Publications
36 results found
, 2022, 5.K. Workshop: National and European studies on health literacy in children and adolescents, European Journal of Public Health, Vol: 32, ISSN: 1101-1262
<jats:title>Abstract</jats:title> <jats:sec> <jats:title> </jats:title> <jats:p>Health literacy describes how people use health information to make informed decisions in context of healthcare, disease prevention and health promotion. Enhancing health literacy of populations is critical and in particular important at an early age, which is understood to be more sustainable because health literacy contributes to improved personal health and development. Low health literacy in child and adolescent populations has been linked to worse health outcomes and health disparities in Europe, making health literacy of children and adolescents an important public health topic. Developing and delivering target group specific interventions and services requires precise data generation on the state of health literacy in early age. In the past decade, several conceptual approaches have been undertaken but methodological sound, validated and reliable measurement tools are still scarce. Available systematic reviews show that most tools originated from North America and/or English speaking countries. However, in the past years European researchers have been involved with research on health literacy in childhood and adolescence, the result of which culminated into heavy progress regarding the development of health literacy measurement instruments, including generic health literacy, digital health and mental health literacy. These new developments lead to the availability of validated tools for school-aged children, including primary and secondary school children. The purpose of this workshop is to bring together five contemporary health literacy studies conducted in child and adolescent populations across Europe, including national and European-wide studies. Both methodological findings regarding the measurement tool and empirical data will be introduced. The first presentation emerges from the HLCA
Foley KA, Maile EJ, Bottle A, et al., 2022, How did the covid-19 pandemic affect lower respiratory tract infections in young children in England?, EUROPEAN JOURNAL OF PUBLIC HEALTH, Vol: 32, ISSN: 1101-1262
Ma R, Foley K, Saxena S, 2022, Access to and use of contraceptive care during the first COVID-19 lockdown in the UK: a web-based survey., BJGP Open, Vol: 6
BACKGROUND: The first wave of lockdown measures to control the COVID-19 pandemic in the UK resulted in suspension of 'non-essential' services, including contraceptive care. AIM: To examine women's perceptions and experiences of contraceptive care in the UK during the first lockdown. DESIGN & SETTING: A cross-sectional survey during the lockdown period from March-June 2020. METHOD: An online questionnaire was designed asking women aged 16-54 years their experiences of contraceptive care during lockdown. Questions were based on Maxwell's evaluation framework on access, acceptability, relevance or appropriateness, and equity. It was promoted on social media from 27 May-9 June 2020. A descriptive analysis was conducted of quantitative data and thematic analysis of free-text data. RESULTS: In total, 214 responses were analysed. General practice was the source of contraception for 43.4% (n = 49) and 52.3% (n = 34) of responders before and during the lockdown, respectively. The study found 55.1% (n = 118) of responders, including regular and new users, were uncertain where or how to get contraception during the pandemic. Responders reported reduced access to contraception during lockdown, and some thought sexual health clinics and general practices were closed. Remote consultations and electronic prescriptions facilitated contraceptive access for some responders. Long-acting reversible contraception (LARC) was unavailable in some areas owing to restrictions, and alternatives were not acceptable to those who used methods for non-contraceptive benefits to treat medical conditions; for example, menorrhagia. CONCLUSION: The study highlighted the need for better information and signposting for contraception during lockdown. Contraception, including LARC, should be reframed as an essential service with robust signposting for pandemic planning and beyond.
Ram B, Foley K, van Sluijs E, et al., 2022, Developing a core outcome set for physical activity interventions in primary schools: a modified-Delphi study, BMJ Open, ISSN: 2044-6055
Objectives To develop a core outcome set for physical activity interventions in primary schools.Design Modified-Delphi. Setting UK and international. Participants 104 participants from four stakeholder groups (educators, public health professionals, health researchers, parents); 16 children (aged 8-9 years) from one London primary school. Interventions Physical activity interventions.Methods Four-stage process: (1) outcomes extracted from relevant studies identified from an umbrella review, and a focus group; (2) list of outcomes produced and domains established; (3) stakeholders completed a 2-round Delphi survey by rating (Round 1) and re-rating (Round 2) each outcome on a 9-point Likert scale from ‘not important’ to ‘critical’; a >70% participant threshold identified the outcomes rated ‘critical’ to measure, and outcomes important to children were identified through a workshop; (4) a stakeholder meeting to achieve consensus of the outcomes to include in the core outcome set. Results Seventy-four studies were extracted from 53 reviews. A list of 50 outcomes was produced and three domains established: ‘physical activity and health’ (16 outcomes), ‘social and emotional health’ (22 outcomes), and ‘educational performance’ (12 outcomes). 104 participants completed survey Round 1; 65 participants completed both rounds. Thirteen outcomes met the threshold; children identified 8 outcomes. Fourteen outcomes achieved consensus to produce the core outcome set; five outcomes for physical activity and health (diet [varied and balanced], energy, fitness, intensity of physical activity, sleep [number of hours]); seven for social and emotional health (anxiety, depression, enjoyment, happiness, self-esteem, stress, wellbeing); and two outcomes for educational performance (concentration, focus).Conclusions We have developed the first core outcome set for physical activity interventions in primary schools in
Bottle A, Neale FK, Foley KA, et al., 2022, Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study, BMJ OPEN, Vol: 12, ISSN: 2044-6055
Foley KA, Saxena SK, Majeed A, et al., 2022, Author response., Br J Gen Pract, Vol: 72, Pages: 318-318
Foley K, Maile E, Bottle R, et al., 2022, Impact of covid-19 on primary care contacts with children and young people aged 0-24 years in England; longitudinal trends study 2015-2020, British Journal of General Practice, ISSN: 0960-1643
Background: The NHS response to covid-19 altered provision and access to primary care.Aim: To examine the impact of covid-19 on general practitioner (GP) contacts with children and young people in England. Design and Setting: Longitudinal trends analysis using electronic health records from the Clinical Practice Research Datalink Aurum database.Methods: We included all children and young people younger than 25 years registered with a GP. We compared the number of total, remote and face-to-face contacts during the first UK lockdown (March to June 2020) with the mean contacts for comparable weeks from 2015 to 2019.Results: We examined 47 607 765 GP contacts with 4 307 120 million children and young people. GP contacts fell 41% during the first lockdown compared with previous years. Children aged 1-14 had greater falls in total contacts (>50%) compared with infants and 15-24s. Face-to-face contacts fell by 88% with the greatest falls occurring among children aged 1-14 (> 90%). Remote contacts more than doubled, increasing most in infants (over 2.5 fold). Total contacts for respiratory illnesses fell by 74% whereas contacts for common non-transmissible conditions shifted largely to remote, mitigating the total fall (31%). Conclusion: During the covid-19 pandemic, children and young people’s contact with GPs fell, particularly for face-to-face assessment. This may be explained by a lower incidence of respiratory illnesses due to fewer social contacts and changing health seeking behaviour. The large shift to remote contacts mitigated total falls in contacts for some age groups and for common non-transmissible conditions.
Ram B, Foley K, van Sluijs E, et al., 2021, A core outcome set for school-based physical activity interventions: an international consensus, Publisher: OXFORD UNIV PRESS, ISSN: 1101-1262
Ram B, Venkatraman T, Foley K, et al., 2020, Impact of school-based physical activity interventions in primary schools: measuring what matters, European Public Health Conference, Publisher: Oxford University Press, Pages: 1-2, ISSN: 1101-1262
BackgroundA growing number of small studies suggest that school-based physical activity initiatives can help children achieve the recommended 60 minutes of physical activity per day. However, the heterogeneity of outcomes and measures used in small studies prevents pooling of results to demonstrate whether short-term health benefits are sustained. Qualitative studies suggest many benefits that are not represented by outcomes in trials to date. The aim of this study was to generate a list of outcomes that have been studied to develop a core outcome set (COS) acceptable to key stakeholders for future studies evaluating school-based physical activity initiatives.MethodsWe searched six databases (MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL and Cochrane Database of Systematic Reviews) systematically for reviews of school-based physical activity interventions, and extracted relevant studies to identify the outcomes and measures used in each paper. A long list was generated from the literature and a previous workshop with stakeholders. This study is registered with COMET (#1322), and with PROSPERO (CRD42019146621).Results75/121 cited studies drawn from 53/2409 reviews met our inclusion criteria. We grouped 65 outcomes into 3 domains: (i) physical activity and health (ii) social and emotional health, and (iii) educational attainment. We will conduct two Delphi survey rounds with four stakeholder groups (health professionals, researchers, educators and parents) to rate the importance of each outcome. A core outcome set will be generated from a consensus process.ConclusionsThere is currently a large variation of outcomes and measures studied that precludes evidence synthesis of the impact of school-based physical activity interventions. Consensus methods are needed to focus research on the outcomes that matter the most to key stakeholders and to provide tools for future studies to assess long-term impact.Key messagesVariations in outcomes studied precludes evidence synt
Alturkistani A, Lam C, Foley K, et al., 2020, Massive Open Online Course (MOOC) evaluation methods: A systematic review, Journal of Medical Internet Research, Vol: 22, Pages: 1-14, ISSN: 1438-8871
Background: Massive open online courses (MOOCs) have the potential for broad education impact due to many learners undertaking these courses. Despite their reach, there is a lack of knowledge about which methods are used for evaluating these courses.Objective: This review aims to identify current MOOC evaluation methods in order to inform future study designs.Methods: We systematically searched the following databases: (1) SCOPUS; (2) Education Resources Information Center (ERIC); (3) IEEE Xplore; (4) Medline/PubMed; (5) Web of Science; (6) British Education Index and (7) Google Scholar search engine for studies from January 2008 until October 2018. Two reviewers independently screened abstracts and titles of the studies. Published studies in English that evaluated MOOCs were included. The study design of the evaluations, the underlying motivation for the evaluation studies, data collection and data analysis methods were quantitatively and qualitatively analyzed. The quality of the included studies was appraised using the Cochrane Collaboration Risk of Bias Tool for RCTs, the NIH - National Heart, Lung and Blood Institute quality assessment tool for cohort observational studies, and for “Before-After (Pre-Post) Studies With No Control Group”.Results: The initial search resulted in 3275 studies, and 33 eligible studies were included in this review. Studies mostly had a cross-sectional design evaluating one version of a MOOC. We found that studies mostly had a learner-focused, teaching-focused or platform-focused motivation to evaluate the MOOC. The most used data collection methods were surveys, learning management system data and quiz grades and the most used data analysis methods were descriptive and inferential statistics. The methods for evaluating the outcomes of these courses were diverse and unstructured. Most studies with cross-sectional design had a low-quality assessment, whereas randomized controlled trials and quasi-experimental studies receiv
Alturkistani A, Lam C, Foley K, et al., 2020, Massive open online course evaluation methods: systematic review (Preprint), Publisher: JMIR Publications
Background:Massive open online courses (MOOCs) have the potential to make a broader educational impact because many learners undertake these courses. Despite their reach, there is a lack of knowledge about which methods are used for evaluating these courses.Objective:The aim of this review was to identify current MOOC evaluation methods to inform future study designs.Methods:We systematically searched the following databases for studies published from January 2008 to October 2018: (1) Scopus, (2) Education Resources Information Center, (3) IEEE (Institute of Electrical and Electronic Engineers) Xplore, (4) PubMed, (5) Web of Science, (6) British Education Index, and (7) Google Scholar search engine. Two reviewers independently screened the abstracts and titles of the studies. Published studies in the English language that evaluated MOOCs were included. The study design of the evaluations, the underlying motivation for the evaluation studies, data collection, and data analysis methods were quantitatively and qualitatively analyzed. The quality of the included studies was appraised using the Cochrane Collaboration Risk of Bias Tool for randomized controlled trials (RCTs) and the National Institutes of Health—National Heart, Lung, and Blood Institute quality assessment tool for cohort observational studies and for before-after (pre-post) studies with no control group.Results:The initial search resulted in 3275 studies, and 33 eligible studies were included in this review. In total, 16 studies used a quantitative study design, 11 used a qualitative design, and 6 used a mixed methods study design. In all, 16 studies evaluated learner characteristics and behavior, and 20 studies evaluated learning outcomes and experiences. A total of 12 studies used 1 data source, 11 used 2 data sources, 7 used 3 data sources, 4 used 2 data sources, and 1 used 5 data sources. Overall, 3 studies used more than 3 data sources in their evaluation. In terms of the data analysis methods
Foley K, Venkatraman T, Ram B, et al., 2019, A protocol for developing a core outcomes set for evaluation of school-based physical activity interventions in primary schools, BMJ Open, Vol: 9, Pages: 1-5, ISSN: 2044-6055
Introduction: Primary school-based physical activity interventions, such as The Daily Mile initiative, have the potential to increase children’s physical activity levels over time, which is associated with a variety of health benefits. Comparing interventions or combining results of several studies of a single intervention is challenging because previous studies have examined different outcomes or used different measures that are not feasible or relevant for researchers in school settings. The development and implementation of a core outcome set (COS) for primary school-based physical activity interventions would ensure outcomes important to those involved in implementing and evaluating interventions are standardized.Methods and Analysis: Our aim is to identify a Core Outcomes Set for studies of school based physical activity interventions. We will achieve this by undertaking a four-stage process: (1) identify a list of outcomes assessed in studies through a systematic review of international literature; (2) establish domains from these outcomes to produce questionnaire items; (3) prioritize outcomes through a 2-stage Delphi survey with four key stakeholder groups (researchers, public health professionals, educators and parents) where stakeholders rate the importance of each outcome on a 9-point Likert scale ( consensus that the outcomes should be included in the COS will be determined as 70% or more of all stakeholders scoring the outcome 7 to 9 and 15% or less scoring 1 to 3); (4) achieve consensus on a final Core Outcomes Set in face-to-face meetings with a sample of stakeholders and primary school children. Ethics and Dissemination: We have received ethical approval from Imperial College London (ref: 19IC5428). The results of this study will be disseminated via conference presentations/public health meetings, peer-reviewed publications and through appropriate media channels. Registration details: This study has been prospectively registered with Core Out
Hayhoe B, Acuyo Cespedes J, Foley K, et al., 2019, Impact of integrating pharmacists into primary care teams on health systems indicators: a systematic review, British Journal of General Practice, Vol: 69, Pages: e665-e674, ISSN: 0960-1643
Background: Evidence suggests that pharmacists integrated in primary care can improve patient outcomes and satisfaction, but their impact on healthcare systems is unclear. Aim: To identify key impacts of integration of pharmacists in primary care on health system indicators such as healthcare utilisation and costs.Design and setting: A systematic review of literature.Method: We examined EMBASE, MEDLINE, SCOPUS, HMIC, CINAHL and CENTRAL, and reference lists of relevant studies. RCTs and observational studies were included, published up to June 2018, which considered health system outcomes of integration of pharmacists in primary care. Risk of bias assessment used the Cochrane Risk of Bias Quality Assessment tool for RCTs, and the NIH National Heart, Lung and Blood Institute quality assessment tool for observational studies. Data were extracted from published reports and findings synthesized.Results: Searches identified 3,058 studies; 28 met the inclusion criteria. Most included studies were of fair quality. Pharmacists in primary care resulted in reduced use of GP appointments and reduced emergency department attendance, but increased overall primary care use. There was no impact on hospitalisations, but some evidence of savings in overall health system costs and medication costs.Conclusion: Integration of pharmacists in primary care may reduce GP workload, as well emergency department use. Further higher quality studies are needed, including research to clarify cost-effectiveness and long-term impact on health system outcomes.
Meinert E, Alturkistani A, Foley K, et al., 2019, Examining cost measurements in production and delivery of three case studies using eLearning for Applied Health Sciences: a cross-case synthesis, Journal of Medical Internet Research, Vol: 21, ISSN: 1438-8871
The World Health Organization World Health Report conveys that a significant increase is needed in global healthcare resourcing to meet current and future demand for health professionals. eLearning presents a possible opportunity to change and optimize training by providing a scalable means for instruction, thus reducing the costs for training health professionals and providing patient education. Research literature often suggests that a benefit of eLearning is its cost-effectiveness compared with face-to-face instruction, yet there is limited evidence comparing design and production costs with other forms of instruction, or the establishment of standards for budgeting for these costs.
Zeeshaan A, Alturkistani A, Brindley D, et al., 2019, Tools for the diagnosis of Herpes simplex virus 1/2: A systematic review of studies published between 2012-2018, JMIR Public Health and Surveillance, Vol: 5, ISSN: 2369-2960
Herpes simplex viruses (HSV) 1 and 2 are common infections affecting the global population. HSV 1 is the most common type estimated to affect 67% of the global population. HSV can have rare, but severe manifestations such as encephalitis and neonatal herpes necessitating the use of reliable and accurate diagnostic tools for the detection of the viruses. Currently used HSV diagnostic tools require highly specialized skills, availability of a laboratory setting and may lack sensitivity. More recent HSV diagnostic tools are numerous and need to be identified and compared in a systematic way to be able to make the best decision about which diagnostic tool to use. Diagnosis of HSV is essential for prompt treatment with antivirals. To select the best test for a patient, knowledge of the performance and limitations of each test are critical. This systematic review summarizes recent study articles evaluating HSV-1 and HSV-2 diagnostic tools.
Arshad Z, Alturkistani A, Brindley D, et al., 2019, Tools for the diagnosis of herpes simplex virus 1/2: systematic review of studies published between 2012 and 2018 (Preprint), Publisher: JMIR Publications
Background:Herpes simplex virus (HSV)-1 and HSV-2 are common infections affecting the global population, with HSV-1 estimated to affect 67% of the global population. HSV can have rare but severe manifestations, such as encephalitis and neonatal herpes, necessitating the use of reliable and accurate diagnostic tools for the detection of the viruses. Currently used HSV diagnostic tools require highly specialized skills and availability of a laboratory setting but may lack sensitivity. The numerous recently developed HSV diagnostic tools need to be identified and compared in a systematic way to make the best decision about which diagnostic tool to use. The diagnosis of HSV is essential for prompt treatment with antivirals. To select the best test for a patient, knowledge of the performance and limitations of each test is critical.Objective:This systematic review has summarized recent studies evaluating HSV-1 and HSV-2 diagnostic tools.Methods:Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, selection criteria, data extraction, and data analysis were determined before the commencement of the study. Studies assessing the specificity/sensitivity of HSV-1 or HSV-2 diagnostic tools published between 2012 and 2018 were included. Quality assessment of included studies was performed using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool.Results:Searches of the PubMed database yielded 264 studies; 11 studies included 11 molecular assays, and 8 studies included 19 different serological assays for the detection of HSV-1, HSV-2, or both. A greater proportion of molecular assay–based tools are being developed by commercial entities. Studies that tested molecular assays mostly focused on cutaneous and mucosal HSV infections (n=13); 2 studies focused on ocular disease, whereas only 1 study focused on the central nervous system manifestations. The Simplexa HSV 1 & 2 Direct is currently the only Food and Drug Ad
Foley K, Alturkistani A, Carter A, et al., 2019, Massive Open Online Courses (MOOC) evaluation methods: protocol for a systematic review, JMIR Research Protocols, Vol: 8, ISSN: 1929-0748
BACKGROUND: Massive open online courses (MOOCs) have increased in popularity in recent years. They target a wide variety of learners and use novel teaching approaches, yet often exhibit low completion rates (10%). It is important to evaluate MOOCs to determine their impact and effectiveness, but little is known at this point about the methodologies that should be used for evaluation. OBJECTIVE: The purpose of this paper is to provide a protocol for a systematic review on MOOC evaluation methods. METHODS: We will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines for reporting this protocol. We developed a population, intervention, comparator, and outcome (PICO) framework to guide the search strategy, based on the overarching question, "What methods have been used to evaluate MOOCs?" The review will follow six stages: 1) literature search, 2) article selection, 3) data extraction, 4) quality appraisal, 5) data analysis, and 6) data synthesis. RESULTS: The systematic review is ongoing. We completed the data searches and data abstraction in October and November 2018. We are now analyzing the data and expect to complete the systematic review by March 2019. CONCLUSIONS: This systematic review will provide a useful summary of the methods used for evaluation of MOOCs and the strengths and limitations of each approach. It will also identify gaps in the literature and areas for future work. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12087.
Meinert E, Alturkistani A, Foley K, et al., 2019, Implementation of blockchains in healthcare: protocol for a systematic review, JMIR Research Protocols, Vol: 8, ISSN: 1929-0748
BackgroundA blockchain is a digitised, decentralised, distributed public ledger; a shared and synchronised database that records cryptocurrency transactions. Despite the shift towards digital platforms enabled by Electronic Medical Records (EMRs), demonstrating a will to reform the healthcare sector, health systems face issues including security, interoperability, data fragmentation, timely access to patient data and silos. Application of healthcare blockchains could enable data interoperability, enhancement of precision medicine and reduction in prescription frauds through implementing novel methods in access and patient consent. Objectives To summarise the evidence on the strategies and frameworks utilised to implement blockchains for patient data in healthcare to ensure privacy and improve interoperability and scalability. It is anticipated this review will assist in development of recommendations that will assist key stakeholders in healthcare blockchain implementation and we predict that the evidence generated will challenge the healthcare status quo, moving away from more traditional approaches and facilitating decision-making of patients, healthcare providers and researchers. ResultsDatabase searches will be initiated in September 2018. We expect to complete the review in December 2018. ConclusionsThis review will summarize the strategies and frameworks used to implement blockchains in healthcare to increase data privacy, interoperability and scalability. This review will also help clarify if the strategies and frameworks required for the operationalisation of blockchains in healthcare ensure the privacy of patient data whilst enabling efficiency, interoperability and scalability.
Meinert E, Alturkistani A, Foley KA, et al., 2019, Blockchain implementation in health care: Protocol for a systematic review, JMIR Research Protocols, Vol: 8, Pages: 153-159, ISSN: 1929-0748
Background: A blockchain is a digitized, decentralized, distributed public ledger that acts as a shared and synchronized database that records cryptocurrency transactions. Despite the shift toward digital platforms enabled by electronic medical records, demonstrating a will to reform the health care sector, health systems face issues including security, interoperability, data fragmentation, timely access to patient data, and silos. The application of health care blockchains could enable data interoperability, enhancement of precision medicine, and reduction in prescription frauds through implementing novel methods in access and patient consent.Objective: To summarize the evidence on the strategies and frameworks utilized to implement blockchains for patient data in health care to ensure privacy and improve interoperability and scalability. It is anticipated this review will assist in the development of recommendations that will assist key stakeholders in health care blockchain implementation, and we predict that the evidence generated will challenge the health care status quo, moving away from more traditional approaches and facilitating decision making of patients, health care providers, and researchers.Methods: A systematic search of MEDLINE/PubMed, Embase, Scopus, ProQuest Technology Collection and Engineering Index will be conducted. Two experienced independent reviewers will conduct titles and abstract screening followed by full-text reading to determine study eligibility. Data will then be extracted onto data extraction forms before using the Cochrane Collaboration Risk of Bias Tool to appraise the quality of included randomized studies and the Risk of Bias in nonrandomized studies of Interventions to assess the quality of nonrandomized studies. Data will then be analyzed and synthesized.Results: Database searches will be initiated in September 2018. We expect to complete the review in January 2019.Conclusions: This review will summarize the strategies and fra
Meinert E, Alturkistani A, Luo D, et al., 2019, Current status and future direction of companion diagnostics, Companion and Complementary Diagnostics: From Biomarker Discovery to Clinical Implementation, Pages: 455-472, ISBN: 9780128135402
This chapter will introduce companion diagnostics (CDxes), its current status, economic and regulatory aspects of CDx, and its future potential while discussing specific disease areas as well as the analytical technologies that are likely to dominate. It will first start by providing an overview of CDx, its definition, and some of the mechanisms that underlie its development. The chapter will then discuss the current status of CDx, its uses in medicine, and critical aspects of its development demonstrated in the discussion about codevelopment, with factors contributing to a market size exceeding 2 billion US dollars. An overview of the present economic and regulatory issues will also be discussed. Specific disease areas such as oncology, aging-related diseases, and other diseases will be considered concerning their future aspects in the use of CDx and the analytical technologies that will underlie their development.
Foley KA, Groome PA, Peng Y, et al., 2018, Identifying priorities for improvement of the quality of personal care in patients undergoing radiotherapy for prostate cancer, European Journal for Person Centered Healthcare, Vol: 6, Pages: 621-621, ISSN: 2052-5648
<jats:p>Background: We previously developed a questionnaire to assess the quality of personal care in prostate cancer radiotherapy. Patients are asked to rate the importance of 143 elements of their care and to rate the quality of their care for each element. In order to improve the quality of care delivered to patients, the elements of care most in need of improvement must be identified.Objective: To develop a method of integrating ratings of importance and ratings of quality to identify elements of care that should become targets for quality improvement.Methods: We surveyed 108 patients undergoing radiotherapy for prostate cancer. We developed 3 methods to identify elements of care to target for quality improvement that were important to the patient(s) and suboptimal in quality. Spearman correlation was used to compare ranking of priorities across all 3 methods. Generalized estimating equations were used to assess the statistical ability of the methods to discriminate between priorities for quality improvement.Results: Integrating importance and quality ratings identified different priorities than using quality ratings alone. Two of the integrated methods identified priorities for quality improvement and their ranks similarly (r=0.91, p<0.0001). All methods identified elements related to communication of information about the disease and its treatment as priorities.Conclusions: Two methods produced similar results although one is easier to understand and theoretically superior since the ratings for importance and quality are linked for each individual. Further consultation with stakeholders will determine how to use these results as part of a quality improvement program.</jats:p>
Meinert E, Van Velthoven M, Brindley D, et al., 2018, The internet of things in healthcare: proof of concept opportunities in Oxford, JMIR Research Protocols, Vol: 7, ISSN: 1929-0748
BackgroundDemands on health services across the globe are increasing due to the combined challenges of an expanding and ageing population, alongside complex comorbidities that transcend the classical boundaries of modern healthcare. To meet these challenges, we must increase the quality of care, and the efficiency with which it is delivered. Continuing to provide and coordinate care in the current manner is not a viable route to sustaining the improvements in health outcomes observed in recent history. To ensure that there continues to be improvement in patient care, prevention of disease and reduced burden on healthcare systems, it is essential that we adapt our models of delivery. Providers of health and social care are evolving to face these pressures by changing the way they think about the care system and importantly how to involve patients in the planning and delivery of services.ObjectivesThe objective of this paper is to provide: 1. An overview of the current state of IoT and key implementation considerations2. Key use cases demonstrating technology capabilities3. Overview of the landscape for healthcare Internet of Things use in Oxford4. Recommendations for PITCH-In proof of concept projectsMethodsThis paper describes the proof-of-concept (PoC) projects that will be created to explore both cost effectiveness, clinical efficacy and user adoption of IoMT systems. The projects will focus on three areas: 1) Bring your own device (BYOD) Integration, 2) Chronic Disease Management and 3) Personal Health Records. ResultsThis project is funded by Research England’s Connecting Capability (CCF) fund. The project started on March 2018 and results are expected by the end of 2019. ConclusionsEmbracing digital solutions to support the evolution and transformation of health services is essential. Importantly, this should not simply be undertaken by providers in isolation. It must embrace and exploit the advances being seen in the consumer devices, national rollout o
Meinert E, Van Velthoven M, Brindley D, et al., 2018, The internet of things in health care in Oxford: protocol for proof-of-concept projects, JMIR Research Protocols, Vol: 7, Pages: 1-12, ISSN: 1929-0748
Background:Demands on health services across are increasing because of the combined challenges of an expanding and aging population, alongside complex comorbidities that transcend the classical boundaries of modern health care. Continuing to provide and coordinate care in the current manner is not a viable route to sustain the improvements in health outcomes observed in recent history. To ensure that there continues to be improvement in patient care, prevention of disease, and reduced burden on health systems, it is essential that we adapt our models of delivery. Providers of health and social care are evolving to face these pressures by changing the way they think about the care system and, importantly, how to involve patients in the planning and delivery of services.Objective:The objective of this paper is to provide (1) an overview of the current state of Internet of Things (IoT) and key implementation considerations, (2) key use cases demonstrating technology capabilities, (3) an overview of the landscape for health care IoT use in Oxford, and (4) recommendations for promoting the IoT via collaborations between higher education institutions and industry proof-of-concept (PoC) projects.Methods:This study describes the PoC projects that will be created to explore cost-effectiveness, clinical efficacy, and user adoption of Internet of Medical Things systems. The projects will focus on 3 areas: (1) bring your own device integration, (2) chronic disease management, and (3) personal health records.Results:This study is funded by Research England’s Connecting Capability Fund. The study started in March 2018, and results are expected by the end of 2019.Conclusions:Embracing digital solutions to support the evolution and transformation of health services is essential. Importantly, this should not simply be undertaken by providers in isolation. It must embrace and exploit the advances being seen in the consumer devices, national rollout of high-speed broadband servi
Meinert E, Van Velthoven M, Brindley D, et al., 2018, The internet of things in health care in Oxford: protocol for proof-of-concept projects (Preprint), Publisher: JMIR Publications
Background:Demands on health services across are increasing because of the combined challenges of an expanding and aging population, alongside complex comorbidities that transcend the classical boundaries of modern health care. Continuing to provide and coordinate care in the current manner is not a viable route to sustain the improvements in health outcomes observed in recent history. To ensure that there continues to be improvement in patient care, prevention of disease, and reduced burden on health systems, it is essential that we adapt our models of delivery. Providers of health and social care are evolving to face these pressures by changing the way they think about the care system and, importantly, how to involve patients in the planning and delivery of services.Objective:The objective of this paper is to provide (1) an overview of the current state of Internet of Things (IoT) and key implementation considerations, (2) key use cases demonstrating technology capabilities, (3) an overview of the landscape for health care IoT use in Oxford, and (4) recommendations for promoting the IoT via collaborations between higher education institutions and industry proof-of-concept (PoC) projects.Methods:This study describes the PoC projects that will be created to explore cost-effectiveness, clinical efficacy, and user adoption of Internet of Medical Things systems. The projects will focus on 3 areas: (1) bring your own device integration, (2) chronic disease management, and (3) personal health records.Results:This study is funded by Research England’s Connecting Capability Fund. The study started in March 2018, and results are expected by the end of 2019.Conclusions:Embracing digital solutions to support the evolution and transformation of health services is essential. Importantly, this should not simply be undertaken by providers in isolation. It must embrace and exploit the advances being seen in the consumer devices, national rollout of high-speed broadband servi
Foley K, Alturkistani A, Carter A, et al., 2018, Massive Open Online Courses (MOOC) evaluation methods: protocol for a systematic review (preprint), Publisher: JMIR Publications
Background: Massive open online courses (MOOCs) have increased in popularity in recent years. They target a wide variety of learners and use novel teaching approaches, yet often exhibit low completion rates (10%). It is important to evaluate MOOCs to determine their impact and effectiveness, but little is known at this point about the methodologies that should be used for evaluation.Objective: The purpose of this paper is to provide a protocol for a systematic review on MOOC evaluation methods.Methods: We will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines for reporting this protocol. We developed a population, intervention, comparator, and outcome (PICO) framework to guide the search strategy, based on the overarching question, “What methods have been used to evaluate MOOCs?” The review will follow six stages: 1) literature search, 2) article selection, 3) data extraction, 4) quality appraisal, 5) data analysis, and 6) data synthesis.Results: The systematic review is ongoing. We completed the data searches and data abstraction in October and November 2018. We are now analyzing the data and expect to complete the systematic review by March 2019.Conclusions: This systematic review will provide a useful summary of the methods used for evaluation of MOOCs and the strengths and limitations of each approach. It will also identify gaps in the literature and areas for future work.
Majeed FA, Allwood D, Foley K, et al., 2018, Healthcare outcomes and quality in the NHS: how do we compare and how might the NHS improve?, BMJ, Vol: 362, ISSN: 0959-8138
Health outcomes in the United Kingdom have improved substantially since the NHS was established in 1948.1 For example, average life expectancy has increased by around 12 years from 68 to 80 years; and infant mortality has fallen nearly 90%, from 34/1000 live births to less than 4/1000.2 The NHS performs well in many international comparisons on measures such as efficiency, equity, and access.3 Despite these achievements, however, problems with health outcomes remain.34 Moreover, other European countries have also improved their health outcomes in recent decades, often at a faster rate than the UK. Consequently, the UK now lags behind many other European countries in key health outcomes in areas such as child health and cancer survival. Here, we review the quality of care and health outcomes in the NHS, focusing on areas that are important to patients, policy makers, and clinicians4 and for which there are comparative international data.
Meinert E, Alturkistani A, Foley KA, et al., 2018, Blockchain implementation in health care: protocol for a systematic review (Preprint), Publisher: JMIR Publications Inc.
Background:A blockchain is a digitized, decentralized, distributed public ledger that acts as a shared and synchronized database that records cryptocurrency transactions. Despite the shift toward digital platforms enabled by electronic medical records, demonstrating a will to reform the health care sector, health systems face issues including security, interoperability, data fragmentation, timely access to patient data, and silos. The application of health care blockchains could enable data interoperability, enhancement of precision medicine, and reduction in prescription frauds through implementing novel methods in access and patient consent.Objective:To summarize the evidence on the strategies and frameworks utilized to implement blockchains for patient data in health care to ensure privacy and improve interoperability and scalability. It is anticipated this review will assist in the development of recommendations that will assist key stakeholders in health care blockchain implementation, and we predict that the evidence generated will challenge the health care status quo, moving away from more traditional approaches and facilitating decision making of patients, health care providers, and researchers.Methods:A systematic search of MEDLINE/PubMed, Embase, Scopus, ProQuest Technology Collection and Engineering Index will be conducted. Two experienced independent reviewers will conduct titles and abstract screening followed by full-text reading to determine study eligibility. Data will then be extracted onto data extraction forms before using the Cochrane Collaboration Risk of Bias Tool to appraise the quality of included randomized studies and the Risk of Bias in nonrandomized studies of Interventions to assess the quality of nonrandomized studies. Data will then be analyzed and synthesized.Results:Database searches will be initiated in September 2018. We expect to complete the review in January 2019.Conclusions:This review will summarize the strategies and framewor
Foley KA, Groome PA, Feldman-Stewart D, et al., 2017, Measuring the Quality of Personal Care in Patients Undergoing Radiotherapy for Prostate Cancer, CLINICAL ONCOLOGY, Vol: 29, Pages: 827-834, ISSN: 0936-6555
Foley K, Groome P, Feldman-Stewart D, et al., 2016, Measuring the Quality of Personal Care in Patients Undergoing Radiation Therapy for Prostate Cancer, INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, Vol: 96, Pages: E257-E257, ISSN: 0360-3016
Greenfield G, Foley K, Majeed A, 2016, Rethinking primary care's gatekeeper role., BMJ, Vol: 354, ISSN: 0959-8138
Gatekeeping is the term used to describe the role of primary care physicians or general practitioners (GPs) in authorising access to specialty care, hospital care, and diagnostic tests.1 Gatekeeping has crucial influences on service utilisation, health outcomes, healthcare costs, and patient satisfaction.In the UK access to NHS and private specialists is generally possible only after a referral from a GP. Gatekeeping was developed as a response to a shortage of specialists and a desire to control healthcare spending2 and has been an accepted practice in the UK for over 100 years.3 The NHS is under considerable pressure to use its resources efficiently, and primary care has helped the NHS to achieve this goal through its gatekeeping function.4 Yet direct access could help reduce GP workload and facilitate greater patient choice. We look at the pros and cons of gatekeeping, describe gatekeeping policies in various countries, and highlight the need for more evidence to devise policy.
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