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Research papers published by our team


Listed in date order

Primary care risk stratification in COPD using routinely collected data: a secondary data analysis

Primary care risk stratification in COPD using routinely collected data: a secondary data analysis

Matt Johnson, Lucy Rigge, David Culliford, Lynn Josephs, Mike Thomas, Tom Wilkinson


Most clinical contacts with chronic obstructive pulmonary disease (COPD) patients take place in primary care, presenting opportunity for proactive clinical management. Electronic health records could be used to risk stratify diagnosed patients in this setting, but may be limited by poor data quality or completeness. We developed a risk stratification database algorithm using the DOSE index (Dyspnoea, Obstruction, Smoking and Exacerbation) with routinely collected primary care data, aiming to calculate up to three repeated risk scores per patient over five years, each separated by at least one year. Among 10,393 patients with diagnosed COPD, sufficient primary care data were present to calculate at least one risk score for 77.4%, and the maximum of three risk scores for 50.6%. Linked secondary care data revealed primary care under-recording of hospital exacerbations, which translated to a slight, non-significant cohort average risk score reduction, and an understated risk group allocation for less than 1% of patients. Algorithmic calculation of the DOSE index is possible using primary care data, and appears robust to the absence of linked secondary care data, if unavailable. The DOSE index appears a simple and practical means of incorporating risk stratification into the routine primary care of COPD patients, but further research is needed to evaluate its clinical utility in this setting. Although secondary analysis of routinely collected primary care data could benefit clinicians, patients and the health system, standardised data collection and improved data quality and completeness are also needed.


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The impact of delayed transfers of care on emergency departments: common sense arguments, evidence and confounding.

The impact of delayed transfers of care on emergency departments: common sense arguments, evidence and confounding.
Dr Brad Keogh & Dr Thomas Monks
There have been claims that Delayed Transfers of Care (DTOCs) of inpatients to home or a less acute setting are related to Emergency Department (ED) crowding. In particular DTOCs were associated with breaches of the UK 4-hour waiting time target in a previously published analysis. However, the analysis has major limitations by not adjusting for the longitudinal trend of the data. The aim of this work is to investigate whether the proposition that DTOCs impact the 4-hour target requires further research
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Older people's experiences in acute care settings: systematic review and synthesis of qualitative studies

Older people's care experiences in hospital may be negative in the absence of relational work by nurses to maintain people's identity, establish caring connections and ensure that individual patient needs, preferences and values are honoured in the care that is delivered. Relational care by nurses can mediate powerful institutional drivers that may otherwise result in negative experiences and poor care.

Jackie Bridges, Joanna Hope - November 8 2019

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Patient involvement in pressure ulcer prevention and adherence to prevention strategies: An integrative review

There is limited research that focuses on the patient view of factors affecting adherence to prevention measures, particularly in community settings. Individual and daily lifestyle considerations and involvement in decision-making around pressure ulcer care are important aspects from the patient perspective. Further research is necessary to explore which factors affect patient adherence in order to improve clinical practice and support patient involvement in preventative strategies.

Jo Hope, Lisette Schoonhoven - October 23 2019

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A novel exploration of the support needs of people initiating insulin pump therapy using a social network approach: a longitudinal mixed‐methods study

A social network approach determined what resources and support people with diabetes require when incorporating a new health technology. Visualisation of support networks using concentric circles enabled people to consider and mobilise support and engage in new activities as their needs changed. The novelty of pump therapy creates new illness‐related work, but mobilisation of personally valued flexible, tailored support can improve the process of adaptation.

C. Reidy, C. Foster, A. Rogers - October 16 2019
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Cognitive impairment is independently associated with mortality, extended hospital stays and early readmission of older people with emergency hospital admissions: A retrospective cohort study

Cognitive impairment is associated with an increased risk of adverse outcomes in hospitalised older people with an unscheduled admission, by increasing hospital mortality, extending hospital stays and increasing frequency of readmissions.

Carole FoggPaul Meredith, David Culliford, Jackie Bridges, Peter Griffiths - August 2019

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Mediating engagement in a social network intervention for people living with a long-term condition: A qualitative study of the role of facilitation.


Successful facilitation of patient-centred interventions for self-management support has traditionally focussed on individual behaviour change. A social network approach to self-management support implicates the need for facilitation that includes an orientation to connecting to and mobilizing support and resources from other people and the local environment.

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