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To investigate the association between student performance in undergraduate objective structured clinical examinations (OSCEs) and the examination schedule to which they were assigned to undertake these examinations. Analysis of routinely... more
To investigate the association between student performance in undergraduate objective structured clinical examinations (OSCEs) and the examination schedule to which they were assigned to undertake these examinations. Analysis of routinely collected data. One UK medical school. 2331 OSCEs of 3 different types (obstetrics OSCE, paediatrics OSCE and simulated clinical encounter examination OSCE) between 2009 and 2013. Students were not quarantined between examinations. (1) Pass rates by day examination started, (2) pass rates by day station undertaken and (3) mean scores by day examination started. We found no evidence that pass rates differed according to the day on which the examination was started by a candidate in any of the examinations considered (p>0.1 for all). There was evidence (p=0.013) that students were more likely to pass individual stations on the second day of the paediatrics OSCE (OR 1.27, 95% CI 1.05 to 1.54). In the cases of the simulated clinical encounter examin...
Research Interests: Obstetrics, Pediatrics, Educational Measurement, Medicine, United Kingdom, and 15 moreMedical Students, Humans, Female, Undergraduate medical education, Male, Obstetrics and Gynaecology, Confidence intervals, Adult, Physical examination, Reproducibility of Results, Clinical Competence, Objective Structured Clinical Examination (OSCE), Medical Education Training, Medical History Taking, and Schools Medical
Longer consultations in primary care have been linked with better quality of care and improved health-related outcomes. However, there is little evidence of any potential association between consultation length and patient experience. To... more
Longer consultations in primary care have been linked with better quality of care and improved health-related outcomes. However, there is little evidence of any potential association between consultation length and patient experience. To examine the relationship between consultation length and patient-reported communication, trust and confidence in the doctor, and overall satisfaction. Analysis of 440 videorecorded consultations and associated patient experience questionnaires from 13 primary care practices in England. Patients attending a face-to-face consultation with participating GPs consented to having their consultations videoed and completed a questionnaire. Consultation length was calculated from the videorecording. Linear regression (adjusting for patient and doctor demographics) was used to investigate associations between patient experience (overall communication, trust and confidence, and overall satisfaction) and consultation length. There was no evidence that consultat...
Research Interests: Primary Care, General Practice, Communication, Primary Health Care, Family Medicine, and 15 moreMedicine, England, Humans, Female, Male, Patient Satisfaction, Middle Aged, Patient Experience, Public health systems and services research, Time Factors, Cross sectional Study, Cross Sectional Studies, Confidence Interval, Surveys and Questionnaires, and Referral and consultation
Patient evaluations of physician communication are widely used, but we know little about how these relate to professionally agreed norms of communication quality. We report an investigation into the association between patient assessments... more
Patient evaluations of physician communication are widely used, but we know little about how these relate to professionally agreed norms of communication quality. We report an investigation into the association between patient assessments of communication quality and an observer-rated measure of communication competence. Consent was obtained to video record consultations with Family Practitioners in England, following which patients rated the physician's communication skills. A sample of consultation videos was subsequently evaluated by trained clinical raters using an instrument derived from the Calgary-Cambridge guide to the medical interview. Consultations scored highly for communication by clinical raters were also scored highly by patients. However, when clinical raters judged communication to be of lower quality, patient scores ranged from "poor" to "very good." Some patients may be inhibited from rating poor communication negatively. Patient evaluation...
Research Interests: Family Medicine, Medicine, Communication Skills, Business and Management, Health Care Quality, and 8 morePhysician Patient Communication, Medical Care, Patient Experience, Public health systems and services research, Science Technology, Life Sciences & Biomedicine, Health Care Surveys, and Health Care Sciences & Services
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The boundary between open and closed magnetic field lines (OCB) delimits the region of open flux in the Earth's magnetosphere. We present an automated... more
The boundary between open and closed magnetic field lines (OCB) delimits the region of open flux in the Earth's magnetosphere. We present an automated technique to derive estimates of the ionospheric projection of the OCB from the characteristics of latitudinal profiles of far ultraviolet (FUV) auroral intensity. For the typical auroral oval, these latitudinal intensity profiles can be well modelled
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ABSTRACT Large-scale properties of reconnection structures on the magnetopause can be explained successfully by simple models incorporating laminar magnetosheath flow with antiparallel reconnection. However, such models are inconsistent... more
ABSTRACT Large-scale properties of reconnection structures on the magnetopause can be explained successfully by simple models incorporating laminar magnetosheath flow with antiparallel reconnection. However, such models are inconsistent with the highly turbulent nature of the magnetosheath flow adjacent to the magnetopause. This presentation proposes a fractal reconnection model that resolves this contradiction by replacing the laminar magnetosheath flow with a turbulent flow which has realistic levels of fluctuation. The resultant fractal reconnection structures preserve the large-scale behaviour of simpler models, consistent with ground-based observations, but have small-scale fluctuations consistent with those observed in situ by spacecraft. We also present observations of evidence for scale-free fluctuations in ionospheric convection associated with dayside reconnection. This scale free behaviour may well arise as a consequence of the fractal reconnection model proposed.
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To investigate if language spoken at home mediates the relationship between ethnicity and doctor-patient communication for South Asian and White British patients. We conducted secondary analysis of patient experience survey data collected... more
To investigate if language spoken at home mediates the relationship between ethnicity and doctor-patient communication for South Asian and White British patients. We conducted secondary analysis of patient experience survey data collected from 5870 patients across 25 English general practices. Mixed effect linear regression estimated the difference in composite general practitioner-patient communication scores between White British and South Asian patients, controlling for practice, patient demographics and patient language. There was strong evidence of an association between doctor-patient communication scores and ethnicity. South Asian patients reported scores averaging 3.0 percentage points lower (scale of 0-100) than White British patients (95% CI -4.9 to -1.1, p=0.002). This difference reduced to 1.4 points (95% CI -3.1 to 0.4) after accounting for speaking a non-English language at home; respondents who spoke a non-English language at home reported lower scores than English-sp...
Research Interests: Communication, Primary Health Care, Language, Medicine, United Kingdom, and 15 moreHumans, Demographics, Female, Male, Ethnic Groups, Adult, Ethnic Group, European Continental Ancestry Group, Asian Continental Ancestry Group, Communication barriers, Cross Sectional Studies, Surveys and Questionnaires, Health Care Surveys, Quality of health care, and Physician-Patient Relations
Research Interests: Geology, Physics, Computational Physics, Convection, Multidisciplinary, and 15 moreMagnetic field, Atmospheric sciences, Ionosphere, Magnetospheric Physics, Power Law, Magnetic Reconnection, Geomagnetic field, Smoothing, Fluctuations, Spectrum, Power Spectrum, Geophysical, Interplanetary Magnetic Field, Spectral Density, and Power spectral density
Research Interests: Gerontology, Quality of life, Public Health, Medicine, Comorbidity, and 14 moreEngland, Humans, Diabetes mellitus, Health related Quality of Life, Female, Mental Disorders, Arthritis, Aged, Adult, Public health systems and services research, Ethnic Group, Quality Life, Self report, and Nervous System Diseases
Research Interests: Biochemistry, Genetics, Chemistry, Organic Chemistry, Developmental Biology, and 15 moreMolecular Biology, Catalysis, DNA damage, Medicine, Click chemistry, Copper, Combinatorial Chemistry, Bioconjugate Chemistry, DMSO, Oxidative Dna Damage, Alkynes, Bioconjugation, Biochemistry and cell biology, Oligonucleotide, and Azides
A number of recent studies have investigated temporal structuring within the magnetosphere ionosphere system. Studies of ground magnetometer measurements, ionospheric velocity fluctuations, inter FTE intervals, and the AE index, have... more
A number of recent studies have investigated temporal structuring within the magnetosphere ionosphere system. Studies of ground magnetometer measurements, ionospheric velocity fluctuations, inter FTE intervals, and the AE index, have shown evidence of scale free behaviour. In contrast little work has been done to characterise the spatial structuring. With the large field of view of the SuperDARN radars we have
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Analysis of the spatio-temporal structure of ionospheric plasma velocity fluctuations measured by HF radars and of associated ground magnetic fluctuations measured by magnetometers reveals that convection fluctuations are primarily... more
Analysis of the spatio-temporal structure of ionospheric plasma velocity fluctuations measured by HF radars and of associated ground magnetic fluctuations measured by magnetometers reveals that convection fluctuations are primarily characterised by a scale-free property (no preferred frequency over the observed range), similar to that of the turbulent solar wind [5, 6]. We consider the implications of this on (a) the interpretation of finite-range and spatially-averaged observations, (b) forecasting space weather from solar wind observations, and (c) the Dungey reconnection model of magnetospheric convection.
Large-scale properties of reconnection structures on the magnetopause can be explained successfully by simple models incorporating laminar magnetosheath flow with antiparallel reconnection. However, such models are inconsistent with the... more
Large-scale properties of reconnection structures on the magnetopause can be explained successfully by simple models incorporating laminar magnetosheath flow with antiparallel reconnection. However, such models are inconsistent with the highly turbulent nature of the magnetosheath flow adjacent to the magnetopause. This presentation proposes a fractal reconnection model that resolves this contradiction by replacing the laminar magnetosheath flow with a turbulent flow which has realistic levels of fluctuation. The resultant fractal reconnection structures preserve the large-scale behaviour of simpler models, consistent with ground-based observations, but have small-scale fluctuations consistent with those observed in situ by spacecraft. We also present observations of evidence for scale-free fluctuations in ionospheric convection associated with dayside reconnection. This scale free behaviour may well arise as a consequence of the fractal reconnection model proposed.
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Worldwide, the incidence of cutaneous melanoma has been reported to be highest in the summer and lowest in the winter. Northern Irish data suggested seasonal variation for women only, especially those with thinner melanomas, sited on... more
Worldwide, the incidence of cutaneous melanoma has been reported to be highest in the summer and lowest in the winter. Northern Irish data suggested seasonal variation for women only, especially those with thinner melanomas, sited on limbs. We interrogated two larger UK cancer registries for temporal differences in melanoma diagnosis and associated patient characteristics. Melanomas diagnosed from 2006 to 2010 in the Eastern England and Scottish cancer registries (n=11,611) were analysed by month of diagnosis, patient demographics and melanoma characteristics, using descriptive and multivariate modelling methods. More patients with melanoma were diagnosed in the summer months (June 9.9%, July 9.7%, August 9.8%) than the winter months (December 7.2%, January 7.2%, February 7.1%) and this pattern was consistent in both regions. There was evidence that the seasonal patterns varied by sex (p=0.015), melanoma thickness (p=0.002), body site (p=0.006), and type (superficial spreading melan...
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To evaluate two 5-item patient experience scales from the English General Practice (GP) Patient Survey for evidence of differential item functioning (DIF) given prior evidence of substantially worse reported health care experiences for... more
To evaluate two 5-item patient experience scales from the English General Practice (GP) Patient Survey for evidence of differential item functioning (DIF) given prior evidence of substantially worse reported health care experiences for South Asian compared with white British respondents. A national survey of English patients' primary care experiences. We used classic test and item response theory analysis to examine the possibility of DIF by patient ethnicity (South Asian, white British) after controlling for age, sex, health status, and quality of life in the English GP Patient Survey conducted in 2011/2012. Data were available for 873,051 respondents (818,219 white British/54,832 South Asian from 7795 English practices) who answered items relating to experiences of GP or nurses' care. Internal consistency reliability was high and similar for South Asian and white British patients. White British patients reported better average experiences than South Asians, but there was n...
Research Interests: Psychology, Demography, Primary Health Care, Item Response Theory, Adolescent, and 15 moreMedicine, Applied Economics, England, Humans, Differential Item Functioning, Female, Male, Patient Satisfaction, Medical Care, Aged, Middle Aged, Adult, Ethnic Group, European Continental Ancestry Group, and Asian Continental Ancestry Group
To investigate the experience of users of out of hours general practitioner services in England, UK. Population based cross sectional postal questionnaire survey. General Practice Patient Survey 2012-13. Potential associations between... more
To investigate the experience of users of out of hours general practitioner services in England, UK. Population based cross sectional postal questionnaire survey. General Practice Patient Survey 2012-13. Potential associations between sociodemographic factors (including ethnicity and ability to take time away from work during working hours to attend a healthcare consultation) and provider organisation type (not for profit, NHS, or commercial) and service users' experience of out of hours care (timeliness, confidence and trust in the out of hours clinician, and overall experience of the service), rated on a scale of 0-100. Which sociodemographic/provider characteristics were associated with service users' experience, the extent to which any observed differences could be because of clustering of service users of a particular sociodemographic group within poorer scoring providers, and the extent to which observed differences in experience varied across types of provider. The ov...
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The boundary between open and closed magnetic field lines (OCB) delimits the region of open flux in the Earth's magnetosphere. We present an automated... more
The boundary between open and closed magnetic field lines (OCB) delimits the region of open flux in the Earth's magnetosphere. We present an automated technique to derive estimates of the ionospheric projection of the OCB from the characteristics of latitudinal profiles of far ultraviolet (FUV) auroral intensity. For the typical auroral oval, these latitudinal intensity profiles can be well modelled
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Research Interests: Gerontology, Quality of life, Public Health, Medicine, Comorbidity, and 14 moreEngland, Humans, Diabetes mellitus, Health related Quality of Life, Female, Mental Disorders, Arthritis, Aged, Adult, Public health systems and services research, Ethnic Group, Quality Life, Self report, and Nervous System Diseases
To investigate initial reliability of the Global Consultation Rating Scale (GCRS: an instrument to assess the effectiveness of communication across an entire doctor-patient consultation, based on the Calgary-Cambridge guide to the medical... more
To investigate initial reliability of the Global Consultation Rating Scale (GCRS: an instrument to assess the effectiveness of communication across an entire doctor-patient consultation, based on the Calgary-Cambridge guide to the medical interview), in simulated patient consultations. Multiple ratings of simulated general practitioner (GP)-patient consultations by trained GP evaluators. UK primary care. 21 GPs and six trained GP evaluators. GCRS score. 6 GP raters used GCRS to rate randomly assigned video recordings of GP consultations with simulated patients. Each of the 42 consultations was rated separately by four raters. We considered whether a fixed difference between scores had the same meaning at all levels of performance. We then examined the reliability of GCRS using mixed linear regression models. We augmented our regression model to also examine whether there were systematic biases between the scores given by different raters and to look for possible order effects. Asses...
Research Interests: General Practice, Communication, Primary Health Care, Medicine, Linear models, and 14 moreResearch methods and Statistics, Humans, Rating Scale, Great Britain, Observer Variation, Reproducibility of Results, Clinical Competence, General Practitioners, Video Recording, Medical Education Training, Quality of health care, Interviews as topic, Referral and consultation, and Physician-Patient Relations
It is believed that some patients are more likely to use out-of-hours primary care services because of difficulties in accessing in-hours care, but substantial evidence about any such association is missing. We analysed data from 567 049... more
It is believed that some patients are more likely to use out-of-hours primary care services because of difficulties in accessing in-hours care, but substantial evidence about any such association is missing. We analysed data from 567 049 respondents to the 2011/2012 English General Practice Patient Survey who reported at least one in-hours primary care consultation in the preceding 6 months. Of those respondents, 7% also reported using out-of-hours primary care. We used logistic regression to explore associations between use of out-of-hours primary care and five measures of in-hours access (ease of getting through on the telephone, ability to see a preferred general practitioner, ability to get an urgent or routine appointment and convenience of opening hours). We illustrated the potential for reduction in use of out-of-hours primary care in a model where access to in-hours care was made optimal. Worse in-hours access was associated with greater use of out-of-hours primary care for ...
Research Interests: Nursing, Emergency Medicine, Primary Care, Primary Health Care, Adolescent, and 15 moreMedicine, England, Logistic Regression, Multivariate Analysis, Humans, Female, Male, Clinical Sciences, Aged, Middle Aged, Adult, General Practitioners, Prehospital Care, Health Services Accessibility, and Health Care Surveys
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We present a technique to measure the magnetic field‐aligned vorticity of mesoscale plasma flows in the F region ionosphere using line‐of‐sight velocity measurements made by the Super Dual Auroral Radar Network (SuperDARN). Vorticity is... more
We present a technique to measure the magnetic field‐aligned vorticity of mesoscale plasma flows in the F region ionosphere using line‐of‐sight velocity measurements made by the Super Dual Auroral Radar Network (SuperDARN). Vorticity is often used as a proxy for magnetic field‐aligned current (FAC) intensity in the ionosphere but also provides information about turbulent processes in the ionosphere and magnetosphere. Using 6 years (2000–2005 inclusive) of vorticity measurements made by six SuperDARN radars in the Northern Hemisphere, we have compiled, for the first time, maps of average vorticity across the northern polar ionosphere. These maps have been subdivided according to different seasonal and interplanetary magnetic field (IMF) conditions. The variations in the morphology of the vorticity maps with IMF direction match very closely those seen in maps of average FAC intensity (determined using different methods and instrumentation), suggesting that vorticity is a good proxy fo...
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We analyze the power spectrum of the line‐of‐sight ionospheric velocity measured by the SuperDARN CUTLASS Finland radar and of contemporaneous magnetic field perturbations measured by nearby IMAGE magnetometers. The measurements come from... more
We analyze the power spectrum of the line‐of‐sight ionospheric velocity measured by the SuperDARN CUTLASS Finland radar and of contemporaneous magnetic field perturbations measured by nearby IMAGE magnetometers. The measurements come from 69–87° AACGM latitude and 0415–2230 MLT during 58 intervals of pulsed ionospheric flow between March 1995 and September 1996. The median power spectrum of both the velocity and magnetic field is of power law form with a best fit exponent of −0.5 and −1.3, respectively. By simulating the effect of the finite sample window on the measured spectral exponent and on the structure seen in the power spectral density of individual spectra, we show that the measured spectral exponent actually corresponds to a true exponent of −0.95 for the velocity and −1.8 for the magnetic field. Furthermore, it is shown that the difference in the exponents of the velocity and magnetic field spectra is at least in part due to a spatial smoothing effect that causes the spec...
Research Interests: Geology, Physics, Computational Physics, Convection, Multidisciplinary, and 15 moreMagnetic field, Atmospheric sciences, Ionosphere, Magnetospheric Physics, Power Law, Magnetic Reconnection, Geomagnetic field, Smoothing, Fluctuations, Spectrum, Power Spectrum, Geophysical, Interplanetary Magnetic Field, Spectral Density, and Power spectral density
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We present an analysis of 8 years of meridional line‐of‐sight ionospheric plasma velocity measurements from the Halley SuperDARN radar which investigates the effect of the interplanetary magnetic field (IMF) clock angle on the scaling... more
We present an analysis of 8 years of meridional line‐of‐sight ionospheric plasma velocity measurements from the Halley SuperDARN radar which investigates the effect of the interplanetary magnetic field (IMF) clock angle on the scaling exponents of the first three order velocity structure functions. We only use velocity measurements made poleward of the open/closed magnetic field line boundary in the nightside ionosphere. The measured scaling exponents are consistent with multifractal Kraichnan‐Iroshnikov turbulence for all clock angles but with varying intermittency that decreases to zero during purely northward IMF conditions. We thus propose that intermittency is inherited from the solar wind but also discuss other possible reasons for this relationship.
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Research Interests: Nursing, Emergency Medicine, Evidence Based Medicine, Risk assessment, Medicine, and 10 moreHumans, Patient Admission, Clinical Sciences, Great Britain, Public health systems and services research, BMJ, Risk Assessment, Emergency Department, Health Services Accessibility, and Referral and consultation
Research Interests: Emergency Medicine, Primary Health Care, Electronic Health Records, Medicine, Logistic Regression, and 14 moreHumans, Female, Male, Aged, Middle Aged, Adult, Odds ratio, Retrospective Studies, Polypharmacy, Logistic Models, Confidence Interval, Cohort Studies, Secondary care, and Pharmacology and pharmaceutical sciences
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Research Interests: General Practice, Interpersonal Communication, Quality Management, Family Medicine, Health Care, and 15 moreModeling and Simulation, Medicine, England, Clinical Practice, Humans, Philosophy and Religious Studies, Patient Satisfaction, Patient Experience, Continuity of Patient Care, Cross Sectional Studies, Rank Correlation, Health Services Accessibility, Health Care Surveys, Quality of health care, and Medical and Health Sciences
Many patients with cancer are diagnosed through an emergency presentation, which is associated with inferior clinical and patient-reported outcomes compared with those of patients who are diagnosed electively or through screening.... more
Many patients with cancer are diagnosed through an emergency presentation, which is associated with inferior clinical and patient-reported outcomes compared with those of patients who are diagnosed electively or through screening. Reducing the proportion of patients with cancer who are diagnosed as emergencies is, therefore, desirable; however, the optimal means of achieving this aim are uncertain owing to the involvement of different tumour, patient and health-care factors, often in combination. Most relevant evidence relates to patients with colorectal or lung cancer in a few economically developed countries, and defines emergency presentations contextually (that is, whether patients presented to emergency health-care services and/or received emergency treatment shortly before their diagnosis) as opposed to clinically (whether patients presented with life-threatening manifestations of their cancer). Consistent inequalities in the risk of emergency presentations by patient characte...
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Research Interests: Demography, Communication, Pakistan, Adolescent, Medicine, and 15 moreEngland, Humans, Minority Groups, Female, Male, Aged, Middle Aged, Adult, Ethnic Group, European Continental Ancestry Group, Asian Continental Ancestry Group, Communication barriers, Health Care Surveys, Interviews as topic, and healthcare disparities
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Doctor-patient communication is a key driver of overall satisfaction with primary care. Patients from minority ethnic backgrounds consistently report more negative experiences of doctor-patient communication. However, it is currently... more
Doctor-patient communication is a key driver of overall satisfaction with primary care. Patients from minority ethnic backgrounds consistently report more negative experiences of doctor-patient communication. However, it is currently unknown whether these ethnic differences are concentrated in one gender or in particular age groups. To determine how reported GP-patient communication varies between patients from different ethnic groups, stratified by age and gender. Analysis of data from the English GP Patient Survey from 2012-2013 and 2013-2014, including 1 599 801 responders. A composite score was created for doctor-patient communication from five survey items concerned with interpersonal aspects of care. Mixed-effect linear regression models were used to estimate age- and gender-specific differences between white British patients and patients of the same age and gender from each other ethnic group. There was strong evidence (P<0.001 for age by gender by ethnicity three-way inte...