A5085526983- Health Systems, Economic Evaluations, Quality of Life
- Dermatology and Skin Diseases
- Physical Activity and Health
- Total Knee Arthroplasty Outcomes
- Healthcare Policy and Management
- Obesity, Physical Activity, Diet
- Allergic Rhinitis and Sensitization
- Children's Physical and Motor Development
- Contact Dermatitis and Allergies
- Food Allergy and Anaphylaxis Research
- Complementary and Alternative Medicine Studies
- Orthopedic Infections and Treatments
- Global Health Care Issues
- Orthopaedic implants and arthroplasty
- Fibromyalgia and Chronic Fatigue Syndrome Research
- Healthcare Systems and Technology
- Urban Transport and Accessibility
- Prostate Cancer Diagnosis and Treatment
- Adolescent and Pediatric Healthcare
- Prostate Cancer Treatment and Research
- Interprofessional Education and Collaboration
- Treatment of Major Depression
- Anesthesia and Pain Management
- Motivation and Self-Concept in Sports
- Geriatric Care and Nursing Homes
University of Bristol
2016-2025
At Bristol
2017-2021
Royal Victoria Infirmary
2016
Great Ormond Street Hospital
2016
University College London
2016
BackgroundCognitive behavioural therapy (CBT) is an effective treatment for people whose depression has not responded to antidepressants. However, the long-term outcome unknown. In a follow-up of CoBalT trial, we examined clinical and cost-effectiveness cognitive as adjunct usual care that included medication over 3–5 years in primary patients with treatment-resistant depression.MethodsCoBalT was randomised controlled trial done across 73 general practices three UK centres. recruited aged...
Abstract Objectives To determine whether patient reported outcomes improve after single stage versus two revision surgery for prosthetic joint infection of the hip, and to cost effectiveness these procedures. Design Pragmatic, parallel group, open label, randomised controlled trial. Setting High volume tertiary referral centres or orthopaedic units in UK (n=12) Sweden (n=3), recruiting from 1 March 2015 19 December 2018. Participants 140 adults (aged ≥18 years) with a hip who required (65...
Periprosthetic joint infection (PJI) affects approximately 1 % of patients following total hip replacement (THR) and often results in severe physical emotional suffering. Current surgical treatment options are debridement, antibiotics implant retention; revision THR; excision the amputation. Revision surgery can be done as either a one-stage or two-stage operation. Both types well-established practice NHS result similar rates re-infection, but little is known about impact these treatments...
Most adolescent girls in the UK do not meet government physical activity recommendations and effective interventions are needed. This study reports results of a feasibility trial PLAN-A, novel school-based peer-led intervention for girls.A two-arm cluster randomised controlled was conducted six English secondary schools (4 & 2 control). Year 8 (age 12-13) were eligible randomisation at school-level. The involved training (out school two consecutive days, plus one top-up day 5 weeks later),...
To our knowledge, there are no trials comparing emollients commonly used for childhood eczema. We aimed to compare the clinical effectiveness and safety of four main emollient types: lotions, creams, gels, ointments.We did a pragmatic, individually randomised, parallel group, phase 4 superiority trial in 77 general practice surgeries England. Children aged between 6 months 12 years with eczema (Patient Orientated Eczema Measure [POEM] score >2) were randomly assigned (1:1:1:1; stratified by...
BackgroundApproximately 20% of people experience chronic pain after total knee replacement, but effective treatments are not available. We aimed to evaluate the clinical effectiveness and cost-effectiveness a new care pathway for replacement.MethodsWe did an unmasked, parallel group, pragmatic, superiority, randomised, controlled trial at eight UK National Health Service (NHS) hospitals. People with 3 months replacement surgery were randomly assigned (2:1) Support Treatment After Replacement...
Background Prostate cancer is the most common among men in UK. Prostate-specific antigen testing followed by biopsy leads to overdetection, overtreatment as well undertreatment of disease. Evidence treatment effectiveness has lacked because paucity randomised controlled trials comparing conventional treatments. Objectives To evaluate treatments for localised prostate (active monitoring, radical prostatectomy and radiotherapy) aged 50–69 years. Design A prospective, multicentre...
Abstract Background Prosthetic joint infection (PJI) following total hip replacement (THR) surgery is a serious complication that negatively impacts patients’ lives and financially burdensome for healthcare providers. As the number of THRs increases, so does this financial burden. This research estimates economic burden with respect to inpatient day case hospital admissions patients receiving revision PJI primary THR. Methods In matched cohort study, National Joint Registry England, Wales,...
Abstract Objective This study investigated if hybrid oesophagectomy with minimally invasive gastric mobilization and thoracotomy enabled faster recovery than open surgery. Methods In eight UK centres, this pragmatic RCT recruited patients for to treat localized cancer. Participants were randomly allocated or surgery, stratified by centre receipt of neoadjuvant treatment. Large dressings aimed mask their allocation six days post-surgery. The authors present the intention-to-treat analysis...
Post herpetic neuralgia (PHN) is the most common complication of herpes zoster, also known as shingles. Amitriptyline has been postulated to prevent PHN. The objective determine whether prophylactic low-dose amitriptyline prevents PHN in patients newly diagnosed with This a multicentre, individually randomized, pragmatic, placebo-controlled superiority trial health economic analysis and nested qualitative study. Patients new-onset shingles are screened by treating clinicians participating...
Background General practice services are under pressure due increased demand. Alongside substantial national recruitment challenges, there exists a shortage of general practitioners to meet current need. Resultingly, allied healthcare professionals, including paramedics, being utilised in practice. Aim To determine the models paramedics settings; mechanisms that underpin effective practice; and impact on safety, costs clinical patient-reported outcomes experience. Design A mixed-methods...
Objectives: To determine the effectiveness and cost-effectiveness of a brief communication skills e-learning package on empathy optimism for practitioners consulting with adult primary care patients presenting musculoskeletal (MSK) pain. Design: A cluster randomised controlled trial from 31/10/22 to 28/6/24 using computer-generated block randomisation allocated general practices intervention or usual control (1:1) stratified by practice size deprivation. Patients, statisticians,...
Objectives: To examine primary care practitioners experiences and use of EMPathicO e-learning to enhance communication clinical empathy realistic optimism. Design: Mixed methods evaluation incorporating thematic analysis qualitative interviews quantitative usage patterns practitioner survey data. Setting: Cluster randomised controlled trial in general practices England Wales. Participants: Primary allocated the intervention arm. Analysis: Thematic data explored undertaking implementing...
Objective Investigate the effectiveness and cost-effectiveness of Lightning Process (LP) in addition to specialist medical care (SMC) compared with SMC alone, for children chronic fatigue syndrome/myalgic encephalitis (CFS/ME). Design Pragmatic randomised controlled open trial. Participants were randomly assigned SMC, or plus LP (SMC+LP). Randomisation was minimised by age gender. Setting Specialist paediatric CFS/ME service. Patients Aged 12–18 years mild/moderate CFS/ME. Main outcome...
Few adolescent girls engage in enough physical activity (PA) to meet recommendations and there is a need for new interventions increase PA. We have previously published the results of PLAN-A cluster randomised feasibility trial which was peer-led school-based PA intervention, showing that intervention feasible held promise aged 12–13 years. In PLAN-A, pupils nominated by their peers as influential attend training teach them how influence, promote normalise amongst peer-group. This paper...
Chronic kidney disease (CKD) prevalence is steadily increasing, in part due to increased multimorbidity our aging global population. When progression failure cannot be avoided, people need unbiased information inform decisions about whether start dialysis, if or when indicated, continue with holistic person-centred care without dialysis (conservative management). Comparisons suggest that while there may some survival benefit from over conservative management, aged 80 years and over, multiple...
Physical activity levels are low amongst adolescent girls, and this population faces specific barriers to being active. Peer influences on health behaviours important in adolescence peer-led interventions might hold promise change behaviour. This paper describes the protocol for a feasibility cluster randomised controlled trial of Peer-Led physical Activity iNtervention Adolescent girls (PLAN-A), intervention aimed at increasing girls' levels. A two-arm will be conducted six secondary...
Approximately 20% of patients experience chronic pain after total knee replacement. There is little evidence for effective interventions the management this pain, and current healthcare provision patchy inconsistent. Given complexity condition, multimodal individualised matched to characteristics are needed. We have undertaken a comprehensive programme work develop care pathway with This protocol describes design randomised controlled trial evaluate clinical- cost-effectiveness complex...
Objectives To determine the feasibility of a randomised controlled trial ‘leave on’ emollients for children with eczema. Design Single-centre, pragmatic, 4-arm, observer-blinded, parallel, trial. Setting General practices in UK. Participants Children eczema aged 1 month to <5 years. Outcome measures Primary outcome—proportion parents who reported use allocated study emollient every day duration follow-up (12 weeks). Other outcomes—participant recruitment and retention, data collection...
Paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and disabling condition. The National Institute for Health Clinical Excellence (NICE) recommends Cognitive Behavioural Therapy (CBT) as treatment option paediatric CFS/ME because there good evidence that it effective. Despite this, most young people in the UK are unable to access local specialist CBT CFS/ME. A randomised controlled trial (RCT) showed FITNET was effective Netherlands but we do not...
Opportunities for working adults to accumulate recommended physical activity levels (at least 150 min of moderate intensity in bouts at 10 throughout the week) may include commute work. Systematic reviews interventions increase active transport suggest studies have tended be poor quality, relying on self-report and lacking robust statistical analyses. We conducted a multi-centre parallel-arm cluster randomised controlled trial, workplaces south-west England south Wales, assess effectiveness...
Atopic dermatitis/eczema affects around 20% of children and is characterised by inflamed, dry, itchy skin. Guidelines recommend 'leave-on' emollients that are applied directly to the skin add or trap moisture used regularly, they can soothe, enhance barrier may prevent disease 'flares'. However, suitability many different varies between people there little evidence help prescribers parents carers decide which type try first. Design: pragmatic, multicentre, individually randomised, parallel...
There is limited evidence relating to the cost-effectiveness of treatments for localised prostate cancer.