pemmaraju, Gopalakrishna, Handford, Charles, Chauhan, Govind, Dong, Huan, Choudri, Mohammed Junaid, Loveday, David, Bawa, Akshdeep, Baldwick, Cheryl, Roberton, Andrew, Burden, Eleanor, Nagi, Sameer, Johnson-Lynn, Sarah, Guiot, Luke, Kostusiak, Milosz, Appleyard, Thomas, Mundy, Gary, Basha, Amr, Abdeen, Bashar, Robertson-Smith, Bill, Hussainy, Haydar Al, Reed, Mike, Jamalfar, Aral, Flintoft, Emily, McGovern, Julia, Alcock, Liam, Koziara, Michal, Ollivere, Benjamin, Zheng, Amy, Atia, Fady, Goff, Thomas, Slade, Henry, Teoh, Kar, Shah, Nikhil, Al-Obaedi, Ossama, Jamal, Bilal, Bell, Stuart, Macey, Alistair, Brown, Cameron, Simpson, Cameron, Alho, Roberto, Wilson, Victoria, Lewis, Charlotte, Blyth, Daniel, Chapman, Laura, Woods, Lisa, Katmeh, Rateb, Pasapula, Chandra, Youssef, Hesham, Tan, Jerry, Famure, Steven, Grazette, Andrew, Lloyd, Adam, Beaven, Alastair, Jackowski, Anna, Piper, Dani, Lotfi, Naeil, Chakravarthy, Jagannath, Elzawahry, Ahmed, Trew, Christopher, Neo, Chryssa, Elamin-Ahmed, Hussam, Ashwood, Neil, Wembridge, Kevin, Eyre-Brook, Alistair, Greaves, Amy, Watts, Anna, Stedman, Tobias, Ker, Andrew, Wong, Li Siang, Fullarton, Mairi, Phelan, Sean, Choudry, Qaisar, Qureshi, Alham, Moulton, Lawrence, Cadwallader, Craig, Jenvey, Cara, Aqeel, Aqeel, Francis, Daniel, Simpson, Robin, Phillips, Jon, Matthews, Edward, Thomas, Ellen, Williams, Mark, Jones, Robin, White, Tim, Ketchen, Debbie, Bell, Katrina, Swain, Keri, Chitre, Amol, Lum, Joann, Syam, Kevin, Dupley, Leanne, O'Brien, Sarah, Ford, David, Chapman, Taya, Zahra, Wajiha, Guryel, Enis, McLean, Elizabeth, Dhaliwal, Kawaljit, Regan, Nora, Berstock, James, Deano, Krisna, Donovan, Richard, Blythe, Andrew, Salmon, Jennifer, Craig, Julie, Hickland, Patrick, Matthews, Scott, Brown, William, Borland, Steven, Aminat, Akinsemoyin, Stamp, Gregory, Zaheen, Humayoon, Jaibaji, Monketh, Egglestone, Anthony, Sampalli, Sridhar Rao, Goodier, Henry, Gibb, Julia, Islam, Saad, Ranaboldo, Tom, Theivendran, Kanthan, Bond, Georgina, Richards, Joanna, Sanghera, Ranjodh, Robinson, Karen, Fong, Angus, Tsang, Bonita, Dalgleish, James, McGregor-Riley, Jonathan, Barkley, Sarah, Eardley, William, Elhassan, Almutasim, Tyas, Ben, Chandler, Henry, McVie, James, Wei, Nicholas, Negus, Oliver, Baldock, Thomas, Ravi, Kuppuswamy, Qazzaz, Layth, Mohamed, Muawia, Sivayoganthan, Sriharan, Poole, William, Slade, George, Beaumont, Hugo, Beaumont, Oliver, Taha, Rowa, Lever, Caroline, Sood, Abhay, Moss, Maximillian, Khatir, Mohammed, Trompeter, Alex, Jeffers, Aisha, Brookes, Charlotte, Dadabhoy, Maria, Bhattacharya, Rajarshi, Singh, Abhinav, Beer, Alexander, Hodgson, Harry, Rahman, Kashed, Barter, Reece, Mackinnon, Thomas, Frasquet-Garcia, Antonio, Aldarragi, Ameer, Warner, Christian, Pantelides, Christopher, Attwood, Joseph, Al-Uzri, Muntadhir, Qaoud, Qaiys Abu, Green, Stephen, Osborne, Alex, Griffiths, Alexandra, Emmerson, Benjamin, Slater, Duncan, Altahoo, Hasan, Scott, Helen, Rowland, David, O'Donnell, Janine, Edwards, Taff, Hafez, Ahmed, Khan, Basharat, Crane, Emily, Axenciuc, Rostislav, Al-Habsi, Ruqaiya, McAlinden, Gavan, Sterne, Jonathan, Wong, Matthew Lynch, Patil, Sunit, Ridha, Ali, Rasidovic, Damir, Searle, Henry, Choudhry, Jamaal, Farhan-Alanie, Muhamed M, Tanagho, Andy, Sharma, Sidharth, Thomas, Suresh, Smith, Ben, McMullan, Mark, Winstanley, Robert, Mirza, Saqeb, Hamlin, Katharine, Elgayar, Lugman, Larsen, Matthew P, Eissa, Mohamed, Stevens, Samuel, Hopper, Graeme P, Fang Soh, Terrence Chi, Doorgakant, Ashtin, Yogeswaran, Apimaan, Myatt, Darren, Mahon, Joseph, Ward, Nicholas, Reid, Susan, Deierl, Krisztian, Brogan, Declan, Little, Max, Deakin, Sue, Baines, Elliott, Jones, Georgie, Boulton, Helen, Douglas, Trixie, Jeyaseelan, Lucky, Abdale, Abdirizak, Islam, Aminul, Atkinson, Kate V, Mohamedfaris, Khalid, Mmerem, Kingsley, Jamal, Shazil, Wharton, Danielle, Rana, Anurag, McAllister, Ross, Sasi, Sijith, Thomas, Terin, Pillai, Anand, Flaherty, David, Khan, Munir, Akkena, Sudheer, Shandala, Yaseen, Lankester, Benedict, Hainsworth, Louis, Ahmed, Hussam Elamin, Walshaw, Thomas, Walker, Reece, and Eardley, William G.P.

Published
2023
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42. Empagliflozin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Author

Abani, O, Abbas, A, Abbas, F, Abbas, J, Abbas, K, Abbas, M, Abbasi, S, Abbass, H, Abbott, A, Abdallah, N, Abdelaziz, A, Abdelfattah, M, Abdelqader, B, Abdul, A, Abdul, B, Abdul, S, Abdul Rasheed, A, Abdulakeem, A, Abdul-Kadir, R, Abdullah, A, Abdulmumeen, A, Abdul-Raheem, R, Abdulshukkoor, N, Abdusamad, K, Abed El Khaleq, Y, Abedalla, M, Abeer Ul Amna, A, Abel, L, Abernethy, K, Abeywickrema, M, Abhinaya, C, Abidin, A, Aboaba, A, Aboagye-Odei, A, Aboah, C, Aboelela, H, Abo-Leyah, H, Abouelela, K, Abou-Haggar, A, Abouibrahim, M, Abousamra, A, Abouzaid, M, Abraham, M, Abraham, T, Abraheem, A, Abrams, J, Abrams, R, Abu, HJ, Abu-Arafeh, A, Abubacker, SM, Abung, A, Abusamra, Y, Aceampong, Y, Achara, A, Acharya, D, Acheampong, F, Acheampong, P, Acheampong, S, Acheson, J, Achieng, S, Acosta, A, Acquah, R, Acton, C, Adabie-Ankrah, J, Adair, P, Adam, AS, Adam, F, Adam, M, Adamali, H, Adamczyk, M, Adams, C, Adams, D, Adams, K, Adams, L, Adams, N, Adams, R, Adams, T, Adamu-Ikeme, L, Adatia, K, Adcock, K, Addai-Boampong, L, Addo, A, Adeagbo, O, Adebiyi, A, Adedeji, O, Adegeye, Y, Adegoke, K, Adell, V, Adenwalla, S, Adeoye, FW, Adesemoye, OA, Adewunmi, EO, Adeyanju, A, Adeyemi, J, Adeyemo, T, Adhikari, B, Adhikari, SA, Adhikary, R, Aditya, A, Adjepong, P, Adkins, G, Adnan, A, Adriaanse, M, Aeron-Thomas, J, Affleck, D, Afnan, C, Afridi, M, Afrim, P, Afriyie, FA, Aftab, ZA, Afum-Adjei Awuah, A, Agarwal, M, Agasiya, PN, Agbeko, R, Agbo, C, Aggarwal, S, Aghababaie, A, Aguilar Jimenez, L, Agyekum, JA, Agyen, K, Ahadome, EK, Ahamed Sadiq, S, Ahammed Nazeer, MH, Ahmad, M, Ahmad, S, Ahmed, A, Ahmed, BAR, Ahmed, B, Ahmed, F, Ahmed, H, Ahmed, I, Ahmed, K, Ahmed, L, Ahmed, M, Ahmed, MC, Ahmed, MS, Ahmed, N, Ahmed, O, Ahmed, RA, Ahmed, R, Ahmed, S, Ahmed, SG, Ahmed, SH, Ahmed Ali, R, Ahmed Mohamud, B, Ahmer, S, Ahonia, A, Aidoo, C, Aiken, C, Ail, D, Ainsworth, M, Aissa, M, Aitken, L, Ajay, B, Ajibode, A, Ajmi, A, Akhtar, N, Akili, S, Akinbiyi, B, Akindolie, O, Akinfenwa, Y, Akinkugbe, O, Akinpelu, I, Akram, M, Aktinade, O, Akudi, U, Al Aaraj, ASAR, Al Balushi, A, Al Dakhola, M, Al Swaifi, A, Al-Abadi, E, Alabi, A, Aladangady, N, Alafifi, M, Alam, A, Alam, S, Al-Asadi, A, Alatzoglou, K, Albert, P, Albertus, A, Albon, L, Alcala, A, Alcorn, G, Alcorn, S, Aldana, A, Alderdice, D, Aldesouki, A, Aldouri, R, Aldridge, J, Aldridge, N, Ale, RM, Alegria, A, Alexander, A, Alexander, C, Alexander, J, Alexander, PDG, Al-fori, J, Alghazawi, L, Alhabsha, O, Al-Hakim, B, Alhameed, R, Al-Hayali, M, Al-Hity, S, Ali, A, Ali, FR, Ali, J, Ali, M, Ali, MS, Ali, N, Ali, O, Ali, R, Ali, S, Aliberti, E, Alin, J, Alina, A, Alipustain, A, Alisjahbana, B, Aliyuda, F, Alizadeh, K, Al-Jibury, M, Al-Juboori, S, Al-Khalil, M, Alkhudhayri, A, Alkhusheh, M, Allan, F, Allan, N, Allanson, A, Allcock, R, Allen, E, Allen, J, Allen, K, Allen, L, Allen, P, Allen, R, Allen, S, Allen, T, Alli, A, Allison, K, Allman, B, Allsop, HK, Allsop, L, Allsup, D, Almahroos, AFT, Al-Moasseb, H, Al-Obaidi, M, Alomari, L, Al-Rabahi, A, Al-Ramadhani, B, Al-Saadi, Z, Al-Sammarraie, R, Alshaer, I, Al-Shahi Salman, R, Al-Shamkhani, W, Alsheikh, F, Al-Sheklly, B, Altaf, S, Alty, A, Alvarez, M, Alvarez Corral, M, Alveyn, E, Alzetani, M, Amamou, S, Amar, N, Ambalavanan, S, Ambrogetti, R, Ambrose, C, Ameen, A, Amelia Ganefianty, A, Ames, K, Amezaga, MR, Amin, A, Amin, K, Amin, S, Amin, T, Amit, B, Amjad, A, Amjad, N, Amoah-Dankwa, J, Amoako-Adusei, A, Amosun, V, Amsal, M, Amsha, K, Amuasi, J, Amutio Martin, N, Amy, P, Anada, A, Anand, A, Anandappa, S, Anantapatnaikuni, SD, Andari, NKN, Anderson, E, Anderson, J, Anderson, L, Anderson, M, Anderson, N, Anderson, R, Anderson, S, Anderson, W, Andreou, P, Andrews, A, Andrews, J, Aneke, K, Ang, A, Ang, WW, Angel, T, Angela, A, Angelini, P, Anguvaa, L, Anichtchik, O, Anim-Somuah, M, Aniruddhan, K, Annett, J, Anning, L, Ansah, M, Anstey, PJ, Anstey, R, Anthony, A, Anthony-Pillai, A, Antill, P, Antonina, Z, Anu, V, Anwar, M, Anwar, S, Apetri, E, Apostolopoulos, A, Appleby, S, Appleyard, D, Aquino, MF, Araba, B, Aransiola, S, Araujo, M, Archer, A, Archer, D, Archer, S, Arcoria, D, Ardley, C, Arhin-Sam, G, Arias, A-M, Aribike, O, Arimoto, R, Arisanti, NLPE, Arkley, C, Armah, C, Armata, I, Armistead, J, Armitage, A, Armstrong, C, Armstrong, M, Armstrong, S, Armstrong, W, Armtrong, P, Arndt, H, Arnison-Newgass, C, Arnold, D, Arnold, R, Arnott, A, Arora, D, Arora, K, Arora, P, Arora, R, Arter, A, Arthur, A, Artini, NM, Arumaithurai, A, Arya, A, Arya, R, Aryal, D, Asandei, D, Asare, GA, Asghar, A, Asghar, M, Ashab, A, Ashbrook-Raby, C, Ashby, H, Ashcroft, J, Ashcroft, S, Asher, G, Ashfak, Z, Ashfaq, A, Asiamah, HA, Ashish, A, Ashley, D, Ashman-Flavell, S, Ashok, S, Ashour, A-E-A, Ashraf, MZ, Ashraf, S, Ashraq, MB, Ashton, D, Ashton, S, Ashworth, A, Ashworth, FJ, Ashworth, R, Aslam, A, Aslam, I, Aslam, S, Aslett, L, Asogan, H, Asrar, A, Assaf, O, Astin-Chamberlain, R, Atabudzi, YE, Athavale, P, Athorne, D, Atkins, B, Atkins, C, Atkins, S, Atkinson, J, Atkinson, V, Atomode, A, Atraskiewicz, B, Attia, AA, Attubato, E, Attwood, M, Aubrey, P, Auer, Z, Aujayeb, A, Aung, AT, Aung, H, Aung, HWW, Aung, KK, Aung, KT, Aung, N, Aung, Y, Aung, ZM, Austin, E, Austin, K, Auwal, A, Avari, M, Avery, M, Aveyard, N, Avis, J, Aviss, G, Avram, C, Avram, P, Awadelkareem, A, Awadzi, G, Awaly, M, Awan, A, Awisi, S, Aya, A, Ayaz, E, Ayerh, JM, Ayers, A, Azam, J, Azeem, A, Azharuddin, M, Aziz, A, Aziz, G, Aziz, I, Aziz, N, Azkoul, A, Azman Shah, A, Azzopardi, G, Azzoug, H, Babatunde, F, Babi, M, Babiker, B, Babington, G, Babirecki, M, Babores, M, Babs-Osibodu, AO, Bac, T, Bacciarelli, S, Bachar, R, Bachour, M-E, Bachti, A, Bacon, G, Bacon, J, Badal, B, Badat, A, Bader, M, Badhan, GR, Badhrinarayanan, S, Bae, JP, Baggaley, A, Baggott, A, Bagley, G, Bagmane, D, Bagshaw, L, Bahadori, K, Bahurupi, Y, Bailey, A, Bailey, J, Bailey, K, Bailey, L, Bailey, MA, Bailey, M, Bailey, P, Bailey, S, Baillie, H, Baillie, JK, Bain, J, Bains, V, Baird, D, Baird, E, Baird, K, Baird, S, Baird, T, Baird, Y, Bajandouh, A, Baker, DC, Baker, E, Baker, J, Baker, K, Baker, M, Baker, R, Baker, T-A, Baker, V, Bakere, H, Bakerly, N, Baker-Moffatt, M, Bakhai, A, Bakhtiar, N, Bakoulas, P, Bakthavatsalam, D, Balachandran, N, Balan, A, Balasingam, P, Balaskas, T, Balasubramaniam, M, Balatoni, N, Balcombe, A, Baldwin, A, Baldwin, C, Baldwin, D, Baldwin, F, Baldwin-Jones, R, Bale, N, Balfour, J, Ball, M, Ball, Ro, Ballard, K, Balluz, I, Balmforth, C, Balogh, E, Baltmr, A, Baluwala, A, Bambridge, G, Bamford, A, Bamford, P, Bamgboye, A, Bancroft, E, Bancroft, H, Banda, J, Bandaru, K, Bandi, S, Bandla, N, Bandyopadhyam, S, Banerjee, A, Banerjee, R, Bang, P, Baniya, S, Bani-Saad, O, Banks, H, Banks, L, Banks, P, Bann, C, Bannister, H, Bannister, O, Banton, L, Bao, T, Baptist, M, Baqai, T, Baral, AM, Baral, SC, Baramova, D, Barber, R, Barbon, E, Barbosa, M, Barbour, J, Barclay, A, Barclay, C, Bardsley, G, Bareford, S, Bari, S, Barimbing, M, Barker, A, Barker, D, Barker, E, 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Bawa, T, Bawani, FS, Bax, S, Baxter, M, Baxter, N, Baxter, Z, Bayes, H, Bayo, L-A, Bazari, F, Bazaz, R, Bazli, A, Beacham, L, Beadles, W, Beadon, K, Beak, P, Beale, A, Beard, K, Bearpark, J, Beasley, A, Beattie, S, Beaumont, K, Beaumont-Jewell, D, Beaver, T, Beavis, S, Beazley, C, Beck, S, Beckett, V, Beckitt, R, Beckley, S, Beddall, H, Beddows, S, Beeby, D, Beeby, S, Beech, G, Beecroft, M, Beer, N, Beer, Sa, Beety, J, Bega, G, Begg, A, Begg, S, Beghini, S, Begum, A, Begum, S, Behan, T, Behrouzi, R, Beishon, J, Beith, C, Belcher, J, Belfield, H, Belfield, K, Belgaumkar, A, Bell, D, Bell, G, Bell, J, Bell, L, Bell, N, Bell, P, Bell, S, Bellamu, J, Bellamy, M, Bellamy, T, Bellini, A, Bellis, A, Bellis, F, Bendall, L, Benesh, N, Benetti, N, Bengu, SA, Benham, L, Benison-Horner, G, Benkenstein, S, Benn, T, Bennett, A, Bennett, C, Bennett, D, Bennett, G, Bennett, K, Bennett, L, Bennett, MR, Bennett, S, Bennion, K, Benoy, G, Benson, V, Bentley, A, Bentley, J, Benton, I, Beranova, E, 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Yeung, CY, Yew, P, Yewatkar, D, Ylquimiche Melly, L, Ynter, I, Yong, H, Yorke, J, Youens, J, Younes Ibrahim, A, Young, E, Young, G, Young, L, Yousafzar, A, Youssouf, S, Yousuf, A, Yovita, H, Yu, C, Yuan, JSJ, Yufaniaputri, N, Yung, B, Yusef, D, Yusef, S, Yusuf, I, Zafar, A-S, Zagalo, S, Zaher, S, Zahoor, A, Zainab, M, Zak, T, Zaki, K, Zakir, N, Zalewska, K, Zamalloa, A, Zaman, M, Zaman, S, Zamikula, J, Zammit, L, Zammit-Mangion, M, Zawadzka, M, Zayed, M, Zebracki, E, Zehnder, D, Zeidan, L, Zeinali, D, Zhang, J, Zhao, X, Zheng, D, Zhu, D, Zia, M, Zibdeh, O, Zill-E-Huma, R, Zin, ET, Zincone, E, Zindoga, G, Zinkin, E, Zinyemba, V, Zipitis, C, Zitter, L, Zmierczak, A, Zubikarai, G, Zubir, A, Zuhra, N, Zulaikha, R, Zulfikar, S, Zullo, C, and Zuriaga-Alvaro, A

Published
2023
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43. Patient Pill Organization Strategies and Adherence Measured in a Cross-Sectional Study of Hypertension

Author

Genelin MP, Helmkamp LJ, Steiner JF, Maertens JA, Hanratty R, Vupputuri S, Havranek EP, Dickinson LM, Blair IV, and Daugherty SL

Subjects
hypertension, medication adherence, management strategies, organization strategies, medication management behaviors, chronic disease, pill count, pharmacy-fill, self-reported adherence, Medicine (General), R5-920
Abstract

Matthew P Genelin,1 Laura J Helmkamp,2 John F Steiner,1,3 Julie A Maertens,2 Rebecca Hanratty,1,4 Suma Vupputuri,5 Edward P Havranek,1,4,6 L Miriam Dickinson,1,2 Irene V Blair,7 Stacie L Daugherty1– 3,6 1University of Colorado School of Medicine, Aurora, CO, USA; 2Adult and Child Consortium for Outcomes Research and Delivery Sciences (ACCORDS), University of Colorado, Aurora, CO, USA; 3Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA; 4Department of Medicine, Denver Health and Hospital Authority, Denver, CO, USA; 5Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA; 6Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA; 7Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USACorrespondence: Matthew P Genelin, University of Colorado School of Medicine, 3500 Rockmont Drive, &num;15-209, Denver, CO, 80202, USA, Email matthew.genelin@cuanschutz.eduBackground: The strategies patients use to organize medications (eg, pill dispenser) may be reflected in adherence measured at follow-up. We studied whether medication organization strategies patients use at home are associated with adherence measured using pharmacy-fills, self-report, and pill counts.Design: Secondary analysis of data from a prospective randomized clinical trial.Setting: Eleven US safety-net and community primary care clinics.Patients: Of the 960 enrolled self-identified non-Hispanic Black and White patients prescribed antihypertensive medications, 731 patients reported pill organization strategies and were included.Variable: Patients were asked if they use any of the following medication organization strategies: finish previous refills first; use a pill dispenser; combine same prescriptions; or combine dissimilar prescriptions.Outcomes: Adherence to antihypertensive medications using pill counts (range, 0.0– 1.0% of the days covered), pharmacy-fill (proportion of days covered > 90%), and self-report (adherent/non-adherent).Results: Of the 731 participants, 38.3% were men, 51.7% were age ≥ 65, 52.9% self-identified as Black or African American. Of the strategies studied, 51.7% finished previous refills first, 46.5% used a pill dispenser, 38.2% combined same prescriptions and 6.0% combined dissimilar prescriptions. Median (IQR) pill count adherence was 0.65 (0.40– 0.87), pharmacy-fill adherence was 75.7%, and self-reported adherence was 63.2%. Those who combined same prescriptions had significantly lower measured pill count adherence than those who did not (0.56 (0.26– 0.82) vs 0.70 (0.46– 0.90), p< 0.01) with no significant difference in pharmacy-fill (78.1% vs 74%, p=0.22) or self-reported adherence (63.0% vs 63.3%, p=0.93).Conclusion: Self-reported medication organization strategies were common. Combining same prescriptions was associated with lower adherence as measured using pill counts but not pharmacy-fills or self-report. Clinicians and researchers should identify the pill organization strategies used by their patients to understand how these strategies may influence measures of patient adherence.Trial Registration: ClinicalTrials.gov NCT03028597; https://clinicaltrials.gov/ct2/show/NCT03028597 (Archived by WebCite at http://www.webcitation.org/72vcZMzAB).Keywords: hypertension, medication adherence, management strategies, organization strategies, medication management behaviors, chronic disease, pill count, pharmacy-fill, self-reported adherence

Published
2023

44. Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis

Author

Anum Iqbal, Charlotte Richardson, Zain Iqbal, Hannah O’Keefe, Barbara Hanratty, Fiona E. Matthews, and Adam Todd

Subjects
Medication Usage, Socioeconomic Status, Health Inequalities, Polypharmacy, Ageing, Meta-analysis, Geriatrics, RC952-954.6
Abstract

Abstract Background Socioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between polypharmacy and an individual’s socioeconomic status. Methods A systematic review and meta-analyses of observational studies was conducted across four databases. Older people (≥ 55 years) from any healthcare setting and residing location were included. The search was conducted across four databases: Medline (OVID), Web of Science, Embase (OVID) and CINAHL. Observational studies from 1990 that reported polypharmacy according to SES were included. A random-effects model was undertaken comparing those with polypharmacy (≥ 5 medication usage) with no polypharmacy. Unadjusted odds ratios (ORs), 95% confidence intervals (CIs) and standard errors (SE) were calculated for each study. Results Fifty-four articles from 13,412 hits screened met the inclusion criteria. The measure of SES used were education (50 studies), income (18 studies), wealth (6 studies), occupation (4 studies), employment (7 studies), social class (5 studies), SES categories (2 studies) and deprivation (1 study). Thirteen studies were excluded from the meta-analysis. Lower SES was associated with higher polypharmacy usage: individuals of lower educational backgrounds displayed 21% higher odds to be in receipt of polypharmacy when compared to those of higher education backgrounds. Similar findings were shown for occupation, income, social class, and socioeconomic categories. Conclusions There are socioeconomic inequalities in polypharmacy among older people, with people of lower SES significantly having higher odds of polypharmacy. Future work could examine the reasons for these inequalities and explore the interplay between polypharmacy and multimorbidity.

Published
2023
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46. Reading 'Rebecca' in the Sixth-Form Classroom: Some Literary-Critical and Pedagogical Explorations

Author

Hanratty, Brian

Abstract

While "Rebecca" is not currently a set text for A-Level English Literature, this paper argues that the novel's multi-faceted richness would justify its inclusion in any list of recommended texts. Divided into four interconnected parts, the paper offers, firstly, some approaches to the reading and teaching of fiction, generally. The second part presents some framing contexts for illuminating many of "Rebecca's" preoccupations. These include: ideas about the Gothic tradition and the presentation of Fatal Women in some Romantic literature; some considerations about patriarchy, misogyny, gender and identity; finally, attention is given to the intersection between dream and reality in "Rebecca" and to the idea of obsession and the double self in two other works by Du Maurier. In the third part, more detailed attention is given to the presentation of character in the novel. The fourth part explores some pedagogical approaches to the novel in the sixth-form classroom.

Published
2022
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48. Data Collection in Care Homes for Older Adults: A National Survey in England

Author

Barbara Hanratty, Arne Timon Wolters, Ann-Marie Towers, Karen Spilsbury, Julienne Meyer, Anne Killett, Liz Jones, Adam Gordon, Jennifer Kirsty Burton, Gizdem Akdur, Lisa Irvine, Krystal Warmoth, Jennifer Liddle, and Claire Goodman

Subjects
aged, nursing homes, long-term care, data collection, minimum datasets, Medicine, Social Sciences
Abstract

Context: In many countries, there is a specification for information that should be collected by care homes. So-called ‘minimum data-sets’ (MDS) are often lengthy, and report on resident health and wellbeing, staff, and facilities. In the UK, the absence of any easily accessible data on the care home population was highlighted at the start of the COVID-19 pandemic. Care homes faced multiple requests for data from external agencies who had little knowledge of what care homes were already collecting. Objective: This study aimed to identify the range (and method) of data collected by care home organisations, in a country without a mandated MDS. Methods: Online survey of care homes (with/without nursing) in England. Care homes recruited via research and care home networks, social media. Questions covered data content, storage, and views on data sharing, analysed with descriptive statistics. Findings: 273 responses were received, representing over 5,000 care homes. Care homes reported extensive data on the health, care and support needs of individual residents, their preferences, and activities. Clinical measures and tools adopted from health were commonly used, but few collected information on quality-of-life. Care homes reported uses of these data that included monitoring care quality, medication use, staff training needs, budgeting, and marketing. Concerns over privacy and data protection regulations are potential barriers to data sharing. Implications: These findings challenge the notion that incentives or mandates are required to stimulate data collection in care homes. Care home organisations are collecting an extensive range of resident-level information for their own uses. Countries considering introducing social care records or an MDS could start by working with care home organisations to review existing data collection and evaluate the implications of collecting and sharing data. A critical approach to the appropriateness of health-related tools in this setting is overdue.

Published
2023
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49. Psychological and psychosocial determinants of COVID Health Related Behaviours (COHeRe): An evidence and gap map

Author

Jennifer Hanratty, Ciara Keenan, Sean R. O'Connor, Rachel Leonard, Yuan Chi, Janet Ferguson, Ariana Axiaq, Sarah Miller, Declan Bradley, and Martin Dempster

Subjects
Social Sciences
Abstract

Abstract Background The COVID‐19 pandemic, caused by the SARS‐CoV‐2 virus, has resulted in illness, deaths and societal disruption on a global scale. Societies have implemented various control measures to reduce transmission of the virus and mitigate its impact. Individual behavioural changes are crucial to the successful implementation of these measures. Common recommended measures to limit risk of infection include frequent handwashing, reducing the frequency of social interactions and the use of face coverings. It is important to identify those factors that can predict the uptake and maintenance of these protective behaviours. Objectives We aimed to identify and map the existing evidence (published and unpublished) on psychological and psychosocial factors that determine uptake and adherence to behaviours aimed at reducing the risk of infection or transmission of COVID‐19. Search Methods Our extensive search included electronic databases (n = 12), web searches, conference proceedings, government reports, other repositories including both published peer reviewed, pre‐prints and grey literature. The search strategy was built around three concepts of interest including (1) context (terms relating to COVID‐19), (2) behaviours of interest and (3) terms related to psychological and psychosocial determinants of COVID Health‐Related Behaviours and adherence or compliance with recommended behaviours, to capture both malleable and non‐malleable determinants (i.e. determinants that could be changed and those that could not). Selection Criteria This Evidence and Gap Map (EGM) includes all types of studies examining determinants of common recommended behaviours aimed at mitigating human‐to‐human spread of COVID‐19. All potential malleable and non‐malleable determinants of one or more behaviours are included in the map. As part of the mapping process, categories are used to group determinants. The mapping categories were based on a previous rapid review by Hanratty 2021. These include: ‘behaviour’, ‘cognition’, ‘demographics’, ‘disease’, ‘emotions’, ‘health status’, ‘information’, ‘intervention’, and ‘knowledge’. Those not suitable for categorisation in any of these groups are included in the map as ‘other’ determinants. Data Collection and Analysis Results were imported to a bibliographic reference manager where duplications of identical studies gathered from multiple sources were removed. Data extraction procedures were managed in EPPI‐Reviewer software. Information on study type, population, behaviours measured and determinants measured were extracted. We appraised the methodological quality of systematic reviews with AMSTAR‐2. We did not appraise the quality of primary studies in this map. Main Results As of 1 June 2022 the EGM includes 1034 records reporting on 860 cross‐sectional, 68 longitudinal, 78 qualitative, 25 reviews, 62 interventional, and 39 other studies (e.g., mixed‐methods approaches). The map includes studies that measured social distancing (n = 487), masks and face coverings (n = 382), handwashing (n = 308), physical distancing (n = 177), isolation/quarantine (n = 157), respiratory hygiene/etiquette (n = 75), cleaning surfaces (n = 59), and avoiding touching the T‐zone (n = 48). There were 333 studies that assessed composite measures of two or more behaviours. The largest cluster of determinants was ‘demographics’ (n = 730 studies), followed by ‘cognition’ (n = 496 studies) and determinants categorised as ‘other’ (n = 447). These included factors such as ‘beliefs’, ‘culture’ and ‘access to resources’. Less evidence is available for some determinants such as ‘interventions’ (n = 99 studies), ‘information’ (n = 101 studies), and ‘behaviour’ (149 studies). Authors' Conclusions This EGM provides a valuable resource for researchers, policy‐makers and the public to access the available evidence on the determinants of various COVID‐19 health‐related behaviours. The map can also be used to help guide research commissioning, by evidence synthesis teams and evidence intermediaries to inform policy during the ongoing pandemic and potential future outbreaks of COVID‐19 or other respiratory infections. Evidence included in the map will be explored further through a series of systematic reviews examining the strength of the associations between malleable determinants and the uptake and maintenance of individual protective behaviours.

Published
2023
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50. UPDATED PROTOCOL: Universal school‐based programmes for improving social and emotional outcomes in children aged 3–11 years: An evidence and gap map

Author

Jennifer Hanratty, Sarah Miller, Leonor Rodriguez, Paul Connolly, Jennifer Roberts, Seaneen Sloan, Aoibheann Brennan‐Wilson, Daragh Bradshaw, Christopher Coughlan, Nicole Gleghorne, Laura Dunne, Sharon Millen, Aimee Smith, and Cadhla O'Sullivan

Subjects
Social Sciences
Abstract

Abstract This is the protocol for an evidence and gap map. The objective of this EGM is to identify and map all primary studies (including randomised and cluster randomised trials) and systematic reviews on universal, school‐based social and emotional learning programmes for young children (3–11 years) to create a live, searchable, and publicly available evidence and gap map.

Published
2023
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