Background Structured Medication Reviews (SMRs) are intended to help deliver the NHS Long Term Pl... more Background Structured Medication Reviews (SMRs) are intended to help deliver the NHS Long Term Plan for medicines optimisation in people living with multiple long-term conditions and polypharmacy. It is challenging to gather the information needed for these reviews due to poor integration of health records across providers and there is little guidance on how to identify those patients most urgently requiring review. Objective To extract information from scattered clinical records on how health and medications change over time, apply interpretable artificial intelligence (AI) approaches to predict risks of poor outcomes and overlay this information on care records to inform SMRs. We will pilot this approach in primary care prescribing audit and feedback systems, and co-design future medicines optimisation decision support systems. Design DynAIRx will target potentially problematic polypharmacy in three key multimorbidity groups, namely, people with (a) mental and physical health prob...
An exploratory investigation into the experiences of unemployed university graduates with common ... more An exploratory investigation into the experiences of unemployed university graduates with common mental health issues (i.e., depression and anxiety) was conducted using Interpretative Phenomenological Analysis. Analysis of semi-structured interviews with 12 graduates in their twenties, all of whom had been unemployed between five and 24 months with common mental health issues, generated themes relating to “Loss of Expectation and Disorientation”, “Waste, Failure and Blame”, and “Stigma and Shame”. Participants had experienced a “Fall from Grace”—a descent from a vaunted position of high-esteem and importance as university graduates, with seemingly bright prospects for a privileged future, into a lowly state of unemployment with mental health issues, leaving them feeling tarnished. These findings are discussed in relation to the literature on graduate unemployment, crisis and stigma, raising some practical issues for universities, including counselling services, and how they can bett...
We investigated the experiences of unemployed university graduates with common mental health issu... more We investigated the experiences of unemployed university graduates with common mental health issues. After conducting semistructured interviews with 12 unemployed bachelor’s degree graduates with common mental health issues, we used interpretative phenomenological analysis to generate three superordinate themes: “fall from grace,” “vulnerability,” and “life on hold.” Our focus in this article is life on hold and its constituent themes: “stagnation,” “moving backward,” and “feeling left behind.” Graduates struggled to complete the broader structural life transition from university student to the adult world of work, experiencing a nebulous state of straddling adolescence and early adulthood. This undermined their sense of adult maturity, leaving them vulnerable to becoming entrenched in their mental health-related difficulties. We discuss these findings in relation to the developmental perspectives of life-course theory, status passages, and separation–individuation in early adulthoo...
Peter Leo Frank was born in Prague. His education was interrupted by spending the war years in a ... more Peter Leo Frank was born in Prague. His education was interrupted by spending the war years in a series of concentration and slave labour camps. He put his survival down to the care and protection of a French doctor, for whom he was able to translate (owing to his fluency in French and German) and resolved to practise medicine in his honour. Having “flown to England in the belly of a Lancaster” at the end of the war to join his father in Macclesfield, he rapidly caught up on his education before attending Manchester Medical School. He trained in orthopaedic and trauma surgery …
The British journal of general practice : the journal of the Royal College of General Practitioners, 2004
Despite generally falling mortality and suicide rates, among young men the rates of violent death... more Despite generally falling mortality and suicide rates, among young men the rates of violent death from accidents and suicide continue to rise. Most research has focused upon suicide, and the potential for effective interventions, particularly in primary care, remains controversial. To compare health service contacts prior to suicidal and accidental deaths among young men. Examination of inquest data, postmortem and toxicology reports, and general practitioner (GP) and hospital records. All sudden, unexpected, violent or unnatural deaths involving young men aged between 15 and 39 years and reported to the four coroner's offices of Merseyside and Cheshire during 1995. We compared data on the timing and nature of final GP contacts before death among young men with a verdict of accident or misadventure and suicide or undetermined death. Out of a total of 268 violent deaths, 130 received verdicts of accident/misadventure and 97 received verdicts of suicide/undetermined death. Informa...
To test whether older drug users (aged 40 and over) could be recruited to an exercise referral (E... more To test whether older drug users (aged 40 and over) could be recruited to an exercise referral (ER) scheme, to evaluate the feasibility and acceptability and measure the impact of participation on health. Observational pilot. Liverpool, UK. (1) 12 men and 5 women recruited to ER. (2) 7 specialist gym instructors. Logistic feasibility and acceptability of ER and associated research, rate of recruitment, level of participation over 8 weeks and changes in health. 22 gym inductions were arranged (recruitment time: 5 weeks), 17 inductions were completed and 14 participants began exercising. Attendance at the gym fluctuated with people missing weeks then re-engaging; in week 8, seven participants were in contact with the project and five of these attended the gym. Illness and caring responsibilities affected participation. Participants and gym instructors found the intervention and associated research processes acceptable. In general, participants enjoyed exercising and felt fitter, but w...
Background: Action to address the structural determinants of health inequalities is prioritised i... more Background: Action to address the structural determinants of health inequalities is prioritised in high level initiatives such as the UN Sustainable Development Goals and many national health strategies. Yet, the focus of much local policy and practice is on behaviour change. Research shows that whilst lifestyle approaches can improve population health, at best they fail to reduce health inequalities because they fail to address structural determinants of behaviour and health outcomes. In health research most efforts have been directed at three streams of work: understanding causal pathways; evaluating the equity impact of national policy; and developing and evaluating lifestyle/behavioural approaches to health improvement. As a result, there is a dearth of research on effective interventions to reduce the socio-economic drivers of inequalities in health that can be developed and implemented at a local level. Objective: To report on an evaluation of the attempt by the Collaboration ...
Systematic annual screening to detect sight‐threatening diabetic retinopathy (STDR) is establishe... more Systematic annual screening to detect sight‐threatening diabetic retinopathy (STDR) is established in the United Kingdom. We designed an observational cohort study to provide up‐to‐date data for policy makers and clinical researchers on incidence of key screening endpoints in people with diabetes attending one screening programme running for over 30 years.
Older people with dementia are particularly at risk of COVID-19; however, relatively little is kn... more Older people with dementia are particularly at risk of COVID-19; however, relatively little is known about the indirect impact of the pandemic on the lives of those living with, and/or caring for someone with, dementia. The aim of this study was to investigate the experiences of people with dementia and informal carers during the closure of available social and medical services in Poland during the COVID-19 pandemic. A qualitative thematic analysis of semi-structured interviews with people with dementia (n = 5) and informal carers (n = 21) was performed between June and August 2020 after the first wave of COVID-19 in Poland. Three overarching themes were identified: (1) care re-organization; (2) psychological responses; (3) emerging needs. The factor underlying all these elements was reliance on other people. Social support and engagement are vital to the ongoing health and well-being of people living with dementia and their informal carers. Services need to be strengthened to provi...
Background: Older people with dementia are particularly at risk of COVID-19, whilst still little ... more Background: Older people with dementia are particularly at risk of COVID-19, whilst still little is known about the indirect impact of the Pandemic on the lives of those living with and caring for someone with dementia. The aim of this study was to investigate the impact of the Pandemic on the lives of people with dementia and their informal carers in the context of using social and medical services in Poland. Methods: A qualitative thematic analysis of semi-structured interviews with people with dementia (n = 5) and informal carers (n = 21) was performed. Interviews were collected between June and August 2020 via phone after the first wave of COVID-19 in Poland. Data were analysed using NVivo software by four team members. Results: Three overarching themes emerged: (1) Care re-organization; (2) Psychological responses; (3) Emerging needs. The factor underlying all these elements were a reliance on other people. Regardless of the type of support (informal or formal), a sense of pres...
BACKGROUND Despite a considerable increase in claims for long-term sickness benefits, and the imp... more BACKGROUND Despite a considerable increase in claims for long-term sickness benefits, and the impact of certifying sickness upon general practitioner (GP) workload, little is known about transition to long-term incapacity for work. AIM To explore the relationship between patient factors and the transition from short-term to long-term work incapacity, in particular focusing on mild mental health and musculoskeletal problems. SETTING Nine practices comprising the Mersey Primary Care R&D Consortium. DESIGN Prospective data collection and audit of sickness certificate details. METHOD GPs issued carbonised sickness certificates for a period of 12 months. The resulting baseline dataset included claimant diagnosis, age, sex, postcode-derived deprivation score, and sickness episode duration. Associations of patient factors with sickness duration outcomes were tested. RESULTS Mild mental disorder accounted for nearly 40% of certified sickness. Relatively few claimants had their diagnosis cha...
Background Structured Medication Reviews (SMRs) are intended to help deliver the NHS Long Term Pl... more Background Structured Medication Reviews (SMRs) are intended to help deliver the NHS Long Term Plan for medicines optimisation in people living with multiple long-term conditions and polypharmacy. It is challenging to gather the information needed for these reviews due to poor integration of health records across providers and there is little guidance on how to identify those patients most urgently requiring review. Objective To extract information from scattered clinical records on how health and medications change over time, apply interpretable artificial intelligence (AI) approaches to predict risks of poor outcomes and overlay this information on care records to inform SMRs. We will pilot this approach in primary care prescribing audit and feedback systems, and co-design future medicines optimisation decision support systems. Design DynAIRx will target potentially problematic polypharmacy in three key multimorbidity groups, namely, people with (a) mental and physical health prob...
An exploratory investigation into the experiences of unemployed university graduates with common ... more An exploratory investigation into the experiences of unemployed university graduates with common mental health issues (i.e., depression and anxiety) was conducted using Interpretative Phenomenological Analysis. Analysis of semi-structured interviews with 12 graduates in their twenties, all of whom had been unemployed between five and 24 months with common mental health issues, generated themes relating to “Loss of Expectation and Disorientation”, “Waste, Failure and Blame”, and “Stigma and Shame”. Participants had experienced a “Fall from Grace”—a descent from a vaunted position of high-esteem and importance as university graduates, with seemingly bright prospects for a privileged future, into a lowly state of unemployment with mental health issues, leaving them feeling tarnished. These findings are discussed in relation to the literature on graduate unemployment, crisis and stigma, raising some practical issues for universities, including counselling services, and how they can bett...
We investigated the experiences of unemployed university graduates with common mental health issu... more We investigated the experiences of unemployed university graduates with common mental health issues. After conducting semistructured interviews with 12 unemployed bachelor’s degree graduates with common mental health issues, we used interpretative phenomenological analysis to generate three superordinate themes: “fall from grace,” “vulnerability,” and “life on hold.” Our focus in this article is life on hold and its constituent themes: “stagnation,” “moving backward,” and “feeling left behind.” Graduates struggled to complete the broader structural life transition from university student to the adult world of work, experiencing a nebulous state of straddling adolescence and early adulthood. This undermined their sense of adult maturity, leaving them vulnerable to becoming entrenched in their mental health-related difficulties. We discuss these findings in relation to the developmental perspectives of life-course theory, status passages, and separation–individuation in early adulthoo...
Peter Leo Frank was born in Prague. His education was interrupted by spending the war years in a ... more Peter Leo Frank was born in Prague. His education was interrupted by spending the war years in a series of concentration and slave labour camps. He put his survival down to the care and protection of a French doctor, for whom he was able to translate (owing to his fluency in French and German) and resolved to practise medicine in his honour. Having “flown to England in the belly of a Lancaster” at the end of the war to join his father in Macclesfield, he rapidly caught up on his education before attending Manchester Medical School. He trained in orthopaedic and trauma surgery …
The British journal of general practice : the journal of the Royal College of General Practitioners, 2004
Despite generally falling mortality and suicide rates, among young men the rates of violent death... more Despite generally falling mortality and suicide rates, among young men the rates of violent death from accidents and suicide continue to rise. Most research has focused upon suicide, and the potential for effective interventions, particularly in primary care, remains controversial. To compare health service contacts prior to suicidal and accidental deaths among young men. Examination of inquest data, postmortem and toxicology reports, and general practitioner (GP) and hospital records. All sudden, unexpected, violent or unnatural deaths involving young men aged between 15 and 39 years and reported to the four coroner's offices of Merseyside and Cheshire during 1995. We compared data on the timing and nature of final GP contacts before death among young men with a verdict of accident or misadventure and suicide or undetermined death. Out of a total of 268 violent deaths, 130 received verdicts of accident/misadventure and 97 received verdicts of suicide/undetermined death. Informa...
To test whether older drug users (aged 40 and over) could be recruited to an exercise referral (E... more To test whether older drug users (aged 40 and over) could be recruited to an exercise referral (ER) scheme, to evaluate the feasibility and acceptability and measure the impact of participation on health. Observational pilot. Liverpool, UK. (1) 12 men and 5 women recruited to ER. (2) 7 specialist gym instructors. Logistic feasibility and acceptability of ER and associated research, rate of recruitment, level of participation over 8 weeks and changes in health. 22 gym inductions were arranged (recruitment time: 5 weeks), 17 inductions were completed and 14 participants began exercising. Attendance at the gym fluctuated with people missing weeks then re-engaging; in week 8, seven participants were in contact with the project and five of these attended the gym. Illness and caring responsibilities affected participation. Participants and gym instructors found the intervention and associated research processes acceptable. In general, participants enjoyed exercising and felt fitter, but w...
Background: Action to address the structural determinants of health inequalities is prioritised i... more Background: Action to address the structural determinants of health inequalities is prioritised in high level initiatives such as the UN Sustainable Development Goals and many national health strategies. Yet, the focus of much local policy and practice is on behaviour change. Research shows that whilst lifestyle approaches can improve population health, at best they fail to reduce health inequalities because they fail to address structural determinants of behaviour and health outcomes. In health research most efforts have been directed at three streams of work: understanding causal pathways; evaluating the equity impact of national policy; and developing and evaluating lifestyle/behavioural approaches to health improvement. As a result, there is a dearth of research on effective interventions to reduce the socio-economic drivers of inequalities in health that can be developed and implemented at a local level. Objective: To report on an evaluation of the attempt by the Collaboration ...
Systematic annual screening to detect sight‐threatening diabetic retinopathy (STDR) is establishe... more Systematic annual screening to detect sight‐threatening diabetic retinopathy (STDR) is established in the United Kingdom. We designed an observational cohort study to provide up‐to‐date data for policy makers and clinical researchers on incidence of key screening endpoints in people with diabetes attending one screening programme running for over 30 years.
Older people with dementia are particularly at risk of COVID-19; however, relatively little is kn... more Older people with dementia are particularly at risk of COVID-19; however, relatively little is known about the indirect impact of the pandemic on the lives of those living with, and/or caring for someone with, dementia. The aim of this study was to investigate the experiences of people with dementia and informal carers during the closure of available social and medical services in Poland during the COVID-19 pandemic. A qualitative thematic analysis of semi-structured interviews with people with dementia (n = 5) and informal carers (n = 21) was performed between June and August 2020 after the first wave of COVID-19 in Poland. Three overarching themes were identified: (1) care re-organization; (2) psychological responses; (3) emerging needs. The factor underlying all these elements was reliance on other people. Social support and engagement are vital to the ongoing health and well-being of people living with dementia and their informal carers. Services need to be strengthened to provi...
Background: Older people with dementia are particularly at risk of COVID-19, whilst still little ... more Background: Older people with dementia are particularly at risk of COVID-19, whilst still little is known about the indirect impact of the Pandemic on the lives of those living with and caring for someone with dementia. The aim of this study was to investigate the impact of the Pandemic on the lives of people with dementia and their informal carers in the context of using social and medical services in Poland. Methods: A qualitative thematic analysis of semi-structured interviews with people with dementia (n = 5) and informal carers (n = 21) was performed. Interviews were collected between June and August 2020 via phone after the first wave of COVID-19 in Poland. Data were analysed using NVivo software by four team members. Results: Three overarching themes emerged: (1) Care re-organization; (2) Psychological responses; (3) Emerging needs. The factor underlying all these elements were a reliance on other people. Regardless of the type of support (informal or formal), a sense of pres...
BACKGROUND Despite a considerable increase in claims for long-term sickness benefits, and the imp... more BACKGROUND Despite a considerable increase in claims for long-term sickness benefits, and the impact of certifying sickness upon general practitioner (GP) workload, little is known about transition to long-term incapacity for work. AIM To explore the relationship between patient factors and the transition from short-term to long-term work incapacity, in particular focusing on mild mental health and musculoskeletal problems. SETTING Nine practices comprising the Mersey Primary Care R&D Consortium. DESIGN Prospective data collection and audit of sickness certificate details. METHOD GPs issued carbonised sickness certificates for a period of 12 months. The resulting baseline dataset included claimant diagnosis, age, sex, postcode-derived deprivation score, and sickness episode duration. Associations of patient factors with sickness duration outcomes were tested. RESULTS Mild mental disorder accounted for nearly 40% of certified sickness. Relatively few claimants had their diagnosis cha...
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