C. McNulty - Academia.edu (original) (raw)

Papers by C. McNulty

Journal of Antimicrobial Chemotherapy, 2011

†Members are listed in the Acknowledgements section. Antibiotic resistance is an increasing commu... more †Members are listed in the Acknowledgements section. Antibiotic resistance is an increasing community problem and is related to antibiotic use. If antibiotic use could be reduced, the tide of increasing resistance could be stemmed. e-Bug is a European project involving 18 European countries, partly funded by The Directorate-General for Health and Consumers (DG SANCO) of the European Commission. It aims to develop and disseminate across Europe a junior and senior school teaching pack and web site (hosting the lesson plans and complementary games) that teach young people about prudent antibiotic use, microbes, transmission of infection, hygiene and vaccines. The aim of e-Bug is to increase young people's understanding, through enjoyable activities, of why it is so important to use antibiotics correctly in order to control antibiotic resistance, and to have good hand and respiratory hygiene to help reduce the spread of infection. Within the senior school pack the sexual transmission of infections has also been included, as the peak age of chlamydial infection is in 16-24 year olds. Teachers, young people and the consortium of 18 countries were closely involved with agreeing learning outcomes and developing the resource activities. Young people helped create the characters and microbe artwork. The resources have been translated, adapted for and disseminated to schools across 10 countries in Europe, and endorsed by the relevant government departments of health and education. The web site has been accessed from .200 countries. The resources will be translated into all European Union languages, and have been used to promote European Antibiotic Awareness Day and better hand and respiratory hygiene during the influenza pandemic in 2009.

Journal of Antimicrobial Chemotherapy, 2011

Bug teaching pack, two e-Bug games were developed to provide content that aimed to entertain as w... more Bug teaching pack, two e-Bug games were developed to provide content that aimed to entertain as well as to educate. A set of agreed learning outcomes (LOs) were provided by the scientific partners of the e-Bug Project and the games were developed using user-centred design techniques (the needs, wants and limitations of the potential game players were assessed at each stage of the design process). The e-Bug games were designed for two age groups: Junior (9-12 year olds); and Senior (13-15 year olds). A study using focus groups was done to gain an understanding as to the types of games enjoyed by the target users. According to the preliminary study, the Junior Game was developed as a platform game and the Senior Game was developed as a story-based detective game. The Junior Game consists of five levels, each associated with a set of LOs. Similarly, the Senior Game consists of four missions, each comprising five stages using problem-based learning techniques and LOs. In this paper, the process of development for each game is described in detail and an illustration is provided of how each game level or mission addresses the target LOs. Development of the games used feedback acquired from children in four schools across the UK (Glasgow, London and two in Gloucester). The children were selected according to their willingness to participate. European Partners of the e-Bug Project also provided further support, translation and requests for modifications. The knowledge gained of LOs and further evaluation of the games is continuing, and preliminary results are in press. The final versions of the games, translated into 11 European languages, are available online via www.e-bug.eu.

Journal of Antimicrobial Chemotherapy, 2011

Journal of Antimicrobial Chemotherapy, 2014

Antimicrobial resistance is a national and worldwide threat to the future of healthcare. Educatin... more Antimicrobial resistance is a national and worldwide threat to the future of healthcare. Educating both healthcare staff and the public in the prudent use of antimicrobials is an essential part of antimicrobial stewardship programmes that aim to contain and control resistance and preserve the usefulness of currently available antibiotics. Using current available evidence, regulatory documents and national antimicrobial stewardship guidance for primary and secondary care, five dimensions for antimicrobial prescribing and stewardship competences have been developed in England, through an independent multiprofessional group led by the Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) of the Department of Health (England). They are designed to complement the generic competency framework for all prescribers from the UK National Prescribing Centre (now part of National Institute for Health and Care Excellence) and are relevant to all independent prescribers, including doctors, dentists and non-medical practitioners. The antimicrobial prescribing and stewardship competences published jointly by ARHAI and PHE in 2013 are believed to be the first of their kind. Implementation of these competences will be an important contribution to the delivery of the UK government's 5 year Antimicrobial Resistance Strategy.

Communicable disease report. CDR review, 1997

An outbreak of gastroenteritis caused by campylobacter infection was identified in May 1995 in a ... more An outbreak of gastroenteritis caused by campylobacter infection was identified in May 1995 in a residential school in Gloucestershire for children with special needs. Eight primary and four secondary cases were identified, mostly confined to one house in the school; faecal specimens from three cases grew Campylobacter jejuni. A retrospective cohort study showed that drinking pasteurised milk from bottles with damaged tops was associated with illness in primary cases (p = 0.01). Bird pecking of milk bottle tops probably accounts for several thousand cases of human campylobacter infections during May and June each year in England and Wales. Milk bottle containers for doorstep delivery should be resistant to contamination by birds.

Communicable disease report. CDR review, Jan 7, 1997

An outbreak of gastroenteritis caused by campylobacter infection was identified in May 1995 in a ... more An outbreak of gastroenteritis caused by campylobacter infection was identified in May 1995 in a residential school in Gloucestershire for children with special needs. Eight primary and four secondary cases were identified, mostly confined to one house in the school; faecal specimens from three cases grew Campylobacter jejuni. A retrospective cohort study showed that drinking pasteurised milk from bottles with damaged tops was associated with illness in primary cases (p = 0.01). Bird pecking of milk bottle tops probably accounts for several thousand cases of human campylobacter infections during May and June each year in England and Wales. Milk bottle containers for doorstep delivery should be resistant to contamination by birds.

BMJ Open, 2013

A qualitative study of GP, NP and patient views about the use of rapid streptococcal antigen dete... more A qualitative study of GP, NP and patient views about the use of rapid streptococcal antigen detection tests (RADTs) in primary care: 'swamped with sore throats?'.

Health technology assessment (Winchester, England), 2014

Antibiotics are still prescribed to most patients attending primary care with acute sore throat, ... more Antibiotics are still prescribed to most patients attending primary care with acute sore throat, despite evidence that there is modest benefit overall from antibiotics. Targeting antibiotics using either clinical scoring methods or rapid antigen detection tests (RADTs) could help. However, there is debate about which groups of streptococci are important (particularly Lancefield groups C and G), and uncertainty about the variables that most clearly predict the presence of streptococci. This study aimed to compare clinical scores or RADTs with delayed antibiotic prescribing. The study comprised a RADT in vitro study; two diagnostic cohorts to develop streptococcal scores (score 1; score 2); and, finally, an open pragmatic randomised controlled trial with nested qualitative and cost-effectiveness studies. The setting was UK primary care general practices. Participants were patients aged ≥ 3 years with acute sore throat. An internet program randomised patients to targeted antibiotic use...

Postgraduate Medical Journal, 2008

Journal of Hospital Infection, 2003

A postal questionnaire survey was undertaken in registered nursing homes in three different healt... more A postal questionnaire survey was undertaken in registered nursing homes in three different health districts in England: Gloucestershire, North Staffordshire and Leeds. Nursing homes may be registered as general nursing or mental health homes. If homes also have provision for residential beds these are defined as dual registered homes. Overall, 9% (438/4900) of residents, with an equal male:female split, had urinary catheters. There was no significant difference in the overall urinary catheterization rate in the three districts ðP ¼ 0:9Þ. There was a wide range of urinary catheterization prevalence between homes, with some homes of all three categories having no catheterized residents and several with a prevalence of over 40%. The wide range of prevalence may be due to differences in residents' underlying medical conditions or to differences in attitudes towards urinary catheterization by nursing home staff. Almost all homes (114/124, 92%) stated they had an infection control policy, but 31% (38/124) did not have a written policy on urinary catheter care. In view of the potential for morbidity, infection control policies should include a section on the care of urinary catheters and this should form part of the continuing training of nursing home staff.

Journal of Antimicrobial Chemotherapy, 2011

Web server log analysis is being increasingly used to evaluate the user behaviour on healthcare r... more Web server log analysis is being increasingly used to evaluate the user behaviour on healthcare resource web sites due to the detailed record of activity that they contain. This study aimed to use this information to evaluate the e-Bug web site, a healthcare resource that provides a range of educational resources about microbes, hand and respiratory hygiene, and antibiotics. This evaluation was conducted by analysing the web server logs of the e-Bug web site for the period January 2008 to November 2009, using a proprietary application named Sawmill. The e-Bug web site has had .900000 page views generated from .88 000 users, with an increase in May 2009 during the swine flu epidemic and a further increase in September 2009 following the official launch of e-Bug. The majority of visitors were from the UK, but visits were recorded from 190 different countries. Word w document resources were downloaded .169000 times, with the most popular being a swine flu factsheet. PowerPoint w document resources were downloaded .36000 times, with the most popular relating to the 'chain of infection'. The majority of visitor referrals originated from search engines, with the most popular referral keywords being variations on the e-Bug name. The most common non-search engine referrals were from other healthcare resources and agencies. Use of the site has increased markedly since the official launch of e-Bug, with average page views of .200 000 per month, from a range of countries, illustrating the international demand for a teaching resource for microbes, hygiene and antibiotics.

Postgraduate medical journal, 2008

BMJ, 2005

genic or mutagenic. Furthermore, these processes may reduce the efficacy of blood. For example, l... more genic or mutagenic. Furthermore, these processes may reduce the efficacy of blood. For example, losses owing to tests and safety measures now reduce the red cell content of a blood pack by 10%, and some patients will therefore require more units, adding to the risk. We think that these large and recurring expenditures on blood safety should be balanced against the costs of the clinical trials still needed to provide an adequate evidence base for the use of transfusion, alternatives, and avoidance strategies. The decisions should involve a well informed public and be understood, and accepted, by them.

Biosensors and Bioelectronics, 2002

The use of volatile production patterns produced by bacterial contaminants in urine samples were ... more The use of volatile production patterns produced by bacterial contaminants in urine samples were examined using electronic nose technology. In two experiments 25 and 45 samples from patients were analysed for specific bacterial contaminants using agar culture techniques and the major UTI bacterial species identified. These samples were also analysed by incubation in a volatile generation test tube system for 4 Á/5 h. The volatile production patterns were then analysed using an electronic nose system with 14 conducting polymer sensors. In the first experiment analysis of the data using a neural network (NN) enabled identification of all but one of the samples correctly when compared to the culture information. Four groups could be distinguished, i.e. normal urine, Escherichia coli infected, Proteus spp. and Staphylococcus spp. In the second experiment it was again possible to use NN systems to examine the volatile production patterns and identify 18 of 19 unknown UTI cases. Only one normal patient sample was mis-identified as an E. coli infected sample. Discriminant function analysis also differentiated between normal urine samples, that infected with E. coli and with Staphylococcus spp. This study has shown the potential for early detection of microbial contaminants in urine samples using electronic nose technology for the first time. These findings will have implications for the development of rapid systems for use in clinical practice.

Archives of Disease in Childhood, 2013

Aims To quantify, describe and compare non-prescribed agent (NPA) use by children with, and witho... more Aims To quantify, describe and compare non-prescribed agent (NPA) use by children with, and without, chronic illness To explore families' experience and motivations for giving (or not) NPAs Methods A questionnaire and semi-structured interview study using an explanatory sequential approach. Parents of children attending fracture, cystic fibrosis (CF), haemato-oncology, neurology and children's development clinics were recruited at first attendance during October-December 2011. Children attending fracture clinic with a chronic illness were re-categorised. Quantitative data were analysed using descriptive statistics and group-wise comparisons using chi-squared and unpaired t-tests. Qualitative data, collected from interviews until data saturation, were coded then thematically analysed independently by three researchers. Results During the study period 664 families attended clinics, 295 completed a questionnaire (response rate 44.4%). Response rates varied by clinic (fracture clinic 33.8%, chronic clinics 57.8%). 60.3% children were male with a mean age of 9.16 years (sd 4.87). Children with a chronic illness were younger (p < 0.001). Overall prevalence of NPA use was 37.3%. Specific prevalences-10% fish oils, 16% vitamins, 15% probiotics, less commonly noted included homoeopathy and hyperbaric oxygen. Differences in NPA use between clinics were small (33%-41.6%, p = 0.21). NPA use was not associated with age, gender, or socioeconomic status. 46.3% parents reported having told their doctor about NPA use. Sixteen parents completed an interview, representing all groups. Ten themes were identified, including the parental intention in providing (or withholding) NPAs. Themes describing why parents did, or did not, provide their children with NPAs included a wish to take an active role, trust (in health professionals, or in the remedy of choice) and accessibility of doctors or NPAs. Conclusions This is the first UK-based study to compare NPA use between children with and without chronic illness, detailing parental motivators. These are complex but relate to intent, trust, and a wish to take an active role in their child's healthcare. The prevalence of NPA use in this study is similar to others. We found no association between NPA use and chronic illness.

Biosensors and …, 2002

The use of volatile production patterns produced by bacterial contaminants in urine samples were ... more The use of volatile production patterns produced by bacterial contaminants in urine samples were examined using electronic nose technology. In two experiments 25 and 45 samples from patients were analysed for specific bacterial contaminants using agar culture techniques and the major UTI bacterial species identified. These samples were also analysed by incubation in a volatile generation test tube system for 4 Á/5 h. The volatile production patterns were then analysed using an electronic nose system with 14 conducting polymer sensors. In the first experiment analysis of the data using a neural network (NN) enabled identification of all but one of the samples correctly when compared to the culture information. Four groups could be distinguished, i.e. normal urine, Escherichia coli infected, Proteus spp. and Staphylococcus spp. In the second experiment it was again possible to use NN systems to examine the volatile production patterns and identify 18 of 19 unknown UTI cases. Only one normal patient sample was mis-identified as an E. coli infected sample. Discriminant function analysis also differentiated between normal urine samples, that infected with E. coli and with Staphylococcus spp. This study has shown the potential for early detection of microbial contaminants in urine samples using electronic nose technology for the first time. These findings will have implications for the development of rapid systems for use in clinical practice.

Journal of Antimicrobial Chemotherapy, Jun 1, 2011

Web server log analysis is being increasingly used to evaluate the user behaviour on healthcare r... more Web server log analysis is being increasingly used to evaluate the user behaviour on healthcare resource web sites due to the detailed record of activity that they contain. This study aimed to use this information to evaluate the e-Bug web site, a healthcare resource that provides a range of educational resources about microbes, hand and respiratory hygiene, and antibiotics. This evaluation was conducted by analysing the web server logs of the e-Bug web site for the period January 2008 to November 2009, using a proprietary ...

Studies in health technology and informatics, 2010

Technology enhanced education has been recently established as a new approach for all stages of e... more Technology enhanced education has been recently established as a new approach for all stages of education. However, among these new IT media it is computer games playing the central role in delivering education in particular to children and teenagers, however, real world sound evaluation is often given little attention. The EU funded e-Bug project developed web games aimed at children to teach basic principles of prudent antibiotics use, hand and respiratory hygiene and aims to reinforces an awareness of microbes, hand and ...

BMC Public Health, 2014

Background: The objectives of this study were to describe and compare chlamydia testing provided ... more Background: The objectives of this study were to describe and compare chlamydia testing provided by general practitioners (GPs) in four selected European countries with well-developed primary health care systems and high reported chlamydia rates; we aimed to compare contrasting countries where chlamydia testing is provided by GPs (England, Sweden) with countries where primary care chlamydia testing is absent or very limited (France, Estonia). Methods: For data generation a structured questionnaire was developed and secondary data sources were searched. The questionnaire developed by the research team allowed a systematic approach to analysing chlamydia care (including testing in general practice) and the gathering of relevant data. Results: There were no significant differences in the burden of the disease or the type of general practice care provision in the study countries. In all four countries, testing for chlamydia (with nucleic acid amplification test, NAAT) is available in the public sector, a substantial proportion (>60%) of young people aged 16-25 years visit their general practitioner (GP) annually, and reimbursement for chlamydia testing costs to the relevant parties (GPs in England, Sweden and Estonia; and patients in France) by the national health insurance system or its equivalent. In countries where chlamydia testing is provided by GPs (England, Sweden) a national strategy or plan on STI control that specifically mentions chlamydia was in force, chlamydia care guidelines for GPs were in place and STI management was more firmly established in the GP residency training curriculum, either formally (England) or informally (Sweden), than in the other countries. Conclusion: Future research on the effectiveness of chlamydia screening (also in the context of general practice care) and program provision should reflect national needs and the prevention of complications.

Journal of Antimicrobial Chemotherapy, 2011

†Members are listed in the Acknowledgements section. Antibiotic resistance is an increasing commu... more †Members are listed in the Acknowledgements section. Antibiotic resistance is an increasing community problem and is related to antibiotic use. If antibiotic use could be reduced, the tide of increasing resistance could be stemmed. e-Bug is a European project involving 18 European countries, partly funded by The Directorate-General for Health and Consumers (DG SANCO) of the European Commission. It aims to develop and disseminate across Europe a junior and senior school teaching pack and web site (hosting the lesson plans and complementary games) that teach young people about prudent antibiotic use, microbes, transmission of infection, hygiene and vaccines. The aim of e-Bug is to increase young people's understanding, through enjoyable activities, of why it is so important to use antibiotics correctly in order to control antibiotic resistance, and to have good hand and respiratory hygiene to help reduce the spread of infection. Within the senior school pack the sexual transmission of infections has also been included, as the peak age of chlamydial infection is in 16-24 year olds. Teachers, young people and the consortium of 18 countries were closely involved with agreeing learning outcomes and developing the resource activities. Young people helped create the characters and microbe artwork. The resources have been translated, adapted for and disseminated to schools across 10 countries in Europe, and endorsed by the relevant government departments of health and education. The web site has been accessed from .200 countries. The resources will be translated into all European Union languages, and have been used to promote European Antibiotic Awareness Day and better hand and respiratory hygiene during the influenza pandemic in 2009.

Journal of Antimicrobial Chemotherapy, 2011

Bug teaching pack, two e-Bug games were developed to provide content that aimed to entertain as w... more Bug teaching pack, two e-Bug games were developed to provide content that aimed to entertain as well as to educate. A set of agreed learning outcomes (LOs) were provided by the scientific partners of the e-Bug Project and the games were developed using user-centred design techniques (the needs, wants and limitations of the potential game players were assessed at each stage of the design process). The e-Bug games were designed for two age groups: Junior (9-12 year olds); and Senior (13-15 year olds). A study using focus groups was done to gain an understanding as to the types of games enjoyed by the target users. According to the preliminary study, the Junior Game was developed as a platform game and the Senior Game was developed as a story-based detective game. The Junior Game consists of five levels, each associated with a set of LOs. Similarly, the Senior Game consists of four missions, each comprising five stages using problem-based learning techniques and LOs. In this paper, the process of development for each game is described in detail and an illustration is provided of how each game level or mission addresses the target LOs. Development of the games used feedback acquired from children in four schools across the UK (Glasgow, London and two in Gloucester). The children were selected according to their willingness to participate. European Partners of the e-Bug Project also provided further support, translation and requests for modifications. The knowledge gained of LOs and further evaluation of the games is continuing, and preliminary results are in press. The final versions of the games, translated into 11 European languages, are available online via www.e-bug.eu.

Journal of Antimicrobial Chemotherapy, 2011

Journal of Antimicrobial Chemotherapy, 2014

Antimicrobial resistance is a national and worldwide threat to the future of healthcare. Educatin... more Antimicrobial resistance is a national and worldwide threat to the future of healthcare. Educating both healthcare staff and the public in the prudent use of antimicrobials is an essential part of antimicrobial stewardship programmes that aim to contain and control resistance and preserve the usefulness of currently available antibiotics. Using current available evidence, regulatory documents and national antimicrobial stewardship guidance for primary and secondary care, five dimensions for antimicrobial prescribing and stewardship competences have been developed in England, through an independent multiprofessional group led by the Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) of the Department of Health (England). They are designed to complement the generic competency framework for all prescribers from the UK National Prescribing Centre (now part of National Institute for Health and Care Excellence) and are relevant to all independent prescribers, including doctors, dentists and non-medical practitioners. The antimicrobial prescribing and stewardship competences published jointly by ARHAI and PHE in 2013 are believed to be the first of their kind. Implementation of these competences will be an important contribution to the delivery of the UK government's 5 year Antimicrobial Resistance Strategy.

Communicable disease report. CDR review, 1997

An outbreak of gastroenteritis caused by campylobacter infection was identified in May 1995 in a ... more An outbreak of gastroenteritis caused by campylobacter infection was identified in May 1995 in a residential school in Gloucestershire for children with special needs. Eight primary and four secondary cases were identified, mostly confined to one house in the school; faecal specimens from three cases grew Campylobacter jejuni. A retrospective cohort study showed that drinking pasteurised milk from bottles with damaged tops was associated with illness in primary cases (p = 0.01). Bird pecking of milk bottle tops probably accounts for several thousand cases of human campylobacter infections during May and June each year in England and Wales. Milk bottle containers for doorstep delivery should be resistant to contamination by birds.

Communicable disease report. CDR review, Jan 7, 1997

An outbreak of gastroenteritis caused by campylobacter infection was identified in May 1995 in a ... more An outbreak of gastroenteritis caused by campylobacter infection was identified in May 1995 in a residential school in Gloucestershire for children with special needs. Eight primary and four secondary cases were identified, mostly confined to one house in the school; faecal specimens from three cases grew Campylobacter jejuni. A retrospective cohort study showed that drinking pasteurised milk from bottles with damaged tops was associated with illness in primary cases (p = 0.01). Bird pecking of milk bottle tops probably accounts for several thousand cases of human campylobacter infections during May and June each year in England and Wales. Milk bottle containers for doorstep delivery should be resistant to contamination by birds.

BMJ Open, 2013

A qualitative study of GP, NP and patient views about the use of rapid streptococcal antigen dete... more A qualitative study of GP, NP and patient views about the use of rapid streptococcal antigen detection tests (RADTs) in primary care: 'swamped with sore throats?'.

Health technology assessment (Winchester, England), 2014

Antibiotics are still prescribed to most patients attending primary care with acute sore throat, ... more Antibiotics are still prescribed to most patients attending primary care with acute sore throat, despite evidence that there is modest benefit overall from antibiotics. Targeting antibiotics using either clinical scoring methods or rapid antigen detection tests (RADTs) could help. However, there is debate about which groups of streptococci are important (particularly Lancefield groups C and G), and uncertainty about the variables that most clearly predict the presence of streptococci. This study aimed to compare clinical scores or RADTs with delayed antibiotic prescribing. The study comprised a RADT in vitro study; two diagnostic cohorts to develop streptococcal scores (score 1; score 2); and, finally, an open pragmatic randomised controlled trial with nested qualitative and cost-effectiveness studies. The setting was UK primary care general practices. Participants were patients aged ≥ 3 years with acute sore throat. An internet program randomised patients to targeted antibiotic use...

Postgraduate Medical Journal, 2008

Journal of Hospital Infection, 2003

A postal questionnaire survey was undertaken in registered nursing homes in three different healt... more A postal questionnaire survey was undertaken in registered nursing homes in three different health districts in England: Gloucestershire, North Staffordshire and Leeds. Nursing homes may be registered as general nursing or mental health homes. If homes also have provision for residential beds these are defined as dual registered homes. Overall, 9% (438/4900) of residents, with an equal male:female split, had urinary catheters. There was no significant difference in the overall urinary catheterization rate in the three districts ðP ¼ 0:9Þ. There was a wide range of urinary catheterization prevalence between homes, with some homes of all three categories having no catheterized residents and several with a prevalence of over 40%. The wide range of prevalence may be due to differences in residents' underlying medical conditions or to differences in attitudes towards urinary catheterization by nursing home staff. Almost all homes (114/124, 92%) stated they had an infection control policy, but 31% (38/124) did not have a written policy on urinary catheter care. In view of the potential for morbidity, infection control policies should include a section on the care of urinary catheters and this should form part of the continuing training of nursing home staff.

Journal of Antimicrobial Chemotherapy, 2011

Web server log analysis is being increasingly used to evaluate the user behaviour on healthcare r... more Web server log analysis is being increasingly used to evaluate the user behaviour on healthcare resource web sites due to the detailed record of activity that they contain. This study aimed to use this information to evaluate the e-Bug web site, a healthcare resource that provides a range of educational resources about microbes, hand and respiratory hygiene, and antibiotics. This evaluation was conducted by analysing the web server logs of the e-Bug web site for the period January 2008 to November 2009, using a proprietary application named Sawmill. The e-Bug web site has had .900000 page views generated from .88 000 users, with an increase in May 2009 during the swine flu epidemic and a further increase in September 2009 following the official launch of e-Bug. The majority of visitors were from the UK, but visits were recorded from 190 different countries. Word w document resources were downloaded .169000 times, with the most popular being a swine flu factsheet. PowerPoint w document resources were downloaded .36000 times, with the most popular relating to the 'chain of infection'. The majority of visitor referrals originated from search engines, with the most popular referral keywords being variations on the e-Bug name. The most common non-search engine referrals were from other healthcare resources and agencies. Use of the site has increased markedly since the official launch of e-Bug, with average page views of .200 000 per month, from a range of countries, illustrating the international demand for a teaching resource for microbes, hygiene and antibiotics.

Postgraduate medical journal, 2008

BMJ, 2005

genic or mutagenic. Furthermore, these processes may reduce the efficacy of blood. For example, l... more genic or mutagenic. Furthermore, these processes may reduce the efficacy of blood. For example, losses owing to tests and safety measures now reduce the red cell content of a blood pack by 10%, and some patients will therefore require more units, adding to the risk. We think that these large and recurring expenditures on blood safety should be balanced against the costs of the clinical trials still needed to provide an adequate evidence base for the use of transfusion, alternatives, and avoidance strategies. The decisions should involve a well informed public and be understood, and accepted, by them.

Biosensors and Bioelectronics, 2002

The use of volatile production patterns produced by bacterial contaminants in urine samples were ... more The use of volatile production patterns produced by bacterial contaminants in urine samples were examined using electronic nose technology. In two experiments 25 and 45 samples from patients were analysed for specific bacterial contaminants using agar culture techniques and the major UTI bacterial species identified. These samples were also analysed by incubation in a volatile generation test tube system for 4 Á/5 h. The volatile production patterns were then analysed using an electronic nose system with 14 conducting polymer sensors. In the first experiment analysis of the data using a neural network (NN) enabled identification of all but one of the samples correctly when compared to the culture information. Four groups could be distinguished, i.e. normal urine, Escherichia coli infected, Proteus spp. and Staphylococcus spp. In the second experiment it was again possible to use NN systems to examine the volatile production patterns and identify 18 of 19 unknown UTI cases. Only one normal patient sample was mis-identified as an E. coli infected sample. Discriminant function analysis also differentiated between normal urine samples, that infected with E. coli and with Staphylococcus spp. This study has shown the potential for early detection of microbial contaminants in urine samples using electronic nose technology for the first time. These findings will have implications for the development of rapid systems for use in clinical practice.

Archives of Disease in Childhood, 2013

Aims To quantify, describe and compare non-prescribed agent (NPA) use by children with, and witho... more Aims To quantify, describe and compare non-prescribed agent (NPA) use by children with, and without, chronic illness To explore families' experience and motivations for giving (or not) NPAs Methods A questionnaire and semi-structured interview study using an explanatory sequential approach. Parents of children attending fracture, cystic fibrosis (CF), haemato-oncology, neurology and children's development clinics were recruited at first attendance during October-December 2011. Children attending fracture clinic with a chronic illness were re-categorised. Quantitative data were analysed using descriptive statistics and group-wise comparisons using chi-squared and unpaired t-tests. Qualitative data, collected from interviews until data saturation, were coded then thematically analysed independently by three researchers. Results During the study period 664 families attended clinics, 295 completed a questionnaire (response rate 44.4%). Response rates varied by clinic (fracture clinic 33.8%, chronic clinics 57.8%). 60.3% children were male with a mean age of 9.16 years (sd 4.87). Children with a chronic illness were younger (p < 0.001). Overall prevalence of NPA use was 37.3%. Specific prevalences-10% fish oils, 16% vitamins, 15% probiotics, less commonly noted included homoeopathy and hyperbaric oxygen. Differences in NPA use between clinics were small (33%-41.6%, p = 0.21). NPA use was not associated with age, gender, or socioeconomic status. 46.3% parents reported having told their doctor about NPA use. Sixteen parents completed an interview, representing all groups. Ten themes were identified, including the parental intention in providing (or withholding) NPAs. Themes describing why parents did, or did not, provide their children with NPAs included a wish to take an active role, trust (in health professionals, or in the remedy of choice) and accessibility of doctors or NPAs. Conclusions This is the first UK-based study to compare NPA use between children with and without chronic illness, detailing parental motivators. These are complex but relate to intent, trust, and a wish to take an active role in their child's healthcare. The prevalence of NPA use in this study is similar to others. We found no association between NPA use and chronic illness.

Biosensors and …, 2002

The use of volatile production patterns produced by bacterial contaminants in urine samples were ... more The use of volatile production patterns produced by bacterial contaminants in urine samples were examined using electronic nose technology. In two experiments 25 and 45 samples from patients were analysed for specific bacterial contaminants using agar culture techniques and the major UTI bacterial species identified. These samples were also analysed by incubation in a volatile generation test tube system for 4 Á/5 h. The volatile production patterns were then analysed using an electronic nose system with 14 conducting polymer sensors. In the first experiment analysis of the data using a neural network (NN) enabled identification of all but one of the samples correctly when compared to the culture information. Four groups could be distinguished, i.e. normal urine, Escherichia coli infected, Proteus spp. and Staphylococcus spp. In the second experiment it was again possible to use NN systems to examine the volatile production patterns and identify 18 of 19 unknown UTI cases. Only one normal patient sample was mis-identified as an E. coli infected sample. Discriminant function analysis also differentiated between normal urine samples, that infected with E. coli and with Staphylococcus spp. This study has shown the potential for early detection of microbial contaminants in urine samples using electronic nose technology for the first time. These findings will have implications for the development of rapid systems for use in clinical practice.

Journal of Antimicrobial Chemotherapy, Jun 1, 2011

Web server log analysis is being increasingly used to evaluate the user behaviour on healthcare r... more Web server log analysis is being increasingly used to evaluate the user behaviour on healthcare resource web sites due to the detailed record of activity that they contain. This study aimed to use this information to evaluate the e-Bug web site, a healthcare resource that provides a range of educational resources about microbes, hand and respiratory hygiene, and antibiotics. This evaluation was conducted by analysing the web server logs of the e-Bug web site for the period January 2008 to November 2009, using a proprietary ...

Studies in health technology and informatics, 2010

Technology enhanced education has been recently established as a new approach for all stages of e... more Technology enhanced education has been recently established as a new approach for all stages of education. However, among these new IT media it is computer games playing the central role in delivering education in particular to children and teenagers, however, real world sound evaluation is often given little attention. The EU funded e-Bug project developed web games aimed at children to teach basic principles of prudent antibiotics use, hand and respiratory hygiene and aims to reinforces an awareness of microbes, hand and ...

BMC Public Health, 2014

Background: The objectives of this study were to describe and compare chlamydia testing provided ... more Background: The objectives of this study were to describe and compare chlamydia testing provided by general practitioners (GPs) in four selected European countries with well-developed primary health care systems and high reported chlamydia rates; we aimed to compare contrasting countries where chlamydia testing is provided by GPs (England, Sweden) with countries where primary care chlamydia testing is absent or very limited (France, Estonia). Methods: For data generation a structured questionnaire was developed and secondary data sources were searched. The questionnaire developed by the research team allowed a systematic approach to analysing chlamydia care (including testing in general practice) and the gathering of relevant data. Results: There were no significant differences in the burden of the disease or the type of general practice care provision in the study countries. In all four countries, testing for chlamydia (with nucleic acid amplification test, NAAT) is available in the public sector, a substantial proportion (>60%) of young people aged 16-25 years visit their general practitioner (GP) annually, and reimbursement for chlamydia testing costs to the relevant parties (GPs in England, Sweden and Estonia; and patients in France) by the national health insurance system or its equivalent. In countries where chlamydia testing is provided by GPs (England, Sweden) a national strategy or plan on STI control that specifically mentions chlamydia was in force, chlamydia care guidelines for GPs were in place and STI management was more firmly established in the GP residency training curriculum, either formally (England) or informally (Sweden), than in the other countries. Conclusion: Future research on the effectiveness of chlamydia screening (also in the context of general practice care) and program provision should reflect national needs and the prevention of complications.