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3. IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) in primary care: study protocol for a cluster randomised controlled implementation trial

Author

McClatchey, Kirstie, Hammersley, Vicky, Steed, Liz, Sheringham, Jessica, Marsh, Viv, Barat, Atena, Delaney, Brigitte, Hamborg, Thomas, Fitzsimmons, Deborah, Holmes, Steve, Jackson, Tracy, Ehrlich, Elisabeth, Morgan, Noelle, Saxon, Ann, Preston, Megan, Price, David, Taylor, Stephanie J. C., and Pinnock, Hilary

Published
2023
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5. Chronic Pain

Author

Murphy, Melisa Z., Jackson, Tracy P., Mishra, Puneet, Edwards, David A., editor, Gulur, Padma, editor, and Sobey, Christopher M., editor

Published
2022
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6. Impact of financial incentives on the implementation of asthma self-management in primary care in Northern Ireland : a mixed methods programme of work

Author

Jackson, Tracy, Pinnock, Hilary, and Kendall, Marilyn

Subjects
asthma, self-management, financial incentive schemes
Abstract

Introduction: Asthma is a common chronic respiratory condition which is responsible for substantial morbidity and economic impact. Supported self-management including asthma action plans improves asthma control, minimises exacerbations and reduces the use of emergency healthcare resources. Despite this evidence an Asthma UK survey (2013) identified that less than a quarter of people with asthma owned an action plan. The exception is Northern Ireland, where a Local Enhanced Service (LES) introduced in 2008 has provided financial incentives to primary care practices for providing asthma action plans; ownership was reported by 63% of individuals with asthma surveyed. Aims and objectives: The aim of this PhD was to 1) systematically review the evidence investigating the impact of financial incentives on implementation outcomes, health outcomes and individual behaviour outcomes for individuals with asthma or diabetes 2) observe trends in implementation and health outcomes associated with the introduction of the LES and 3) explore the process by which organisational change was implemented in primary care in Northern Ireland from the perspective of primary care staff. Methods: The programme of work proceeded in three phases: 1. Following Cochrane methodology, I systematically reviewed the evidence investigating the impact of financial incentives on provision of supported self-management in asthma and diabetes (another long-term condition with a robust evidence base) on implementation outcomes (action plan ownership); health outcomes (asthma control/attacks) and individual behaviour outcomes (self-efficacy). I used a Population, Intervention, Comparison, Outcome and Setting (PICOS) search strategy and duplicate screening, data extraction and Downs' and Black's (1998) quality assessment. Studies were weighted by robustness of design, number of participants and the quality score. Narrative synthesis was conducted due to heterogeneity of studies. 2. I explored the context of Northern Ireland and its healthcare system using routine data to observe trends in: asthma-related hospitalisations; asthma-related deaths and asthma action plan provision across Northern Ireland over a five-year period. 3. In the qualitative phase, I conducted telephone interviews with a representative involved with delivering the LES in up to 20 primary care practices and undertook four case studies involving in-depth interviews with clinical and administrative staff members and document analysis. The Adams et al (2014) financial incentives framework underpinned the topic guide; interviews were recorded, transcribed verbatim and analysed using two approaches: a. Grounded Theory approach to explore primary care staff perceptions of the LES and self-management for asthma. b. Framework approach informed by the Normalization Process Theory (NPT) (May et al., 2009). Results: 1. I included 12 studies (from 2,541 initial hits) in the systematic review. Results were mixed. Delivery of care improved in three diabetes studies; was unchanged in six and deteriorated in one. There were fewer hospitalisations/emergency department visits in one diabetes study. In the one asthma study, the proportion of patients receiving an action plan increased from 4% to 88%, but health outcomes were not measured. Authors highlighted the importance of context when implementing a financial incentive scheme. 2. Routine LES data were available from 2011; deaths since 2008. Asthma action plan provision has remained high in Northern Ireland since 2011/2012 with primary care reporting 76% of eligible patients having been provided an asthma action plan. Asthma related hospital admissions have increased between 2011/12 and 2015/16 by over 300 admissions/year. There were 31 deaths in 2008 and this has fluctuated over the years with no clear trend. 3. Fifteen semi-structured telephone interviews, six individual in-depth interviews and two group interviews were conducted with 23 participants (five general practitioners; five nurses; 13 administrative staff) from 15 primary care practices. Four of the participants in the scoping semi-structured interviews also took part in either an individual in-depth interview or a group interview. Themes were agreed in discussion with a multi-disciplinary group which included contributions from the primary care, secondary care and patient perspective. a. Themes clustered around targeting poor asthma control; communicating with patients; strategies for achieving targets; financial incentives. All participants highlighted the difficulty of getting patients with asthma to attend appointments, with some expressing feelings of frustration at lack of patient involvement and uncertainty of how to improve patient engagement, particularly in patients with poorly controlled asthma. b. Processes created since the introduction of the LES appear successfully embedded into primary care practice routines. Working together in multi-disciplinary teams was frequently discussed by participants in relation to the scheme, from inception to implementation and delivery in primary care practices. Significant support from the Public Health Agency and pharmaceutical companies in providing funding and training for nurses was acknowledged as a key to the successful embedding of new processes for asthma self-management, but there was concern regarding reduction in funding from both of these sources and the impact on the future provision of asthma self-management education in primary care. Asthma care was identified as a nurse-led process. Participants were generally positive about receiving financial incentives for the extra work undertaken, however the payments were viewed as necessary in able to complete the additional work required by the financial incentive scheme. Providing the best quality of care for patients, however, was the frequently cited as the main motivator for clinical staff. Conclusions: Financial incentive schemes have inconsistent impact on implementation and health outcomes; context is likely to be an important factor in determining success. In Northern Ireland, three quarters of people with asthma have been provided with an action plan over the last five years of the LES; alongside a possible trend to an increase in asthma-related hospital admissions and deaths. The financial incentives of the LES were received positively by primary care staff; however patient health was the highest priority when delivering care. Primary care staff identified multi-disciplinary teamwork throughout the lifespan of the LES as key to its "normalization", which was now so embedded that concerns were expressed regarding threats to funding and withdrawal of external support. Understanding how practices reacted to the LES and normalized this healthcare scheme could inform further policy on similar initiatives.

Published
2019

7. Diagnosis and Treatment of Spontaneous Intracranial Hypotension

Author

Callen, Andrew L., primary, Friedman, Deborah I., additional, Parikh, Simy, additional, Rau, Jill C., additional, Schievink, Wouter I., additional, Cutsforth-Gregory, Jeremy K., additional, Amrhein, Timothy J., additional, Haight, Elena, additional, Cowan, Robert P., additional, Barad, Meredith J., additional, Hah, Jennifer M., additional, Jackson, Tracy, additional, Deline, Connie, additional, Buchanan, Andrea J., additional, and Carroll, Ian, additional

Published
2024
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8. Dipeptidyl peptidase-1 inhibition in patients hospitalised with COVID-19: a multicentre, double-blind, randomised, parallel-group, placebo-controlled trial

Author

Chalmers, James, Abo-Leyah, Hani, New, Benjamin JM, Almaden-Boyle, Christine, Connell, David, Taylor, Jennifer, Strachan, Jodie, Loftus, Heather, Young, Lesley, Strachan, Angela, Band, Margaret, McLaren-Neil, Fiona, Pilvinyte, Kristina, Adamson, Simon, Lahnsteiner, Eva, Rauchhaus, Petra, Hogarth, Fiona, George, Jacob, Burns, Tricia, Coote, Elizabeth, Keiller, Marney, Patel, Manish, Smith, Andrew, Sage, Elizabeth, Cooper, Jamie, Miller, David, Dosanjh, Davinder, Sutton, Benjamin, Underwood, Jonathan, Frayling, Sharon, Haynes, Matthew, Broad, Lauren, Jones, Laura, Rahilly, Karen, Oliver, Catherine, Evans, Terriann, Balan, Andrea, Davies, Rhys, Forde, Donal, Nye, Clemency, Haboubi, Dr, Hilton, Zoe, Williams, Jennie, McQueen, Alison, Spears, Mark, Edmond, Ian, Salutous, Dario, McGenily, Laura, Scott, Rhona, Henderson, Eilidh, Collins, Andrea, Dhasmana, Devesh, Liu, Patrick, Morrow, Ana, Couser, Mandy, Davey, Fleur, Hicks, Alexander, Wiffen, Laura, Fox, Lauren, Abdelrahim, Mohamed, Darbyshire, Alexander, Cowen, Elena, Rowley, Megan, Giles, Benjamin, Yang, Yingjia, Brown, Tom, Rupani, Hitasha, Hawes, Elizabeth, Barnes, Debi, Brogan, Fiona, Bungue-Tuble, Roneleeh, Howe, Serena, Turner, Charlotte, Baryschpolec, Sonia, Longhurst, Bev, Moon, Maria, Watkins, Lynn, Baker-Moffat, Michelle, Murray, Lisa, Harrington-Davies, Yasmin, Burrows, Kate, Minnis, Chrissie, Wands, Mary, Bamgboye, Adefunke, Wong, Charlotte, Brightling, Christopher, Diver, Sarah, Russell, Richard, McAuley, Hamish, Elneima, Omer, Yousuf, Ahmed, McCourt, Paula, Hargadon, Beverley, Parker, Sarah, Bourne, Michelle, Suntharalingam, Jay, Hartley, Tom, Masan, Vidan, Sturney, Sharon, MacKenzie, Rob, Marchand, Clare, Mason, Rebecca, White, Katie, Kirby, Alison, Meda, Manjula, Diwakar, Lavanya, Russell, Peter, Finn, Joanne, Harris, Sophie, Muir, Carol, Cook, Gemma, Staines, Nikki, Cook, Chris, Thompson, AA Roger, Condliffe, Alison, Hull, Rebecca, Dowey, Rebecca, Turton, Helena, Collini, Paul, Gabriel, Zoé, Hardman, Simon, Newell, Helen, Middle, Janet, Simpson, Phillip, Colton, Hayley, Barker, Joann, Birchall, Katie, Harrington, Kate, Housley, Kay, Lenagh, Rebecca, Wilson, Jayne, Wesonga, Joan, Whitham, Rachel, Bird, Sarah, Jackson, Yvonne, Mbuyisa, Angeline, Anderson, Samantha, Wilson, Anna, Kibutu, Faith, Walker, Sara, Cawthron, Kay, Macharia, Irene, Smart, Lynne, Emery, Anna, Howell, Alice, Hurditch, Elizabeth, Ford, Amber, Turner, Kim, Watson, Lisa, Bowler, Helen, Jackson, Tracy, Jaques, Carol, Dyer, Nichole, Ducker, Shelley, Goodall, Vicky, Udale, Emily, Keir, Holly R, Long, Merete B, Giam, Yan Hui, Vadiveloo, Thenmalar, Pembridge, Thomas, Hull, Rebecca C, Delgado, Lilia, Gilmour, Amy, Hughes, Chloe, Richardson, Hollian, Cassidy, Diane, Dosanjh, Davinder PS, Sage, Beth, Condliffe, Alison M, Shoemark, Amelia, MacLennan, Graeme, and Chalmers, James D

Published
2022
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9. Protocol for a multicenter, double-blinded placebo-controlled randomized controlled trial comparing intravenous ferric derisomaltose to oral ferrous sulfate for the treatment of iron deficiency anemia in pregnancy: The IVIDA2 trial

Author

Lewkowitz, Adam K., Stout, Molly J., Carter, Ebony B., Ware, Crystal F., Jackson, Tracy L., D'Sa, Viren, Deoni, Sean, Odibo, Anthony O., Gopalakrishnan, Riley, Liu, Jingxia, Rouse, Dwight J., Auerbach, Michael, and Tuuli, Methodius G.

Published
2022
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10. Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial

Author

Emsley, Richard, Peat, George, Snow, Martyn, Campbell, Marion, Howell, Tessa, Johnson, Hilary, McDonnell, Stephen, Pinkney, Thomas, Williams, Mark, Campbell, Helen, Davies, Jackie, Li, Jiyang, Bagg, Christina, Haywood, Laura, Nicholson, Anne, Riches, Joanne, Symons, Sean, Vertue, Mark, Al Mouazzen, Louay, Bray, Rachel, Clark, Damian, Coulthard, James, Holland, Tim, Howells, Nick, Jones, Andrew, Kapur, Richard, Kiszely, Alastair, Krishnan, Harry, MacDonald-Taylor, Karen, Manara, Jon, Murray, James, Negrut, Corina, Pai, Vishai, Porteous, Andrew, Putnis, Sven, Robinson, James, Rupasinghe, Shav, Selvaratnam, Veenesh, Smith, James, Smith, Nick, Stevens, Jarrad, Taylor, Clare, Theodorides, Anthony, Vetharajan, Niraj, Vint, Helen, Young, Lucy, Bullock, Susan, Cook, Rebecca, Dodds, Alexander, Freeman-Hicks, Amanda, Hillout, Paula, Cornell, Thomas, Coutts, Abbie, Dean, Suzy, Devooght-Johnson, Nicki, Ferrell, Emma, Fletcher, Eve, Hall, Chrissie, Kent, Benjamin, Kessly, Sandra, Kincaid, Robin, Lazizi, Mohamed, Mostafa, Ahmed, Nisbett, Toby, Powell, Tim, Riddlestone, Peter, Roberton, Andrew, Summers, Jessica, Whitbread, Lucy, Wroath, Belinda, Fenlon, Emma, Hall, Andrew, Jeffrey, Helen, Thonse, Raghuram, Dunne, Debra, Metcalfe, Andy, McGowan, Kerri, Middleton, Simon, Shah, Feisal, Spalding, Tim, Marie Suddens, Charlie, Sweed, Tamar, Teuke, Joanna, Thompson, Peter, Wright, David, Amero, Justine, Brown, Emma, Chissell, Hugh, Croucher, Andrea, Dickinson, Gareth, Hawkes-Blackburn, Catherine, Peacocke, Alice, Smith, Graham, Snipe, Carol, Dearnley, Kim, Mayahi, Reza, Andrews, Barry, Barcelona, Massimo, Giles, Hazel, Gokturk, Abdulkerim, Harnett, Paul, Jeeves, Katie, Kadunyi, Joyce, Mendoza, Sheena, Reichert, Ines, Santamaria, Marta, Virdee, Harshinder, Anand, Sanjeev, Aslam-Pervez, Nayef, Draycott, Stephen, Howarth, Faye, Jina, Irfan, Maher, Niall, Ross, Denise, Worstenholme, Lindsey, Baig, Abdul, Bhaskaran, Arun, Banks, Daniel, Brear, Tracy, Christie, Carla, Cowen, Laura, Davis, Jack, Dixey, Ross, Esler, Colin, Essop-Adam, Amirah, Haines, Christina, Houchen-Wolloff, Linzy, Varachia, Husein, Wood, Richard, Gray, Glaxy, Nichols, Jessica, Panes, Alice, Partridge, Susan, Rogerson, Lawrie, Sharma, Pankaj, Triggs, David, Venables, Ian, Wilcock, Danielle, Buckley, Sarah, Darian, Thelma, Denis, Elizabeth, Duncan, Jo, Hirst, Charlotte, Newman, James, Richardson, Fern, Smith, Jon, Adcode, Megan, Cottingham, Megan, Foster, Eliza, Kelly, Andrew, McKay, Niamh, Rewbury, Jane, Whitcher, Alison, Williams, James, Zebracki, Esther, Davies, Llinos, Jayachandran, Jayadeep, Tardivel, Alison, Whitehead, Victoria, Batting, Martha, Bond, Amy, Deakin, Marc, Dodd, Christopher, Hudak, Alison, Hynes, Samantha, Jones, Luke, Lang, Gail, McKenna, David, Morris, Susan, Scott-Dempster, Clare, Sykes, Adam, Vichos, Iason, Wood, Simon, Clifton, Rupert, Diaz, Stephanie, Hendy, Craig, Modi, Nishil, O'Mahony, Brendan, O'Sullivan, Susan, Parker, Nicola, Pecheva, Mira, Rumonovic, Rowan, McLoughlin, Emma, Rushbrook, Jeremy, Thornhill, Anna, Parkinson, Valerie, Sales, Rafael, Van De Snepscheut-Jones, Katja, Wilcock, David, Wright, Daniel, Allison, Joanna, Baker, Simon, Beesley, Kate, Ferrari, Gill, Lankester, Benedict, Lewis, Alison, Lyons, Joanne, O'Callaghan, Jamie, Sutcliffe, Sarah, Wood, Dianne, Bannister, Emily, Brown, Chloe, Burden, Debbie, Campbell, Terence, Craig, Emma, Easow, Rashmi, Foxton, Julie, Hazlerigg, Alexandra, Jayabev, Chethan, Murdoch, Rosie, Parsons, Georgie, Brown, Harry, Carvelli, Paula, Montaser, Rugaia, Pepper, Ali, Sivarajan, Sinduja, Templeton-Ward, Oliver, Wilson, Eva, Cronin, Julie, Diment, Sarah, King, Victoria, Shean, Katharine, Vachtsevanos, Leonidas, Wilcocks, Katharine, Wilson, Ben, McNestry, Paul, Ollerenshaw, Joanna, Stoddard, James, Sutton, Paul, Anand, Sanjay, Bell, Judith, Chikate, Albert, Daniel, Diane, Davies, Timothy, Finnigan, Tom, Frasquet-Garcia, Antonio, Hopkins, Susan, Kerrison, Sharon, McGowan, Angela, Sands Johnson, David, Smith, Lara, Turner, Philip, Wilkinson, Helen, Allsop, Lynne, Anthony, Deborah, Boulton, Rebecca, Brown, Sarah, Desai, Vikram, Gill, Mandy, Heeley, Cheryl, Kulkarni, Sushrut, Lovegrove, Wayne, Nash, Dominic, Ann Sewell, Terri, Shelton, Sarah, Slack, Katie, Cartwright, James, Connor, Lynda, Davies, Andrew, Davies, Caroline, Gainard, Glyn, Graham-Woollard, Dave, Murphy, Carl, Quinn, Leanne, Thomas, Caradog, Travers, Jenny, Williams, Marie, Bell, Amanda, Deo, Sunny, Francis, Katharine, Jackson, Tracy, McCafferty, Laura, Navadgi, Basalingappa, Plank, Karan, Satish, Venkat, Thelwall, Claire, Knight, Rachel, Patel, Rahul, Paton, Bruce, Acharya, Ashutosh, Aland, Utuman, Areirobulos, Miltiades, de Feyter, Pascal, Ditchfield, Lisa, Iqbaz, Hafiz, Massey, Daniel, Stables, Gareth, Appleby, Sarah, Brown, Michael, Cable, Sarah, Damen, Alexander, Da Rocha, Joana, Foster, Louise, Hamilton, Elizabeth, Hatton, Catriona, Honeywell, Cassie, Kulkarni, Kunal, Markham, Lucy, Mohammed, Haadiya, O'Grady, John, Joshi, Yogesh, Mclintock, Heather, Morgan, Tania, Stockport, Jane, Agrawal, Pranshu, Armstrong, Jo, Briggs, Shannon, Coupe, Ben, Evans, Anne, Gilbert, Rob, Latham, Sandra, Mohammed, Aslam, Beard, David J, Davies, Loretta, Cook, Jonathan A, Stokes, Jamie, Leal, Jose, Fletcher, Heidi, Abram, Simon, Chegwin, Katie, Greshon, Akiko, Jackson, William, Bottomley, Nicholas, Dodd, Matt, Bourke, Henry, Shirkey, Beverly A, Paez, Arsenio, Lamb, Sarah E, Barker, Karen, Phillips, Michael, Brown, Mark, Lythe, Vanessa, Mirza, Burhan, Carr, Andrew, Monk, Paul, Morgado Areia, Carlos, O'Leary, Sean, Haddad, Fares, Wilson, Chris, and Price, Andrew

Published
2022
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30. Mental Health Status of Rhode Island Middle School and High School Students Before Versus During the COVID‐19 Pandemic.

Author

Murdock, Abigail R., Rogers, Michelle L., Jackson, Tracy L., Monteiro, Karine, and Chambers, Laura C.

Subjects
SUICIDE risk factors, COVID-19, CROSS-sectional method, ADOLESCENT health, SUICIDAL ideation, SADNESS, HIGH school students, QUESTIONNAIRES, MULTIPLE regression analysis, DESCRIPTIVE statistics, MIDDLE school students, ODDS ratio, RACE, DESPAIR, HUMAN comfort, SOCIAL support, COMPARATIVE studies, SOCIODEMOGRAPHIC factors, SEXUAL minorities, PSYCHOSOCIAL factors, COVID-19 pandemic
Abstract

Background: The COVID‐19 pandemic negatively affected adolescent mental health due to school closures, isolation, family loss/hardships, and reduced health care access. Methods: We compared adolescent mental health in Rhode Island before versus during the pandemic, separately among middle and high schoolers. This serial cross‐sectional study used Youth Risk Behavior Survey data from 2019 and 2021 (N = 7403). Multivariable logistic regression models estimated the association between year and mental health status, adjusting for sociodemographics. Results: Middle schoolers in 2021 had higher odds of ever seriously considering suicide (22.6% vs 16.7%) and ever attempting suicide (9.3% vs 6.1%) compared to 2019. Among high schoolers, those in 2021 had higher odds of experiencing persistent sadness/hopelessness in the past year (37.4% vs 32.0%). However, high schoolers in 2019 and 2021 had similar odds of considering suicide in the past year, while those in 2021 had lower odds of having attempted suicide in the past year (8.5% vs 14.6%). Conclusion: The COVID‐19 pandemic may have worsened multiple aspects of adolescent mental health in Rhode Island, particularly among middle schoolers. Implications for school health policy, practice, and equity: Promoting school connectedness, creating supportive environments, and diversifying the mental health workforce may help overcome adverse pandemic effects. [ABSTRACT FROM AUTHOR]

Published
2024
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41. IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) in primary care:study protocol for a cluster randomised controlled implementation trial

Author

McClatchey, Kirstie, Hammersley, Vicky, Steed, Liz, Sheringham, Jessica, Marsh, Viv, Barat, Atena, Delaney, Brigitte, Hamborg, Thomas, Fitzsimmons, Deborah, Holmes, Steve, Jackson, Tracy, Ehrlich, Elisabeth, Morgan, Noelle, Saxon, Ann, Preston, Megan, Price, David, Taylor, Stephanie J C, and Pinnock, Hilary

Subjects
Asthma/therapy, Primary Health Care, Self-Management, General Practice, Quality of Life, Humans, Randomized Controlled Trials as Topic
Abstract

BACKGROUND: Asthma is a common long-term condition and major public health problem. Supported self-management for asthma that includes a written personalised asthma action plan, supported by regular professional review, reduces unscheduled consultations and improves asthma outcomes and quality of life. However, despite unequivocal inter/national guideline recommendations, supported self-management is poorly implemented in practice. The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) implementation strategy has been developed to address this challenge. The aim of this implementation trial is to determine whether facilitated delivery of the IMP2ART strategy increases the provision of asthma action plans and reduces unscheduled care in the context of routine UK primary care.METHODS: IMP2ART is a parallel group, cluster randomised controlled hybrid II implementation trial. One hundred forty-four general practices will be randomly assigned to either the IMP2ART implementation strategy or control group. Following a facilitation workshop, implementation group practices will receive organisational resources to help them prioritise supported self-management (including audit and feedback; an IMP2ART asthma review template), training for professionals and resources to support patients to self-manage their asthma. The control group will continue with usual asthma care. The primary clinical outcome is the between-group difference in unscheduled care in the second year after randomisation (i.e. between 12 and 24 months post-randomisation) assessed from routine data. Additionally, a primary implementation outcome of asthma action plan ownership at 12 months will be assessed by questionnaire to a random sub-group of people with asthma. Secondary outcomes include the number of asthma reviews conducted, prescribing outcomes (reliever medication and oral steroids), asthma symptom control, patients' confidence in self-management and professional support and resource use. A health economic analysis will assess cost-effectiveness, and a mixed methods process evaluation will explore implementation, fidelity and adaptation.DISCUSSION: The evidence for supported asthma self-management is overwhelming. This study will add to the literature regarding strategies that can effectively implement supported self-management in primary care to reduce unscheduled consultations and improve asthma outcomes and quality of life.TRIAL REGISTRATION: ISRCTN15448074. Registered on 2 December 2019.

Published
2023

42. The relationship between physician burnout and depression, anxiety, suicidality and substance abuse:A mixed methods systematic review

Author

Ryan, Emer, Hore, Kevin, Power, Jessica, and Jackson, Tracy

Subjects
Suicide, Depression/epidemiology, Physicians/psychology, Burnout, Professional/epidemiology, Public Health, Environmental and Occupational Health, Substance-Related Disorders/epidemiology, Humans, Anxiety/epidemiology
Abstract

IntroductionThe World Health Organization defines burnout as a problem associated with employment, a category distinct from psychological disorders such as depression, anxiety, suicidality and disorders of substance abuse. Evaluating the association between burnout as an occupational exposure and psychological morbidity may indicate that burnout can act as an occupational risk factor for mental ill-health. The systematic review explores this relationship in physicians due to the increased risk in this population and the implications for healthcare delivery.MethodsA mixed methods systematic review of the literature was conducted across Medline, Cinahl Plus, PsycInfo, Web of Science and The Cochrane Library. Databases were systematically searched using keywords relating to physician burnout and depression, anxiety, suicidality and substance abuse. Identified articles were screened for eligibility by two independent researchers. Data extraction was performed and studies assessed for risk of bias. Quantitative and qualitative results were integrated using a convergent segregated approach and results portrayed as a narrative synthesis.ResultsSixty-one articles were included in the review. There was notable heterogeneity in the measurement and criteria used to define burnout limiting the assimilation of results. Despite this, all studies that measured the association between depression and burnout reported a significant association. Studies that reported association between burnout and anxiety were similarly uniformly consistent. Most studies that reported the association between burnout and suicidality indicated that a significant association exists however difficulty in measurement of suicidality may have influenced variability of results. The reported association between substance abuse and burnout was more variable, suggesting that any association is likely to be weak or influenced by other variables. Qualitative studies described the manifestations of chronic workplace stress as well as perceived links with psychological morbidity. These included lack of time for work-life balance, the contribution of professional relationships and a culture of invulnerability that exists among physicians.ConclusionThe systematic review cannot conclude causality but suggests that physician burnout is associated with depression, anxiety and suicidality. Qualitative data provides insight into the nature of this association. The review indicates the need for longitudinal research and provides considerations for intervention strategies to prevent the development and progression of burnout.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172938, identifier: CRD42020172938.

Published
2023

43. IMP2ART: development of a multi-level programme theory integrating the COM-B model and the iPARIHS framework, to enhance implementation of supported self-management of asthma in primary care.

Author

Steed, Liz, Sheringham, Jessica, McClatchey, Kirstie, Hammersley, Vicky, Marsh, Viv, Morgan, Noelle, Jackson, Tracy, Holmes, Steve, Taylor, Stephanie, and Pinnock, Hilary

Subjects
ACCESS to primary care, PRIMARY care, MEDICAL personnel, ASTHMA, BEHAVIORAL assessment
Abstract

Background: Supported asthma self-management, incorporating an asthma action plan and annual clinical review, has been recommended by UK/global guidelines for over three decades. However, implementation remains poor, as only around a third of individuals receive basic asthma care, according to the UKs leading respiratory charity Asthma and Lung UK. A systematic review of implementation studies recommended that a whole systems approach targeting patients, healthcare professional education, and organisations is needed to improve implementation of supported asthma self-management in primary care. The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) is a national Hybrid-II implementation cluster randomised controlled trial that aims to evaluate such an approach. This paper describes the development of the implementation strategy for IMP2ART with particular focus on the integration of multiple level theories. Methods: The Medical Research Council design and evaluation of complex interventions framework and the Person-Based Approach to intervention development were used as guidance for stages of strategy development. Specifically, we (i) set up a multidisciplinary team (including practicing and academic clinicians, health psychologists, public health and patient colleagues), (ii) reviewed and integrated evidence and theory, (iii) developed guiding principles, (iv) developed prototype materials, and (v) conducted a pre-pilot study before final refinement. Results: The implementation strategy included resources for patients, team-based and individual healthcare professional education, practice audit and feedback, and an asthma review template, as well as a facilitator role accessible to primary care practices for 12 months. The synthesis of the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) and Capability, Opportunity, Motivation and Behaviour (COM-B) frameworks led to an evolved framework bringing together important implementation and behaviour change elements which will be used as a basis for the study process evaluation. Conclusions: A description of rigorous implementation strategy development for the IMP2ART study is provided along with newly theorised integration of implementation and behaviour change science which may be of benefit to others targeting implementation in primary care. Trial registration: ISRCTN15448074. Registered on 2nd December 2019. [ABSTRACT FROM AUTHOR]

Published
2023
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44. Intrauterine Postpartum Hemorrhage-Control Devices.

Author

Jackson, Tracy L. and Tuuli, Methodius G.

Subjects
*POSTPARTUM hemorrhage, *PUERPERIUM, *BLOOD loss estimation, *UTERINE contraction, *COMPRESSIVE force, *SYMPTOMS
Abstract

Postpartum hemorrhage, defined as a cumulative blood loss of 1,000 mL or more or blood loss associated with signs or symptoms of hypovolemia regardless of the route of delivery, is the leading cause of preventable maternal death worldwide. The United States has one of the highest maternal mortality rates among developed countries, with about 14% of all maternal deaths associated with postpartum hemorrhage. Although postpartum hemorrhage has multiple causes, the most common is uterine atony--when the uterus fails to adequately contract after childbirth--accounting for 80% of all postpartum hemorrhages. When postpartum hemorrhage occurs despite preventive measures, therapeutic measures are used. Intrauterine hemorrhage-control devices are often the second-line therapy when medical management is unsuccessful. Despite its widespread use in current obstetric practice, the mechanism of intrauterine balloon tamponade, such as the Bakri balloon, is counterintuitive to the physiologic uterine contraction that occurs after delivery to control bleeding, and data on its effectiveness are mixed. Vacuuminduced hemorrhage control, such as with the Jada System, cleared by the U.S. Food and Drug Administration in 2020, is a novel modality for control of postpartum bleeding. It mimics postpartum physiology by applying low-level intrauterine negative pressure to facilitate uterine compressive forces, thereby constricting blood vessels to achieve hemostasis. Preliminary data from four studies are promising but are limited by a lack of control groups, selection bias, or modest sample sizes. The results of ongoing and planned randomized controlled trials will clarify the role of the Jada System for reducing morbidity from postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

Published
2023
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45. Features of successful interventions to improve adherence to inhaled corticosteroids in children with asthma: A narrative systematic review

Author

Pearce, Christina J, Chan, Amy, Jackson, Tracy, Fleming, Louise, Foot, Holly, Bush, Andy, and Horne, Rob

Subjects
Pulmonary and Respiratory Medicine, Asthma/drug therapy, Reproducibility of Results, asthma, Adrenal Cortex Hormones/therapeutic use, Asthma, children, systematic review, Adrenal Cortex Hormones, Pediatrics, Perinatology and Child Health, Humans, adherence, inhaled corticosteroids, Child, intervention
Abstract

INTRODUCTION: Nonadherence to inhaled corticosteroids (ICSs) in children with asthma leads to significant morbidity and mortality. Few adherence interventions have been effective and little is known about what contributes to intervention effectiveness. This systematic review summarizes the efficacy and the characteristics of effective interventions.METHODS: Six databases were systematically searched on October 3, 2020 for randomized control trials measuring adherence to ICS in children with asthma. A narrative synthesis was conducted focusing on intervention efficacy and study reliability. Intervention content was coded based on the National Institute for Health and Care Excellence guidelines for medicines adherence (the Perceptions and Practicalities Approach, PAPA) and behavior change techniques (BCTs), to determine the effective aspects of the intervention.RESULTS: Of 240 studies identified, 25 were eligible for inclusion. Thirteen of the 25 studies were categorized as being highly reliable. Nine of the 13 interventions were effective at increasing adherence and 6 of those met the criteria for a PAPA intervention. Techniques targeting perceptions and practicalities in successful interventions included rewards, reminders, feedback and monitoring of adherence, pharmacological support, instruction on how to take their ICS/adhere, and information about triggers for symptoms and nonadherence.CONCLUSION: Adherence interventions in children with asthma have mixed effectiveness. Effective intervention studies were more frequently of higher quality, were tailored to individuals' perceptual and practical adherence barriers, and used multiple BCTs. However, due to the small number of included studies and varying study design quality, conclusions drawn here are preliminary. Future research is needed to test a PAPA-based intervention with a rigorous study design.

Published
2022

46. A Hybrid Architecture (CO-CONNECT) to Facilitate Rapid Discovery and Access to Data Across the United Kingdom in Response to the COVID-19 Pandemic: Development Study

Author

Jefferson, Emily, primary, Cole, Christian, additional, Mumtaz, Shahzad, additional, Cox, Samuel, additional, Giles, Thomas Charles, additional, Adejumo, Sam, additional, Urwin, Esmond, additional, Lea, Daniel, additional, Macdonald, Calum, additional, Best, Joseph, additional, Masood, Erum, additional, Milligan, Gordon, additional, Johnston, Jenny, additional, Horban, Scott, additional, Birced, Ipek, additional, Hall, Christopher, additional, Jackson, Aaron S, additional, Collins, Clare, additional, Rising, Sam, additional, Dodsley, Charlotte, additional, Hampton, Jill, additional, Hadfield, Andrew, additional, Santos, Roberto, additional, Tarr, Simon, additional, Panagi, Vasiliki, additional, Lavagna, Joseph, additional, Jackson, Tracy, additional, Chuter, Antony, additional, Beggs, Jillian, additional, Martinez-Queipo, Magdalena, additional, Ward, Helen, additional, von Ziegenweidt, Julie, additional, Burns, Frances, additional, Martin, Joanne, additional, Sebire, Neil, additional, Morris, Carole, additional, Bradley, Declan, additional, Baxter, Rob, additional, Ahonen-Bishopp, Anni, additional, Smith, Paul, additional, Shoemark, Amelia, additional, Valdes, Ana M, additional, Ollivere, Benjamin, additional, Manisty, Charlotte, additional, Eyre, David, additional, Gallant, Stephanie, additional, Joy, George, additional, McAuley, Andrew, additional, Connell, David, additional, Northstone, Kate, additional, Jeffery, Katie, additional, Di Angelantonio, Emanuele, additional, McMahon, Amy, additional, Walker, Mat, additional, Semple, Malcolm Gracie, additional, Sims, Jessica Mai, additional, Lawrence, Emma, additional, Davies, Bethan, additional, Baillie, John Kenneth, additional, Tang, Ming, additional, Leeming, Gary, additional, Power, Linda, additional, Breeze, Thomas, additional, Murray, Duncan, additional, Orton, Chris, additional, Pierce, Iain, additional, Hall, Ian, additional, Ladhani, Shamez, additional, Gillson, Natalie, additional, Whitaker, Matthew, additional, Shallcross, Laura, additional, Seymour, David, additional, Varma, Susheel, additional, Reilly, Gerry, additional, Morris, Andrew, additional, Hopkins, Susan, additional, Sheikh, Aziz, additional, and Quinlan, Philip, additional

Published
2022
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47. Dipeptidyl peptidase-1 inhibition in patients hospitalised with COVID-19: a multicentre, double-blind, randomised, parallel-group, placebo-controlled trial

Author

Keir, Holly R, primary, Long, Merete B, additional, Abo-Leyah, Hani, additional, Giam, Yan Hui, additional, Vadiveloo, Thenmalar, additional, Pembridge, Thomas, additional, Hull, Rebecca C, additional, Delgado, Lilia, additional, Band, Margaret, additional, McLaren-Neil, Fiona, additional, Adamson, Simon, additional, Lahnsteiner, Eva, additional, Gilmour, Amy, additional, Hughes, Chloe, additional, New, Benjamin JM, additional, Connell, David, additional, Dowey, Rebecca, additional, Turton, Helena, additional, Richardson, Hollian, additional, Cassidy, Diane, additional, Cooper, Jamie, additional, Suntharalingam, Jay, additional, Diwakar, Lavanya, additional, Russell, Peter, additional, Underwood, Jonathan, additional, Hicks, Alexander, additional, Dosanjh, Davinder PS, additional, Sage, Beth, additional, Dhasmana, Devesh, additional, Spears, Mark, additional, Thompson, AA Roger, additional, Brightling, Christopher, additional, Smith, Andrew, additional, Patel, Manish, additional, George, Jacob, additional, Condliffe, Alison M, additional, Shoemark, Amelia, additional, MacLennan, Graeme, additional, Chalmers, James D, additional, Chalmers, James, additional, Almaden-Boyle, Christine, additional, Taylor, Jennifer, additional, Strachan, Jodie, additional, Loftus, Heather, additional, Young, Lesley, additional, Strachan, Angela, additional, Pilvinyte, Kristina, additional, Rauchhaus, Petra, additional, Hogarth, Fiona, additional, Burns, Tricia, additional, Coote, Elizabeth, additional, Keiller, Marney, additional, Sage, Elizabeth, additional, Miller, David, additional, Dosanjh, Davinder, additional, Sutton, Benjamin, additional, Frayling, Sharon, additional, Haynes, Matthew, additional, Broad, Lauren, additional, Jones, Laura, additional, Rahilly, Karen, additional, Oliver, Catherine, additional, Evans, Terriann, additional, Balan, Andrea, additional, Davies, Rhys, additional, Forde, Donal, additional, Nye, Clemency, additional, Haboubi, Dr, additional, Hilton, Zoe, additional, Williams, Jennie, additional, McQueen, Alison, additional, Edmond, Ian, additional, Salutous, Dario, additional, McGenily, Laura, additional, Scott, Rhona, additional, Henderson, Eilidh, additional, Collins, Andrea, additional, Liu, Patrick, additional, Morrow, Ana, additional, Couser, Mandy, additional, Davey, Fleur, additional, Wiffen, Laura, additional, Fox, Lauren, additional, Abdelrahim, Mohamed, additional, Darbyshire, Alexander, additional, Cowen, Elena, additional, Rowley, Megan, additional, Giles, Benjamin, additional, Yang, Yingjia, additional, Brown, Tom, additional, Rupani, Hitasha, additional, Hawes, Elizabeth, additional, Barnes, Debi, additional, Brogan, Fiona, additional, Bungue-Tuble, Roneleeh, additional, Howe, Serena, additional, Turner, Charlotte, additional, Baryschpolec, Sonia, additional, Longhurst, Bev, additional, Moon, Maria, additional, Watkins, Lynn, additional, Baker-Moffat, Michelle, additional, Murray, Lisa, additional, Harrington-Davies, Yasmin, additional, Burrows, Kate, additional, Minnis, Chrissie, additional, Wands, Mary, additional, Bamgboye, Adefunke, additional, Wong, Charlotte, additional, Diver, Sarah, additional, Russell, Richard, additional, McAuley, Hamish, additional, Elneima, Omer, additional, Yousuf, Ahmed, additional, McCourt, Paula, additional, Hargadon, Beverley, additional, Parker, Sarah, additional, Bourne, Michelle, additional, Hartley, Tom, additional, Masan, Vidan, additional, Sturney, Sharon, additional, MacKenzie, Rob, additional, Marchand, Clare, additional, Mason, Rebecca, additional, White, Katie, additional, Kirby, Alison, additional, Meda, Manjula, additional, Finn, Joanne, additional, Harris, Sophie, additional, Muir, Carol, additional, Cook, Gemma, additional, Staines, Nikki, additional, Cook, Chris, additional, Condliffe, Alison, additional, Hull, Rebecca, additional, Collini, Paul, additional, Gabriel, Zoé, additional, Hardman, Simon, additional, Newell, Helen, additional, Middle, Janet, additional, Simpson, Phillip, additional, Colton, Hayley, additional, Barker, Joann, additional, Birchall, Katie, additional, Harrington, Kate, additional, Housley, Kay, additional, Lenagh, Rebecca, additional, Wilson, Jayne, additional, Wesonga, Joan, additional, Whitham, Rachel, additional, Bird, Sarah, additional, Jackson, Yvonne, additional, Mbuyisa, Angeline, additional, Anderson, Samantha, additional, Wilson, Anna, additional, Kibutu, Faith, additional, Walker, Sara, additional, Cawthron, Kay, additional, Macharia, Irene, additional, Smart, Lynne, additional, Emery, Anna, additional, Howell, Alice, additional, Hurditch, Elizabeth, additional, Ford, Amber, additional, Turner, Kim, additional, Watson, Lisa, additional, Bowler, Helen, additional, Jackson, Tracy, additional, Jaques, Carol, additional, Dyer, Nichole, additional, Ducker, Shelley, additional, Goodall, Vicky, additional, and Udale, Emily, additional

Published
2022
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48. Sustaining stakeholder engagement for health research during the COVID-19 pandemic:Lessons from the RESPIRE programme in Bangladesh, India, Malaysia, and Pakistan

Author

Fernandes, Genevie, Jackson, Tracy, Kashif, Aaliyan, Rahman, Ahmed Ehsanur, Roy, Ajay Kumar, Asmd, Ashraful Islam, Paul, Biswajit, Agarwal, Dhiraj, Akter, Fahmeda, Muanka, Farishtey, Habib, G M Monsur, Mahmood, Hana, Regi, Harsh, Lubree, Himangi, Nathan, Jayakayatri Jeevajothi, Yusuf, Osman Mohammad, Baig, Ramsha Tariq, Isaac, Rita, Patil, Rutuja, Jabeen, Sabrina, Ahmed, Salahuddin, Islam, Mohammad Shahidul, Juvekar, Sanjay, and Williams, Siân

Subjects
Bangladesh, Stakeholder Participation, Health Policy, Public Health, Environmental and Occupational Health, Malaysia, COVID-19, Humans, India, Pakistan, Pandemics
Published
2022

49. Effectiveness of home-based pulmonary rehabilitation: systematic review and meta-analysis

Author

Uzzaman, Md. Nazim, primary, Agarwal, Dhiraj, additional, Chan, Soo Chin, additional, Patrick Engkasan, Julia, additional, Habib, G.M. Monsur, additional, Hanafi, Nik Sherina, additional, Jackson, Tracy, additional, Jebaraj, Paul, additional, Khoo, Ee Ming, additional, Mirza, Fatim Tahirah, additional, Pinnock, Hilary, additional, Shunmugam, Ranita Hisham, additional, and Rabinovich, Roberto A., additional

Published
2022
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