Imperial College London

Dr Benita Cox

Business School

Principal Teaching Fellow
 
 
 
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Contact

 

+44 (0)20 7594 9164b.cox

 
 
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Location

 

456ACE ExtensionSouth Kensington Campus

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Summary

 

Publications

Publication Type
Year
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60 results found

Dawoodbhoy FM, Delaney J, Cecula P, Yu J, Tan J, Peacock I, Cox Bet al., 2021, AI in patient flow: applications of artificial intelligence to improve patient flow in NHS acute mental health inpatient units, Heliyon, Vol: 7, ISSN: 2405-8440

Introduction:Growing demand for mental health services, coupled with funding and resource limitations, creates an opportunity for novel technological solutions including artificial intelligence (AI). This study aims to identify issues in patient flow on mental health units and align them with potential AI solutions, ultimately devising a model for their integration at service level.Method:Following a narrative literature review and pilot interview, 20 semi-structured interviews were conducted with AI and mental health experts. Thematic analysis was then used to analyse and synthesise gathered data and construct an enhanced model.Results:Predictive variables for length-of-stay and readmission rate are not consistent in the literature. There are, however, common themes in patient flow issues. An analysis identified several potential areas for AI-enhanced patient flow. Firstly, AI could improve patient flow by streamlining administrative tasks and optimising allocation of resources. Secondly, real-time data analytics systems could support clinician decision-making in triage, discharge, diagnosis and treatment stages. Finally, longer-term, development of solutions such as digital phenotyping could help transform mental health care to a more preventative, personalised model.Conclusions:Recommendations were formulated for NHS trusts open to adopting AI patient flow enhancements. Although AI offers many promising use-cases, greater collaborative investment and infrastructure are needed to deliver clinically validated improvements. Concerns around data-use, regulation and transparency remain, and hospitals must continue to balance guidelines with stakeholder priorities. Further research is needed to connect existing case studies and develop a framework for their evaluation.

Journal article

Cecula P, Yu J, Dawoodbhoy F, Delaney J, Tan J, Peacock I, Cox Bet al., 2021, Applications of artificial intelligence to improve patient flow on mental health inpatient units - Narrative literature review, Heliyon, Vol: 7, ISSN: 2405-8440

Background:Despite a growing body of research into both Artificial intelligence and mental health inpatient flow issues, few studies adequately combine the two. This review summarises findings in the fields of AI in psychiatry and patient flow from the past 5 years, finds links and identifies gaps for future research.Methods:The OVID database was used to access Embase and Medline. Top journals such as JAMA, Nature and The Lancet were screened for other relevant studies. Selection bias was limited by strict inclusion and exclusion criteria.Research:3,675 papers were identified in March 2020, of which a limited number focused on AI for mental health unit patient flow. After initial screening, 323 were selected and 83 were subsequently analysed. The literature review revealed a wide range of applications with three main themes: diagnosis (33%), prognosis (39%) and treatment (28%). The main themes that emerged from AI in patient flow studies were: readmissions (41%), resource allocation (44%) and limitations (91%). The review extrapolates those solutions and suggests how they could potentially improve patient flow on mental health units, along with challenges and limitations they could face.Conclusion:Research widely addresses potential uses of AI in mental health, with some focused on its applicability in psychiatric inpatients units, however research rarely discusses improvements in patient flow. Studies investigated various uses of AI to improve patient flow across specialities. This review highlights a gap in research and the unique research opportunity it presents.

Journal article

Sayma M, Saleh D, Kerwat D, Jamshaid S, Ahmed A, Oyewole F, Wahid AS, Perry C, Cox Bet al., 2020, A qualitative inquiry into the barriers and facilitators to achieving home death, BMJ Supportive and Palliative Care, Vol: 10, ISSN: 2045-4368

OBJECTIVES: To explore the barriers and facilitators to patients achieving death at home. METHODS: In-depth, semistructured interviews with end-of-life care experts were conducted to develop an insight into the barriers and facilitators to achieving death at home. Thirty-three interviews were conducted compromising of a mixture of face-to-face and tele interviews. Experts included healthcare professionals working in the community, hospital and policy/academic settings. Thematic analysis was undertaken on interview transcripts. RESULTS: Three overarching themes, further divided into a total of 12 subthemes were identified. The three themes were 'managing people', 'education' and 'planning'. The 'managing people' theme included subthemes of patient preferences and family influences; the 'education' theme encompassed knowledge and training, perceptions of death and communication and the 'planning' theme contained seven subthemes including 'coordination', 'resources' and 'cost'. CONCLUSIONS: Multiple barriers and facilitators to achieving death at home were identified in this study. Of particular significance was the identification of the fear and stigma associated with death among doctors, patients and their families serving as a barrier to home death, not previously identified in the literature. Additionally, the importance of social networks and resource provision were highlighted as key in influencing patient death at home.

Journal article

Silva G, Gor R, Patel N, Gupta S, Manivannan T, Manu S, Sharma A, Gardiner D, Cox Bet al., 2019, How effective are organ donation committees, and how can they be improved?, British Journal of Health Care Management, Vol: 25, Pages: 113-121, ISSN: 1358-0574

Background: Organ donation committees were established in 2008 by NHS Blood and Transplant to improve the rates of organ donation in the UK. Aims: The aims of this study were three-fold: to review the role and structure of organ donation committees in England; to assess how effective organ donation committees are at driving improvements; and to make recommendations regarding the future role, responsibilities and structure of organ donation committees. Methods: This study adopted a cross-sectional mixed-methods research approach using questionnaires and semi-structured interviews. results: There was a divergence between how each committee functioned and how effective they were in achieving their aims. Discussion: There were seven key findings which related to the effectiveness of organ donation committees. These included, but were not limited to, a lack of consistency in how the role of an organ donation committee was viewed by members of NHS Blood and Transplant; and that the influence a chair has within their respective NHS Trust is key to an organ donation committee being effective in achieving its aims. conclusion: A framework and several recommendations were produced and aimed to help improve the effectiveness of organ donation committees.

Journal article

Ahmed I, Ahmad NS, Ali S, Ali S, George A, Saleem H, Uppal E, Soo J, Mobasheri M, King D, Cox BM, Darzi Aet al., 2018, Medication adherence apps: A review and content analysis, JMIR mHealth and uHealth, Vol: 6, ISSN: 2291-5222

Background:Medication adherence is a costly and damaging problem for both healthcare providers and patients alike. Patients adhere to only 50% of drugs prescribed for chronic diseases in developed nations. Digital health has paved the way for innovative smartphone solutions to tackle this challenge. However, despite the numerous applications (apps) available claiming to improve adherence, a thorough review of adherence applications has not been carried out to date.Objective:(i)To review medication adherence apps (otherwise known as mAdherence app) in the Apple App store and the Google Play repository in terms of their evidence base, medical professional involvement in development, and strategies used to facilitate behaviour change and improve adherence.(ii)To provide a system of classification for these apps. Methods:In April 2015, relevant mAdherence apps were identified by systematically searching the Apple and Google Play app stores using a combination of relevant search terms. Data extracted for each app included app store source, app price, documentation of healthcare professional (HCP) involvement during app development and evidence base for each respective app.Free apps were downloaded to explore the strategies used to promote medication adherence. Testing involved a standardised medication regimen of three reminders over a four-hour period. Non-adherence features designed to enhance user experience were also documented.Results:The App repository search identified a total of 5889 applications. 806 fulfilled the inclusion criteria initially and were tested. 682 applications were further analysed for data extraction. Of these, 61.7% were free for testing, 8.5% were inaccessible and 29.8% required payment. Of the 421 free applications, 13.8% were developed with HCP involvement and an evidence base was identified in only 0.95%. Of the paid apps, 4.4% had HCP involvement, 0.5% had a documented evidence base and 0.5% had both. 31% of inaccessible apps were produce

Journal article

Weldon SM, Kelay T, Ako E, Cox BM, Bello F, Kneebone Ret al., 2017, Sequential simulation used as a novel educational tool aimed at healthcare managers: a patient-centred approach, BMJ Simulation & Technology Enhanced Learning, Vol: 4, Pages: 13-18, ISSN: 2056-6697

Background A new challenge for healthcare managers is to improve the patient experience. Simulation is often used for clinical assessment and rarely for those operating outside of direct clinical care. Sequential simulation (SqS) is a form of simulation that re-creates care pathways, widening its potential use.Local problem Numbers, outcome measures and system profiling are used to inform healthcare decisions. However, none of these captures the personal subtleties of a patient’s experience.Intervention 56 students attended a teaching module using SqS and facilitated workshops as part of their induction week on an MSc International Health Management course. The workshop was voluntary and was offered as an opportunity for the students to gain an insight into the UK health system through the medium of simulation.Methods An evaluation survey incorporating quantitative and qualitative student feedback was conducted. Descriptive statistics were generated from the quantitative data, and thematic analysis was undertaken for the qualitative data.Results There was strong agreement for the acceptability of the workshop approach in relation to the aims and objectives. Likert scale (1–-5) mean total=4.49. Participants responded enthusiastically (revealed through the qualitative data) with ideas related to perspectives sharing, understanding healthcare management and processes and the consideration of feasibility and practicalities. They also suggested other applications that SqS could be used for.Conclusion The SqS approach has demonstrated that simulation has a wider potential than for clinical assessment alone. Further studies are required to determine its potential uses and affordances beyond its current format.

Journal article

Wahid AS, Sayma M, Jamshaid S, Kerwat D, Oyewole F, Saleh D, Ahmed A, Cox B, Perry C, Payne Set al., 2017, Barriers and facilitators influencing death at home: A meta-ethnography., Palliative Medicine, ISSN: 0269-2163

BACKGROUND: In many countries, achieving a home death represents a successful outcome from both a patient welfare and commissioning viewpoint. Significant variation exists in the proportion of home deaths achieved internationally, with many countries unable to meet the wishes of a large number of patients. This review builds on previous literature investigating factors influencing home death, synthesising qualitative research to supplement evidence that quantitative research in this field may have been unable to reach. AIM: To identify and understand the barriers and facilitators influencing death at home. DESIGN: Meta-ethnography. DATA SOURCES: The review adhered to the PRISMA guidelines. A systematic literature search was conducted using five databases: PubMed, EMBASE, Ovid, CINAHL and PsycINFO. Databases were searched from 2006 to 2016. Empirical, UK-based qualitative studies were included for analysis. RESULTS: A total of 38 articles were included for analysis. Seven overarching barriers were identified: lack of knowledge, skills and support among informal carers and healthcare professionals; informal carer and family burden; recognising death; inadequacy of processes such as advance care planning and discharge; as well as inherent patient difficulties, either due to the condition or social circumstances. Four overarching facilitators were observed: support for patients and healthcare professionals, skilled staff, coordination and effective communication. CONCLUSION: Future policies and clinical practice should develop measures to empower informal carers as well as emphasise earlier commencement of advance care planning. Best practice discharge should be recommended in addition to addressing remaining inequity to enable non-cancer patients greater access to palliative care services.

Journal article

Lefevre DJ, cox B, 2016, Delayed instructional feedback may be more effective, but is this contrary to learners' preferences?, British Journal of Educational Technology, Vol: 48, Pages: 1357-1367, ISSN: 0007-1013

This research investigates learners' preferences for the timing of feedback provided to multiple-choice questions within technology-based instruction, hitherto an area of little empirical attention. Digital materials are undergoing a period of renewed prominence within online learning and multiple-choice questions remain a common component. There is evidence that a delay in the provision of feedback following a learner's response to multiple-choice questions leads to an increase in subsequent performance. However, the learner's perspective on delayed feedback is yet to be explored. Learner preferences are pertinent as learning designs that run contrary to preferred learning behaviours can have a negative affect on motivation and therefore engagement. During a series of formative tests, subjects were presented with a choice of viewing either immediate or delayed feedback and their choices were recorded. Over a 2-year period data were collected relating to 599 subjects. Qualitative interviews were also conducted to investigate why subjects made their choices. In this research, subjects expressed a marked preference for immediate feedback, 95.33% chose to view feedback immediately following their response to a question. The reasons for this preference are explored and the implications for learning design are considered.

Journal article

Lefevre D, Cox B, 2016, Feedback in technology-based instruction: Learner preferences, BRITISH JOURNAL OF EDUCATIONAL TECHNOLOGY, Vol: 47, Pages: 248-256, ISSN: 0007-1013

Journal article

King D, Zaman S, Zaman SS, Kahlon GK, Naik A, Jessel AS, Nanavati N, Shah A, Cox B, Darzi Aet al., 2015, Identifying Quality Indicators Used by Patients to Choose Secondary Health Care Providers: A Mixed Methods Approach, JMIR MHEALTH AND UHEALTH, Vol: 3, ISSN: 2291-5222

Journal article

Murugesh-Warren A, Dubb S, Sudbury D, Saeed A, Nnajiuba U, Mashayekhi S, Abdel-Gadir S, Caris J, Cox Bet al., 2015, An extension of the UTAUT 2 with a focus of age in healthcare: What do different ages want?, INTERNATIONAL JOURNAL OF INTEGRATED CARE, Vol: 15, ISSN: 1568-4156

Journal article

Johnston MJ, King D, Arora S, Cooper K, Panda NA, Gosling R, Singh K, Sanders B, Cox B, Darzi Aet al., 2014, Requirements of a new communication technology for handover and the escalation of patient care: a multi-stakeholder analysis, Journal of Evaluation in Clinical Practice, Vol: 20, Pages: 486-497, ISSN: 1356-1294

Rationale, aims and objectivesIn order to enable safe and efficient information transfer between health care professionals during clinical handover and escalation of care, existing communication technologies must be updated. This study aimed to provide a user‐informed guide for the development of an application‐based communication system (ABCS), tailored for use in patient handover and escalation of care.MethodsCurrent methods of inter‐professional communication in health care along with information system needs for communication technology were identified through literature review. A focus group study was then conducted according to a topic guide developed by health innovation and safety researchers. Fifteen doctors and 11 nurses from three London hospitals participated in a mixture of homogeneous and heterogeneous sessions. The sessions were recorded and transcribed verbatim before being subjected to thematic analysis.ResultsSeventeen information system needs were identified from the literature review. Participants identified six themes detailing user perceptions of current communication technology, attitudes to smartphone technology and anticipated requirements of an application produced for handover and escalation of care. Participants were in favour of an ABCS over current methods and expressed enthusiasm for a system with integrated patient information and group‐messaging functions.ConclusionDespite concerns regarding confidentiality and information governance a robust guide for development and implementation of an ABCS was produced, taking input from multiple stakeholders into account. Handover and escalation of care are vital processes for patient safety and communication within these must be optimized. An ABCS for health care professionals would be a welcome innovation and may lead to improvements in patient safety.

Journal article

Kesavan S, Kelay T, Collins RE, Cox B, Bello F, Kneebone RL, Sevdalis Net al., 2013, Clinical information transfer and data capture in the acute myocardial infarction pathway: an observational study, JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Vol: 19, Pages: 805-811, ISSN: 1356-1294

Journal article

Gauher ST, Khehar R, Rajput G, Hayat A, Bakshi B, Chawla H, Cox BM, Warrens ANet al., 2013, The factors that influence attitudes toward organ donation for transplantation among UK university students of Indian and Pakistani descent, CLINICAL TRANSPLANTATION, Vol: 27, Pages: 359-367, ISSN: 0902-0063

Journal article

Kelay T, Kesavan S, Collins RE, Kyaw-Tun J, Cox B, Bello F, Kneebone RL, Sevdalis Net al., 2013, Techniques to aid the implementation of novel clinical information systems: A systematic review, INTERNATIONAL JOURNAL OF SURGERY, Vol: 11, Pages: 783-791, ISSN: 1743-9191

Journal article

Yang X, Han R, Guo Y, Bradley J, Cox B, Dickinson R, Kitney Ret al., 2012, Modelling and performance analysis of clinical pathways using the stochastic process algebra PEPA, Bmc Bioinformatics, Vol: 13, ISSN: 1471-2105

Journal article

Cox B, Kuzmenko O, Swartzman S, 2010, Ethical data sharing involving industry: Government-industry collaboration

Collaborations that involve the sharing of medical and biometric data between government and industry partners present particular ethical challenges. In this paper, ethical implications of data sharing and recommendations for data management in these collaborations are identified. Recommendations for adhering to privacy laws and examples of government-industry collaborations using medical or biometric data are also discussed. Conflicts of interest, ownership, and the purpose of the collaboration are identified as pertinent ethical issues. These issues and recommendations are intended to contribute to international debate and consensus-building among experts. This investigation contributes to the European Union's FP7 ETHICAL Project, which aims to encourage international discussion on medical and biometric data ethics. Copyright © 2010 The Authors.

Conference paper

Siew ST, Mohd-Nor R, Swartzman S, Lim T, Cox B, Yeo AW, Menevidis Zet al., 2010, Ethical implications of digitised medical and biometric data

In this paper, ethical implications of data collection, use and retention of medical and biometric data in biometrics and medical applications are identified. These implications are discussed in the context of five main ethical principles - privacy, confidentiality, security, property and ownership, and reliability and trustworthiness. In addition, to illustrate unethical uses of medical and biometric data, cases of misuse are described. Our research contributes to the European Union's FP7 ETHICAL project, which aims to promote international debate on ethical implications of data collection, use, and retention of biometric and medical data. Copyright © 2010 The Authors.

Conference paper

Swartzman S, Cox B, 2010, Information technology and ethical international data sharing

The exchange of medical and biometric data across borders can present ethical concerns and dilemmas. This paper provides examples of existing national and international normative frameworks, including binding legislation and non-binding guidelines on international data sharing, to illustrate the status quo and cross-national inconsistencies. Ethical implications of these normative frameworks and of international data sharing in general are discussed. Ethical recommendations extracted from academic literature on transborder data flows are sampled. This analysis of current norms and ethical implications and recommendations is intended to promote international debate towards a consensus on ethical exchange of medical and biometric data between countries. Copyright © 2010 The Authors.

Conference paper

Meyer D, Cox B, 2010, Can Signalling Theory and the Semaphoric Nature of Information Systems Explain Clinicians' Ambivalence to Informatics?, 13th World Congress on Medical and Health Informatics of International-Medical-Informatics-Association (Medinfo), Publisher: IOS PRESS, Pages: 671-675, ISSN: 0926-9630

Conference paper

Bayer S, Petsoulas C, Cox B, Honeyman A, Barlow JGet al., 2010, Facilitating stroke care planning through simulation modelling, Health Informatics Journal, Vol: 16, Pages: 129-143

Stroke is a leading cause of death and long-term severe disability. A major difficulty facing stroke care provision in the UK is the lack of service integration between the many authorities, professionals and stakeholdersinvolved in the process. The objective of this article is to describe a prototype model to support integrative planning for local stroke care services. The model maps the flow of care in the acute and community segments of the care pathway for stroke patients and allows xploring alternatives for care provision. Simulationmodelling can help to develop an understanding of the systemic impact of service change and improve the design and targeting of future services.

Journal article

Morris S, Cox B, Bosanquet N, 2009, Cost of skin cancer in England, EUROPEAN JOURNAL OF HEALTH ECONOMICS, Vol: 10, Pages: 267-273, ISSN: 1618-7598

Journal article

Cauldwell M, Beattie C, Cox B, Denby W, Ede-Golightly J, Linton Fet al., 2007, The Impact of Electronic Patient Records on Workflow in General Practice, Health Informatics Journal, Vol: 13, Pages: 155-160, ISSN: 1460-4582

Journal article

Cox B, Lefevre D, Brenton H, 2007, Towards an osmotic strategy for overcoming academic attitudinal barriers to e-learning, 2nd International Conference on e-Learning (ICEL 2007), Publisher: ACADEMIC CONFERENCES LTD, Pages: 113-116

Conference paper

Handley K, Cox B, 2007, 'Beyond model answers: learners' perceptions of self-assessment materials in e-learning applications', ALT-J Research in Learning Technology, Vol: 15, Pages: 21-36, ISSN: 0968-7769

Journal article

Lefevre DJ, Cox B, 2006, Do cultural schemata impact on students’ engagement with eLearning content?, CATaC 2006

Conference paper

Lefevre DJ, Cox B, Bourguet M-J, Stewart Cet al., 2005, Adaptive learning environments to overcome cultural and language barriers to learning, IADIS International Conference on Cognition and Exploratory Learning in Digital Age

Conference paper

Morris S, Cox B, Bosanquet N, 2005, Cost of skin cancer in England (Discussion Paper), TBS/DP05/39

Report

Honeyman A, Cox B, Fisher B, 2005, Potential impacts of patient access to their electronic care records, Informatics in Primary Care, Vol: 13, Pages: 55-60, ISSN: 1476-0320

Journal article

Hamid I, Modi P, Pirani T, Velji I, Cox Bet al., 2005, Information-system development priorities for a paediatric intensive care unit, British Journal of Healthcare Computing and Information Management, Vol: 22, Pages: 29-31, ISSN: 0265-5217

Journal article

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