A5017047819- Telemedicine and Telehealth Implementation
- Healthcare Systems and Technology
- Mental Health and Patient Involvement
- Patient-Provider Communication in Healthcare
- Interprofessional Education and Collaboration
- Primary Care and Health Outcomes
- Health Policy Implementation Science
- Technology Use by Older Adults
- COVID-19 and healthcare impacts
- Innovative Approaches in Technology and Social Development
- COVID-19 Clinical Research Studies
- Medical Malpractice and Liability Issues
- Healthcare Systems and Challenges
- Health Systems, Economic Evaluations, Quality of Life
- Information Systems Theories and Implementation
- Healthcare innovation and challenges
- Empathy and Medical Education
- Health disparities and outcomes
- Medical Research and Practices
- Innovative Human-Technology Interaction
- Healthcare Quality and Management
- SARS-CoV-2 and COVID-19 Research
- Mobile Health and mHealth Applications
- Colorectal Cancer Surgical Treatments
- Clinical practice guidelines implementation
University of Leicester
2023-2025
University of Oxford
2016-2024
Nuffield Health
2022
Pilgrim Hospital
2020-2021
Barts Health NHS Trust
2021
St Bartholomew's Hospital
2021
Northampton General Hospital NHS Trust
2021
Heart of England NHS Foundation Trust
2017
Centre for Mental Health
2004-2005
Background: Many promising technological innovations in health and social care are characterized by nonadoption or abandonment individuals failed attempts to scale up locally, spread distantly, sustain the innovation long term at organization system level. Objective: Our objective was produce an evidence-based, theory-informed, pragmatic framework help predict evaluate success of a technology-supported program. Methods: The study had 2 parallel components: (1) secondary research (hermeneutic...
Abstract Individuals with potential exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) do not necessarily develop PCR or antibody positivity, suggesting that some individuals may clear subclinical infection before seroconversion. T cells can contribute the rapid clearance of SARS-CoV-2 and other infections 1–3 . Here we hypothesize pre-existing memory cell responses, cross-protective against (refs. 4–11 ), would expand in vivo support viral control, aborting infection....
A boost from infection During clinical trials of severe acute respiratory syndrome coronavirus 2 vaccines, no one who had survived with the virus was tested. year after pandemic declared, vaccination previously infected persons is a reality. Reynolds et al. address knowledge gap in cohort UK health care workers given Pfizer/BioNTech vaccine which half participants experienced natural infections early (see Perspective by Crotty). Genotyping indicated that genetic component underlies...
Failures and partial successes are common in technology-supported innovation programmes health social care. Complexity theory can help explain why. Phenomena may be simple (straightforward, predictable, few components), complicated (multiple interacting components or issues) complex (dynamic, unpredictable, not easily disaggregated into constituent components). The recently published NASSS framework applies this taxonomy to Non-adoption Abandonment of technology by individuals difficulties...
Establishing and running remote consultation services is challenging politically (interest groups may gain or lose), organizationally (remote consulting requires implementation work new roles workflows), economically (costs benefits are unevenly distributed across the system), technically (excellent care needs dependable links high-quality audio images), relationally (interpersonal interactions altered), clinically (patients unique, some examinations require contact, clinicians have...
Fewer than 1% of UK general practice consultations occur by video.To explain why video are not more widely used in practice.Analysis a sub-sample data from three mixed-method case studies remote consultation services various settings 2019-2021.The dataset included interviews and focus groups with 121 participants primary care (33 patients, 55 GPs, 11 other clinicians, nine managers, four support staff, national policymakers, five technology industry). Data were transcribed, coded...
BackgroundWe hypothesised that host-response biomarkers of viral infections might contribute to early identification individuals infected with SARS-CoV-2, which is critical breaking the chains transmission. We aimed evaluate diagnostic accuracy existing candidate whole-blood transcriptomic signatures for infection predict positivity nasopharyngeal SARS-CoV-2 PCR testing.MethodsWe did a nested case-control study among prospective cohort health-care workers (aged ≥18 years) at St Bartholomew's...
The COVID-19 pandemic-related rise in remote consulting raises questions about the nature and type of risks general practice.To develop an empirically based theory-informed taxonomy associated with consultations.Qualitative sub-study data selected from wider datasets three large, multi-site, mixed-method studies care practice before during pandemic UK.Semi-structured interviews focus groups, a total 176 clinicians 43 patients. Data were analysed thematically, taking account existing...
Until COVID-19, implementation and uptake of video consultations in health care was slow. However, the pandemic created a "burning platform" for scaling up such services. As organizations look to expand maintain use "new normal," it is important understand infrastructural influences changes that emerged during may influence sustainability going forward.This study aims draw lessons from 4 National Health Service (NHS) on how information infrastructures shaped, were shaped by, rapid scale-up...
Introduction Research to date into assisted living technologies broadly consists of 3 generations: technical design, experimental trials and qualitative studies the patient experience. We describe a fourth-generation paradigm: in their organisational, social, political policy context. Fourth-generation are necessarily organic emergent; they view technology as part dynamic, networked potentially unstable system. They use co-design methods generate stabilise local solutions, taking account...
Health and care technologies often succeed on a small scale but fail to achieve widespread use (scale-up) or become routine practice in other settings (spread). One reason for this is under-theorization of the process scale-up spread, which potentially fruitful theoretical approach consider adoption as social practices.This study aimed an in-depth case assisted living explore feasibility usefulness explaining assisted-living technology across local system health care.This was individual...
Requirements for physical distancing as a result of COVID-19 and the need to reduce risk infection prompted policy supporting rapid roll out video consulting across four nations UK-England, Northern Ireland, Scotland Wales. Drawing on three studies accelerated implementation uptake nations, we present comparative interpretive analysis spread scale-up during pandemic. Data include interviews with 59 national level stakeholders, 55 health social care staff 30 patients, 20 documents, responses...
IMPORTANCE Supplementing potassium in an effort to maintain high-normal serum concentrations is a widespread strategy used prevent atrial fibrillation after cardiac surgery (AFACS), but not evidence-based, carries risks, and costly. OBJECTIVE To determine whether lower concentration trigger for supplementation noninferior trigger. DESIGN, SETTING, AND PARTICIPANTS This open-label, noninferiority, randomized clinical trial was conducted at 23 surgical centers the United Kingdom Germany....
Background Remote and digital services must be equitable, but some patients have difficulty using these services. Designing measures to overcome disparities can challenging for practices. Personas (fictional cases) are a potentially useful tool in this regard. Aim To develop test set of personas reflect the lived experiences challenges that older people who disadvantaged face when navigating remote primary care Design setting Qualitative study NHS community health offering video...
<sec> <title>BACKGROUND</title> Online harm affects many people and has been associated with self-harm suicidal ideation. Although there is an emerging body of evidence that addressing adverse online experiences should be part the support offered to who are at risk suicide, little guidance date on how this might provided safe conversations can had subject. A UK charity dedicated offering emotional anyone experiencing mental discomfort, having difficulty coping, or being suicide developed a...
A number of evaluations models integrated care have not produced the expected result reduced hospital admissions, and in some cases even found people receiving services using hospitals more than matched controls. We tested three hypotheses for these surprising results with a group 50 experts seminar: (1) problems model; (2) implementation; (3) evaluation. Our did rule out any came up advice as to manage issues. For example, model designers should rigorously test underlying logic;...
BackgroundLittle is known about the opportunities for shared decision-making when older high-risk patients are offered major surgery. This study examines how, when, and why clinicians can share surgery.MethodsThis was a multi-method qualitative study, combining video recordings of preoperative consultations, interviews, focus groups (33 patients, 19 relatives, 36 clinicians), with observations documentary analysis in clinics five hospitals UK undertaking orthopaedic, colorectal, and/or...
Abstract Integrated care is an aim and a method for organising health services, particularly older people those with chronic conditions. Policy expects that integrated programmes will provide person‐centred coordinated which improve patient or client experience, enable population health, prevent hospital admissions thereby reduce costs. However, empirical evaluations of interventions have shown disappointing results. We analysed in‐depth case study using Strong Structuration Theory to ask:...
Introduction Surgical treatments are being offered to more patients than ever before, and increasingly high-risk (typically multimorbid over 75). Shared decision making is seen as essential practice. However, little currently known about what ‘good’ shared involves nor how it applies in the context of surgery for patients. This new study aims identify patients, their families clinical teams negotiate major surgery. Methods analysis Focusing on joint replacement, colorectal cardiac surgery,...
New models of care are being pursued throughout England to balance increasing demand for improved health and social services against reducing public expenditure. A dominant discourse has emerged about the value community-based integrated care, despite failures programmes consistently demonstrate reductions in hospital admissions. Discourse analysis policy establishes how issues aging, admissions fragmentation problematised, solutions made possible by argumentative structures policy. These...