Aoife Molloy - Academia.edu (original) (raw)

Papers by Aoife Molloy

Healthcare Public Health

Knowledge management is the process of identifying, appraising, and synthesizing evidence to info... more Knowledge management is the process of identifying, appraising, and synthesizing evidence to inform healthcare organization and delivery. This chapter summarizes the role and use of evidence in healthcare. Evidence identification, appraisal, and synthesis are described, and the use of evidence to inform the development of healthcare guidelines is discussed. The challenges of guideline implementation are explored and potential solutions are outlined. The future direction of knowledge management is complex and may involve individualized risk scoring and new approaches to analysing large datasets. Knowledge management should be used to guide more coherent care across healthcare systems; evidence and knowledge management must also promote appropriateness in healthcare.

Overview: About 120,000 people are infected with 2019-nCoV virus and have developed Covid19 at th... more Overview: About 120,000 people are infected with 2019-nCoV virus and have developed Covid19 at the time of writing (12 th March 2020) [1]. This study researched the mortality risk after admission to hospital for patients with medium to severe symptoms based on length of stay in hospital [2]. The AI that was trained in this paper can be used for health systems to support prioritisation, to inform hospital treatment and to optimise bed management or for people to estimate a level of quarantine based on their medical history. The AI is available online for free on https:\\www.coronavirusrisk.org for individuals accessible with an easy user interface. For processing large population datasets a Webservice endpoint is available from https://www.i5analytics.com/free-healthcare-ai.

BMJ Quality & Safety

BackgroundThe NHS England evidence-based interventions programme (EBI), launched in April 2019, i... more BackgroundThe NHS England evidence-based interventions programme (EBI), launched in April 2019, is a novel nationally led initiative to encourage disinvestment in low value care.MethodWe sought to evaluate the effectiveness of this policy by using a difference-in-difference approach to compare changes in volume between January 2016 and February 2020 in a treatment group of low value procedures against a control group unaffected by the EBI programme during our period of analysis but subsequently identified as candidates for disinvestment.ResultsWe found only small differences between the treatment and control group after implementation, with reductions in volumes in the treatment group 0.10% (95% CI 0.09% to 0.11%) smaller than in the control group (equivalent to 16 low value procedures per month). During the month of implementation, reductions in volumes in the treatment group were 0.05% (95% CI 0.03% to 0.06%) smaller than in the control group (equivalent to 7 low value procedures)...

Frontiers in Marine Science, 2021

With the accelerating development of direct and indirect anthropogenic threats, including climate... more With the accelerating development of direct and indirect anthropogenic threats, including climate change and pollution as well as extractive industries such as deep-sea mining, there is an urgent need for simple but effective solutions to identify conservation priorities for deep-sea species. The International Union for Conservation of Nature (IUCN) Red List of Threatened Species is an effective and well-recognized tool to promote the protection of species and presents an opportunity to communicate conservation threats to industry, policy makers, and the general public. Here, we present the Vent Red List for molluscs: a complete global assessment of the extinction risk of all described molluscs endemic to hydrothermal vents, a habitat under imminent threat from deep-sea mining. Of the 184 species assessed, 62% are listed as threatened: 39 are Critically Endangered, 32 are Endangered, and 43 are Vulnerable. In contrast, the 25 species that are fully protected from deep-sea mining by ...

Minerva Anestesiologica, 2021

BACKGROUND Intrathecal analgesia (IA) has been recommended by the Enhanced Recovery After Surgery... more BACKGROUND Intrathecal analgesia (IA) has been recommended by the Enhanced Recovery After Surgery (ERAS) Society for laparoscopic colon resections; however, although IA is used in open liver resections, it has not been extensively studied in laparoscopic hepatobiliary surgery. This retrospective chart review was undertaken to explore postoperative pain within 48 hours among patients who underwent laparoscopic liver resections (LLR), receiving either IA with or without patient-controlled analgesia (IA±PCA) versus PCA alone. METHODS After ethics approval, charts were reviewed for adult patients who underwent LLR between January 2016 and April 2019, and had IA±PCA or PCA alone. Patients with any contraindication to IA with morphine, obstructive sleep apnea, body mass index >40 kg/m2, history of chronic pain, and/or history of drug use were excluded. Descriptive statistics used to describe postoperative pain levels at 48 hours by treatment group for each pain outcome. RESULTS Of 111 patients identified, 79 patients were finally included; 22 patients had IA±PCA and 57 patients had PCA only. There were no statistically significant differences in baseline characteristics, use of non-opioid pain control, and postoperative complications between the two groups. IA use was associated with reduced postoperative opioid consumption (measured in oral morphine equivalents) compared to PCA alone (mean difference [95% confidence interval] -45.92 [-83.10 to -8.75]; p=0.016). CONCLUSIONS IA has the potential to decrease postoperative opioid use for patients undergoing LLR, and appears to be safe and effective in the setting of LLR. These findings are consistent with the ERAS Society recommendations for laparoscopic colorectal surgery.

BMC Infectious Diseases, 2017

Background: The potential for HIV transmission between a pregnant woman and her unborn child was ... more Background: The potential for HIV transmission between a pregnant woman and her unborn child was first recognized in 1982. Since then a complex package of measures to reduce risk has been developed. This project aims to review UK management of HIV in pregnancy as part of the British HIV Association (BHIVA) audit programme. Methods: The National Study of HIV in Pregnancy and Childhood (NSHPC), a population-based surveillance study, provided data for pregnancies with an expected delivery date from 1/1/13-30/6/14. Services also completed a survey on local management policies. Data were audited against the 2012 BHIVA pregnancy guidelines. Results: During the audit period 1483 pregnancies were reported and 112 services completed the survey. Use of dedicated multidisciplinary teams was reported by 99% although 26% included neither a specialist midwife nor nurse. 17% of services reported delays >1 week for HIV specialist review of women diagnosed antenatally. Problematic urgent HIV testing had been experienced by 9% of services although in a further 49% the need for urgent testing had not arisen. Delays of >2 h in obtaining urgent results were common. Antiretroviral therapy (ART) was started during pregnancy in 37% women with >94% regimens in accordance with guidelines. Late ART initiation was common, particularly in those with a low CD4 count or high viral load. Eleven percent of services reported local policy contrary to guidelines regarding delivery mode for women with a VL <50 copies/mL at ≥36 weeks. According to NSHPC reports 27% of women virologically eligible for vaginal delivery planned to deliver by CS. Conclusions: Pregnant women in the UK are managed largely in accordance with BHIVA guidelines. Improvements are needed to ensure timely referral and ART initiation to ensure the best possible outcomes.

SUMMARYBackgroundREGEN-COV is a combination of 2 monoclonal antibodies (casirivimab and imdevimab... more SUMMARYBackgroundREGEN-COV is a combination of 2 monoclonal antibodies (casirivimab and imdevimab) that bind to two different sites on the receptor binding domain of the SARS-CoV-2 spike protein. We aimed to evaluate the efficacy and safety of REGEN-COV in patients admitted to hospital with COVID-19.MethodsIn this randomised, controlled, open-label platform trial, several possible treatments were compared with usual care in patients hospitalised with COVID-19. Eligible and consenting patients were randomly allocated (1:1) to either usual standard of care alone (usual care group) or usual care plus a single dose of REGEN-COV 8g (casirivimab 4g and imdevimab 4g) by intravenous infusion (REGEN-COV group). The primary outcome was 28-day mortality assessed first among patients without detectable antibodies to SARS-CoV-2 at randomisation (seronegative) and then in the overall population. The trial is registered with ISRCTN (50189673) and clinicaltrials.gov (NCT04381936).FindingsBetween 18...

The Lancet, 2021

Background Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunom... more Background Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19. Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospital with COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients were randomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once per day by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatment groups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment and were twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants and local study staff were not masked to the allocated treatment, but all others involved in the trial were masked to the outcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) were eligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was 65•3 years (SD 15•7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomly allocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall, 561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days (rate ratio 0•97, 95% CI 0•87-1•07; p=0•50). No significant difference was seen in duration of hospital stay (median 10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days (rate ratio 1•04, 95% CI 0•98-1•10; p=0•19). Among those not on invasive mechanical ventilation at baseline, no significant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilation or death (risk ratio 0•95, 95% CI 0•87-1•03; p=0•24). Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or other prespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restricted to patients in whom there is a clear antimicrobial indication.

The Lancet, 2021

Background In this study, we aimed to evaluate the effects of tocilizumab in adult patients admit... more Background In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg-800 mg (depending on weight) given intravenously. A second dose could be given 12-24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936).

Shoulder & Elbow, 2021

[Formula: see text][Formula: see text] These care pathway guidelines for the shoulder have been w... more [Formula: see text][Formula: see text] These care pathway guidelines for the shoulder have been written in collaboration with the NHS Evidence Based Interventions (EBI) programme. The EBI programme is a partnership between the Academy of Medical Royal Colleges, NHS Clinical Commissioners, the National Institute for Health and Care Excellence, as well as NHS England and Improvement

Archives of Disease in Childhood, 2021

Poster, 2019

providing excellent cancer care. As a result, our multidisciplinary team looked at our current pa... more providing excellent cancer care. As a result, our multidisciplinary team looked at our current pathway and evaluated it against best practices, recent directives and programmes such as the Accelerate, Coordinate, and Evaluate (ACE) Programme. The ACE programme encourages the utilisation of Straight-to-Test (STT) to improve time to diagnosis, and so we challenged ourselves to implement it effectively by appointing a dedicated 'Pathway Coordinator' (Band 6 Nurse). The coordinator receives referrals, triages them with consultants, and then places them either into clinics or directly to investigations (STT). They also conduct a preprocedure assessment over telephone within 48-72 hours that helps confirm the patient's indication, fitness and willingness to have a definitive test. By collecting and comparing data on whether patients attend clinic or go directly to scope and how long it takes for them to receive treatment, before and after the new job role, we can accurately assess the new pathways' direct impact on patients receiving treatment. Initial Results showed that nearly half of patients went straight to test, with an improved number of days between referral and scope and referral and diagnosis, indicating that adapting this patient centred approach through a targeted role effectively addresses some of the challenges that the 2ww pathway presents.

Future Hospital Journal, 2016

The Five Year Forward View describes 'closing the care and quality gap' as one of three strategic... more The Five Year Forward View describes 'closing the care and quality gap' as one of three strategic challenges facing the English NHS by 2020. The need for a coherent national strategy for achieving high-quality, affordable care has rarely been more pressing, but how effectively do existing national decisions and interventions support clinicians delivering care on the front line? And, in a complex and dynamic environment with multiple players, how should the health service move forward to develop a balanced strategy for quality that accommodates longer term goals as well as more immediate political priorities? Research by a team at the Health Foundation has assessed how the array of organisations, initiatives and approaches to quality stack up as an emergent strategy. Four concepts were used to provide a yardstick for quality-related policies and activities to help identify potential imbalances, gaps and duplication. The findings of this work, together with suggested steps to rectify the issues identified, are described here.

Infectious Disease Reports, 2012

Leuconostoc lactis is a recognised cause of infection in immunocompromised hosts. It is intrinsic... more Leuconostoc lactis is a recognised cause of infection in immunocompromised hosts. It is intrinsically resistant to multiple antibiotics and treatment options may be limited. We report a case of safe and effective use of tigecycline in the treatment of Leuconostoc catheter-related line sepsis in a neutropenic patient. To our knowledge, this is the first reported case of successful use of tigecycline for Leuconostoc bacteremia.

Healthcare Public Health

Knowledge management is the process of identifying, appraising, and synthesizing evidence to info... more Knowledge management is the process of identifying, appraising, and synthesizing evidence to inform healthcare organization and delivery. This chapter summarizes the role and use of evidence in healthcare. Evidence identification, appraisal, and synthesis are described, and the use of evidence to inform the development of healthcare guidelines is discussed. The challenges of guideline implementation are explored and potential solutions are outlined. The future direction of knowledge management is complex and may involve individualized risk scoring and new approaches to analysing large datasets. Knowledge management should be used to guide more coherent care across healthcare systems; evidence and knowledge management must also promote appropriateness in healthcare.

Overview: About 120,000 people are infected with 2019-nCoV virus and have developed Covid19 at th... more Overview: About 120,000 people are infected with 2019-nCoV virus and have developed Covid19 at the time of writing (12 th March 2020) [1]. This study researched the mortality risk after admission to hospital for patients with medium to severe symptoms based on length of stay in hospital [2]. The AI that was trained in this paper can be used for health systems to support prioritisation, to inform hospital treatment and to optimise bed management or for people to estimate a level of quarantine based on their medical history. The AI is available online for free on https:\\www.coronavirusrisk.org for individuals accessible with an easy user interface. For processing large population datasets a Webservice endpoint is available from https://www.i5analytics.com/free-healthcare-ai.

BMJ Quality & Safety

BackgroundThe NHS England evidence-based interventions programme (EBI), launched in April 2019, i... more BackgroundThe NHS England evidence-based interventions programme (EBI), launched in April 2019, is a novel nationally led initiative to encourage disinvestment in low value care.MethodWe sought to evaluate the effectiveness of this policy by using a difference-in-difference approach to compare changes in volume between January 2016 and February 2020 in a treatment group of low value procedures against a control group unaffected by the EBI programme during our period of analysis but subsequently identified as candidates for disinvestment.ResultsWe found only small differences between the treatment and control group after implementation, with reductions in volumes in the treatment group 0.10% (95% CI 0.09% to 0.11%) smaller than in the control group (equivalent to 16 low value procedures per month). During the month of implementation, reductions in volumes in the treatment group were 0.05% (95% CI 0.03% to 0.06%) smaller than in the control group (equivalent to 7 low value procedures)...

Frontiers in Marine Science, 2021

With the accelerating development of direct and indirect anthropogenic threats, including climate... more With the accelerating development of direct and indirect anthropogenic threats, including climate change and pollution as well as extractive industries such as deep-sea mining, there is an urgent need for simple but effective solutions to identify conservation priorities for deep-sea species. The International Union for Conservation of Nature (IUCN) Red List of Threatened Species is an effective and well-recognized tool to promote the protection of species and presents an opportunity to communicate conservation threats to industry, policy makers, and the general public. Here, we present the Vent Red List for molluscs: a complete global assessment of the extinction risk of all described molluscs endemic to hydrothermal vents, a habitat under imminent threat from deep-sea mining. Of the 184 species assessed, 62% are listed as threatened: 39 are Critically Endangered, 32 are Endangered, and 43 are Vulnerable. In contrast, the 25 species that are fully protected from deep-sea mining by ...

Minerva Anestesiologica, 2021

BACKGROUND Intrathecal analgesia (IA) has been recommended by the Enhanced Recovery After Surgery... more BACKGROUND Intrathecal analgesia (IA) has been recommended by the Enhanced Recovery After Surgery (ERAS) Society for laparoscopic colon resections; however, although IA is used in open liver resections, it has not been extensively studied in laparoscopic hepatobiliary surgery. This retrospective chart review was undertaken to explore postoperative pain within 48 hours among patients who underwent laparoscopic liver resections (LLR), receiving either IA with or without patient-controlled analgesia (IA±PCA) versus PCA alone. METHODS After ethics approval, charts were reviewed for adult patients who underwent LLR between January 2016 and April 2019, and had IA±PCA or PCA alone. Patients with any contraindication to IA with morphine, obstructive sleep apnea, body mass index >40 kg/m2, history of chronic pain, and/or history of drug use were excluded. Descriptive statistics used to describe postoperative pain levels at 48 hours by treatment group for each pain outcome. RESULTS Of 111 patients identified, 79 patients were finally included; 22 patients had IA±PCA and 57 patients had PCA only. There were no statistically significant differences in baseline characteristics, use of non-opioid pain control, and postoperative complications between the two groups. IA use was associated with reduced postoperative opioid consumption (measured in oral morphine equivalents) compared to PCA alone (mean difference [95% confidence interval] -45.92 [-83.10 to -8.75]; p=0.016). CONCLUSIONS IA has the potential to decrease postoperative opioid use for patients undergoing LLR, and appears to be safe and effective in the setting of LLR. These findings are consistent with the ERAS Society recommendations for laparoscopic colorectal surgery.

BMC Infectious Diseases, 2017

Background: The potential for HIV transmission between a pregnant woman and her unborn child was ... more Background: The potential for HIV transmission between a pregnant woman and her unborn child was first recognized in 1982. Since then a complex package of measures to reduce risk has been developed. This project aims to review UK management of HIV in pregnancy as part of the British HIV Association (BHIVA) audit programme. Methods: The National Study of HIV in Pregnancy and Childhood (NSHPC), a population-based surveillance study, provided data for pregnancies with an expected delivery date from 1/1/13-30/6/14. Services also completed a survey on local management policies. Data were audited against the 2012 BHIVA pregnancy guidelines. Results: During the audit period 1483 pregnancies were reported and 112 services completed the survey. Use of dedicated multidisciplinary teams was reported by 99% although 26% included neither a specialist midwife nor nurse. 17% of services reported delays >1 week for HIV specialist review of women diagnosed antenatally. Problematic urgent HIV testing had been experienced by 9% of services although in a further 49% the need for urgent testing had not arisen. Delays of >2 h in obtaining urgent results were common. Antiretroviral therapy (ART) was started during pregnancy in 37% women with >94% regimens in accordance with guidelines. Late ART initiation was common, particularly in those with a low CD4 count or high viral load. Eleven percent of services reported local policy contrary to guidelines regarding delivery mode for women with a VL <50 copies/mL at ≥36 weeks. According to NSHPC reports 27% of women virologically eligible for vaginal delivery planned to deliver by CS. Conclusions: Pregnant women in the UK are managed largely in accordance with BHIVA guidelines. Improvements are needed to ensure timely referral and ART initiation to ensure the best possible outcomes.

SUMMARYBackgroundREGEN-COV is a combination of 2 monoclonal antibodies (casirivimab and imdevimab... more SUMMARYBackgroundREGEN-COV is a combination of 2 monoclonal antibodies (casirivimab and imdevimab) that bind to two different sites on the receptor binding domain of the SARS-CoV-2 spike protein. We aimed to evaluate the efficacy and safety of REGEN-COV in patients admitted to hospital with COVID-19.MethodsIn this randomised, controlled, open-label platform trial, several possible treatments were compared with usual care in patients hospitalised with COVID-19. Eligible and consenting patients were randomly allocated (1:1) to either usual standard of care alone (usual care group) or usual care plus a single dose of REGEN-COV 8g (casirivimab 4g and imdevimab 4g) by intravenous infusion (REGEN-COV group). The primary outcome was 28-day mortality assessed first among patients without detectable antibodies to SARS-CoV-2 at randomisation (seronegative) and then in the overall population. The trial is registered with ISRCTN (50189673) and clinicaltrials.gov (NCT04381936).FindingsBetween 18...

The Lancet, 2021

Background Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunom... more Background Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19. Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospital with COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients were randomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once per day by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatment groups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment and were twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants and local study staff were not masked to the allocated treatment, but all others involved in the trial were masked to the outcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) were eligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was 65•3 years (SD 15•7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomly allocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall, 561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days (rate ratio 0•97, 95% CI 0•87-1•07; p=0•50). No significant difference was seen in duration of hospital stay (median 10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days (rate ratio 1•04, 95% CI 0•98-1•10; p=0•19). Among those not on invasive mechanical ventilation at baseline, no significant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilation or death (risk ratio 0•95, 95% CI 0•87-1•03; p=0•24). Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or other prespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restricted to patients in whom there is a clear antimicrobial indication.

The Lancet, 2021

Background In this study, we aimed to evaluate the effects of tocilizumab in adult patients admit... more Background In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg-800 mg (depending on weight) given intravenously. A second dose could be given 12-24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936).

Shoulder & Elbow, 2021

[Formula: see text][Formula: see text] These care pathway guidelines for the shoulder have been w... more [Formula: see text][Formula: see text] These care pathway guidelines for the shoulder have been written in collaboration with the NHS Evidence Based Interventions (EBI) programme. The EBI programme is a partnership between the Academy of Medical Royal Colleges, NHS Clinical Commissioners, the National Institute for Health and Care Excellence, as well as NHS England and Improvement

Archives of Disease in Childhood, 2021

Poster, 2019

providing excellent cancer care. As a result, our multidisciplinary team looked at our current pa... more providing excellent cancer care. As a result, our multidisciplinary team looked at our current pathway and evaluated it against best practices, recent directives and programmes such as the Accelerate, Coordinate, and Evaluate (ACE) Programme. The ACE programme encourages the utilisation of Straight-to-Test (STT) to improve time to diagnosis, and so we challenged ourselves to implement it effectively by appointing a dedicated 'Pathway Coordinator' (Band 6 Nurse). The coordinator receives referrals, triages them with consultants, and then places them either into clinics or directly to investigations (STT). They also conduct a preprocedure assessment over telephone within 48-72 hours that helps confirm the patient's indication, fitness and willingness to have a definitive test. By collecting and comparing data on whether patients attend clinic or go directly to scope and how long it takes for them to receive treatment, before and after the new job role, we can accurately assess the new pathways' direct impact on patients receiving treatment. Initial Results showed that nearly half of patients went straight to test, with an improved number of days between referral and scope and referral and diagnosis, indicating that adapting this patient centred approach through a targeted role effectively addresses some of the challenges that the 2ww pathway presents.

Future Hospital Journal, 2016

The Five Year Forward View describes 'closing the care and quality gap' as one of three strategic... more The Five Year Forward View describes 'closing the care and quality gap' as one of three strategic challenges facing the English NHS by 2020. The need for a coherent national strategy for achieving high-quality, affordable care has rarely been more pressing, but how effectively do existing national decisions and interventions support clinicians delivering care on the front line? And, in a complex and dynamic environment with multiple players, how should the health service move forward to develop a balanced strategy for quality that accommodates longer term goals as well as more immediate political priorities? Research by a team at the Health Foundation has assessed how the array of organisations, initiatives and approaches to quality stack up as an emergent strategy. Four concepts were used to provide a yardstick for quality-related policies and activities to help identify potential imbalances, gaps and duplication. The findings of this work, together with suggested steps to rectify the issues identified, are described here.

Infectious Disease Reports, 2012

Leuconostoc lactis is a recognised cause of infection in immunocompromised hosts. It is intrinsic... more Leuconostoc lactis is a recognised cause of infection in immunocompromised hosts. It is intrinsically resistant to multiple antibiotics and treatment options may be limited. We report a case of safe and effective use of tigecycline in the treatment of Leuconostoc catheter-related line sepsis in a neutropenic patient. To our knowledge, this is the first reported case of successful use of tigecycline for Leuconostoc bacteremia.