Kimberley Foley - Academia.edu (original) (raw)

Papers by Kimberley Foley

Abstract This chapter will introduce companion diagnostics (CDxes), its current status, economic ... more Abstract This chapter will introduce companion diagnostics (CDxes), its current status, economic and regulatory aspects of CDx, and its future potential while discussing specific disease areas as well as the analytical technologies that are likely to dominate. It will first start by providing an overview of CDx, its definition, and some of the mechanisms that underlie its development. The chapter will then discuss the current status of CDx, its uses in medicine, and critical aspects of its development demonstrated in the discussion about codevelopment, with factors contributing to a market size exceeding 2 billion US dollars. An overview of the present economic and regulatory issues will also be discussed. Specific disease areas such as oncology, aging-related diseases, and other diseases will be considered concerning their future aspects in the use of CDx and the analytical technologies that will underlie their development.

The report contains statistics and analysis of the UK communications sector. It is a reference fo... more The report contains statistics and analysis of the UK communications sector. It is a reference for industry, stakeholders, academics and consumers. It provides context to the work Ofcom undertakes in furthering the interests of consumers and citizens in the markets we regulate. The report contains data and analysis on broadcast television and radio, fixed and mobile telephony, internet take-up and consumption and post. We publish this report to support Ofcom's regulatory goal to research markets constantly and to remain at the forefront of technological understanding. It also fulfils the requirements on Ofcom under Section 358 of the Communications Act 2003 to publish an annual factual and statistical report. It also addresses the requirement to undertake and make public our consumer research (as set out in Sections 14 and 15 of the same Act). Much of the data included in this report is available for anyone to access, use and share on the open data pages of Ofcom's website: www.ofcom.org.uk/opendata About this document an average of 5 hours 44 minutes a day in 2016, up 50 minutes from 2006, whereas 16-24s watched an average of 1 hour 54 minutes, 41 minutes less than in 2006.

BMJ Open, Aug 1, 2022

Objectives To describe the impact of the COVID-19 pandemic on outpatient appointments for childre... more Objectives To describe the impact of the COVID-19 pandemic on outpatient appointments for children and young people. Setting All National Health Service (public) hospitals in England. Participants All people in England aged <25 years. Outcome measures Outpatient department attendance numbers, rates and modes (face to face vs telephone) by age group, sex and socioeconomic deprivation. Results Compared with the average for January 2017 to December 2019, there was a 3.8 million appointment shortfall (23.5%) for the under-25 population in England between March 2020 and February 2021, despite a total rise in phone appointments of 2.6 million during that time. This was true for each age group, sex and deprivation fifth, but there were smaller decreases in face to face and total appointments for babies under 1 year. For all ages combined, around one in six first and one in four follow-up appointments were by phone in the most recent period. The proportion of appointments attended was high, at over 95% for telephone and over 90% for face-to-face appointments for all ages. Conclusions COVID-19 led to a dramatic fall in total outpatient appointments and a large rise in the proportion of those appointments conducted by telephone. The impact that this has had on patient outcomes is still unknown. The differential impact of COVID-19 on outpatient activity in different sociodemographic groups may also inform design of paediatric outpatient services in the post-COVID period.

JMIR Research Protocols, Dec 4, 2018

Background: Demands on health services across are increasing because of the combined challenges o... more Background: Demands on health services across are increasing because of the combined challenges of an expanding and aging population, alongside complex comorbidities that transcend the classical boundaries of modern health care. Continuing to provide and coordinate care in the current manner is not a viable route to sustain the improvements in health outcomes observed in recent history. To ensure that there continues to be improvement in patient care, prevention of disease, and reduced burden on health systems, it is essential that we adapt our models of delivery. Providers of health and social care are evolving to face these pressures by changing the way they think about the care system and, importantly, how to involve patients in the planning and delivery of services. Objective: The objective of this paper is to provide (1) an overview of the current state of Internet of Things (IoT) and key implementation considerations, (2) key use cases demonstrating technology capabilities, (3) an overview of the landscape for health care IoT use in Oxford, and (4) recommendations for promoting the IoT via collaborations between higher education institutions and industry proof-of-concept (PoC) projects. Methods: This study describes the PoC projects that will be created to explore cost-effectiveness, clinical efficacy, and user adoption of Internet of Medical Things systems. The projects will focus on 3 areas: (1) bring your own device integration, (2) chronic disease management, and (3) personal health records. Results: This study is funded by Research England's Connecting Capability Fund. The study started in March 2018, and results are expected by the end of 2019. Conclusions: Embracing digital solutions to support the evolution and transformation of health services is essential. Importantly, this should not simply be undertaken by providers in isolation. It must embrace and exploit the advances being seen in the consumer devices, national rollout of high-speed broadband services, and the rapidly expanding medical device industry centered on mobile and wearable technologies. Oxford University Hospitals and its partner providers, patients, and stakeholders are building on their leading position as an exemplar site for digital maturity in the National Health Service to implement and evaluate technologies and solutions that will capitalize on the IoT. Although early in the application to health, the IoT and the potential it provides to make the patient a partner at the center of decisions about care represent an exciting opportunity. If achieved, a fully connected and interoperable health care environment will enable continuous acquisition and real-time analysis of patient data, offering

British Journal of General Practice, Aug 27, 2019

Background Evidence suggests that pharmacists integrated into primary care can improve patient ou... more Background Evidence suggests that pharmacists integrated into primary care can improve patient outcomes and satisfaction, but their impact on healthcare systems is unclear.

Aims Covid testing and primary care data for Children and Young People (CYP) has not yet been lin... more Aims Covid testing and primary care data for Children and Young People (CYP) has not yet been linked at the national level in England. However, such linkage has been established using the Discover Whole System Integrated Care (WSIC) database in Northwest London (NWL). We describe pattern of primary care utilisation, among CYP of 0-24 years of age in NWL before and after testing positive for Covid-19 infection. The insights are needed in understanding the impact of Covid-19 infection on both the patient and the health care system.

BMJ Open, Sep 1, 2022

Objectives To develop a core outcome set (COS) for physical activity interventions in primary sch... more Objectives To develop a core outcome set (COS) for physical activity interventions in primary schools. Design Modified-Delphi study. Setting The UK and international. Participants 104 participants from four stakeholder groups (educators, public health professionals, health researchers, parents); 16 children (aged 8-9 years) from 1 London primary school. Interventions Physical activity interventions. Methods Four-stage process: (1) outcomes extracted from relevant studies identified from an umbrella review and a focus group; (2) list of outcomes produced and domains established; (3) stakeholders completed a two-round Delphi survey by rating (Round 1) and re-rating (Round 2) each outcome on a ninepoint Likert Scale from 'not important' to 'critical': a>70% participant threshold identified the outcomes rated 'critical' to measure, and outcomes important to children were identified through a workshop; and (4) a stakeholder meeting to achieve consensus of the outcomes to include in the COS. Results In total, 74 studies were extracted from 53 reviews. A list of 50 outcomes was produced and three domains were established: 'physical activity and health' (16 outcomes), 'social and emotional health' (22 outcomes) and 'educational performance' (12 outcomes). 104 participants completed survey Round 1; 65 participants completed both rounds. In total, 13 outcomes met the threshold; children identified 8 outcomes. Fourteen outcomes achieved consensus to produce the COS: five outcomes for physical activity and health (diet (varied and balanced), energy, fitness, intensity of physical activity, sleep (number of hours)); seven outcomes for social and emotional health (anxiety, depression, enjoyment, happiness, self-esteem, stress, well-being); and two outcomes for educational performance (concentration, focus). Conclusions We have developed the first COS for physical activity interventions in primary schools in consultation with those interested in the development and application of an agreed standardised set of outcomes. Future studies including these outcomes will reduce heterogeneity across studies. Trial registration number Core Outcome Measures in Effectiveness Trials Initiative registration number 1322; Results. ⇒ This is the first study to develop a core outcome set (COS) for physical activity interventions in primary schools. ⇒ The COS has been developed in consultation with participants from key stakeholder groups. ⇒ This study uses robust methodology as recommended by the Core Outcome Measures in Effectiveness in Trials Initiative. ⇒ There were an unbalanced number of participants in each stakeholder group. ⇒ The low representation of international participants may limit the use of this COS to UK schools only.

Background: Community-college students are at high risk for tobacco use. Because the use of mobil... more Background: Community-college students are at high risk for tobacco use. Because the use of mobile phone text messaging is nearly ubiquitous today, short message service (SMS) may be an effective strategy for tobacco risk communication in this population. Little is known, however, concerning the message structure significantly influencing perceived tobacco risk. Objective: We aim to outline the rationale and design of Project Debunk, a randomized trial comparing the effects of different SMS text message structures. Methods: We conducted a 6-month randomized trial comparing 8 arms, based on the combination of the 3 message structures delivered to young adults in a 2×2×2 study design: framing (gain-framed or loss-framed), depth (simple or complex), and appeal (emotional or rational). Participants were invited to participate from 3 community colleges in Houston from September 2016 to July 2017. Participants were randomized to 1 arm and received text messages in 2 separate campaigns. Each campaign consisted of 2 text messages per day for 30 days. Perceived tobacco risk was assessed at baseline, 2 months after the first campaign, and 2 months after the second campaign. We assessed the perceived risk of using conventional products (eg, combustible cigarettes) and new and emerging products (eg, electronic cigarettes). The validity of message structures was assessed weekly for each campaign. A 1-week follow-up assessment was also conducted to understand immediate reactions from participants. Results: We completed data collection for the baseline survey on a rolling basis during this time and assessed the validity of the message structure after 1 week of SMS text messages. For the entire sample (N=636), the average age was 20.92 years (SD 2.52), about two-thirds were male (430/636, 67.6%), and most were black or African American (259/636, 40.7%) or white (236/636, 37.1%). After 1 week of receiving text messages, the following was noted: (a) loss-framed messages were more likely to be perceived as presenting a loss than gain-framed messages (F 7,522 =13.13, P<.001), (b) complex messages were perceived to be more complex than simple messages (F 7,520 =2.04, P=.05), and (c) emotional messages were perceived to be more emotionally involving than rational messages (F 7,520 =6.46, P<.001).

Journal of Medical Internet Research, Jun 4, 2019

Background: The World Health Report (2006) by the World Health Organization conveys that a signif... more Background: The World Health Report (2006) by the World Health Organization conveys that a significant increase is needed in global health care resourcing to meet the current and future demand for health professionals. Electronic learning (e-Learning) presents a possible opportunity to change and optimize training by providing a scalable means for instruction, thus reducing the costs for training health professionals and providing patient education. Research literature often suggests that a benefit of e-Learning is its cost-effectiveness compared with face-to-face instruction, yet there is limited evidence with respect to the comparison of design and production costs with other forms of instruction or the establishment of standards pertaining to budgeting for these costs. Objective: To determine the potential cost favorability of e-Learning in contrast to other forms of learning, there must first be an understanding of the components and elements for building an e-Learning course. Without first taking this step, studies lack the essential financial accounting rigor for course planning and have an inconsistent basis for comparison. This study aimed to (1) establish standard ingredients for the cost of e-Learning course production and (2) determine the variance instructional design has on the production costs of e-Learning courses. Methods: This study made use of a cross-case method among 3 case studies using mixed methods, including horizontal budget variance calculation and qualitative interpretation of responses from course designers for budget variance using total quality management themes. The different implementation-specific aspects of these cases were used to establish common principles in the composition of budgets in the production and delivery of an applied health professional e-Learning course. Results: A total of 2 case studies reported significant negative budget variances caused by issues surrounding underreporting of personnel costs, inaccurate resource task estimation, lack of contingency planning, challenges in third-party resource management, and the need to update health-related materials that became outdated during course production. The third study reported a positive budget variance because of the cost efficiency derived from previous implementation, the strong working relationship of the course project team, and the use of iterative project management methods. Conclusions: This research suggests that the delivery costs of an e-Learning course could be underestimated or underreported and identifies factors that could be used to better control budgets. Through consistent management of factors affecting the cost of course production, further research could be undertaken using standard economic evaluation methods to evaluate the advantages of using e-Learning.

JMIR Research Protocols, Feb 8, 2019

Background: A blockchain is a digitized, decentralized, distributed public ledger that acts as a ... more Background: A blockchain is a digitized, decentralized, distributed public ledger that acts as a shared and synchronized database that records cryptocurrency transactions. Despite the shift toward digital platforms enabled by electronic medical records, demonstrating a will to reform the health care sector, health systems face issues including security, interoperability, data fragmentation, timely access to patient data, and silos. The application of health care blockchains could enable data interoperability, enhancement of precision medicine, and reduction in prescription frauds through implementing novel methods in access and patient consent. Objective: To summarize the evidence on the strategies and frameworks utilized to implement blockchains for patient data in health care to ensure privacy and improve interoperability and scalability. It is anticipated this review will assist in the development of recommendations that will assist key stakeholders in health care blockchain implementation, and we predict that the evidence generated will challenge the health care status quo, moving away from more traditional approaches and facilitating decision making of patients, health care providers, and researchers. Methods: A systematic search of MEDLINE/PubMed, Embase, Scopus, ProQuest Technology Collection and Engineering Index will be conducted. Two experienced independent reviewers will conduct titles and abstract screening followed by full-text reading to determine study eligibility. Data will then be extracted onto data extraction forms before using the Cochrane Collaboration Risk of Bias Tool to appraise the quality of included randomized studies and the Risk of Bias in nonrandomized studies of Interventions to assess the quality of nonrandomized studies. Data will then be analyzed and synthesized. Results: Database searches will be initiated in September 2018. We expect to complete the review in January 2019. Conclusions: This review will summarize the strategies and frameworks used to implement blockchains in health care to increase data privacy, interoperability, and scalability. This review will also help clarify if the strategies and frameworks required for the operationalization of blockchains in health care ensure the privacy of patient data while enabling efficiency, interoperability, and scalability.

European journal of public health, Sep 1, 2020

BMJ, Jul 13, 2018

Health outcomes in the United Kingdom have improved substantially since the NHS was established i... more Health outcomes in the United Kingdom have improved substantially since the NHS was established in 1948. 1 For example, average life expectancy has increased by around 12 years from 68 to 80 years; and infant mortality has fallen nearly 90%, from 34/1000 live births to less than 4/1000. 2 The NHS performs well in many international comparisons on measures such as efficiency, equity, and access. 3 Despite these achievements, however, problems with health outcomes remain. 3 4 Moreover, other European countries have also improved their health outcomes in recent decades, often at a faster rate than the UK. Consequently, the UK now lags behind many other European countries in key health outcomes in areas such as child health and cancer survival. Here, we review the quality of care and health outcomes in the NHS, focusing on areas that are important to patients, policy makers, and clinicians 4 and for which there are comparative international data. Management of long term conditions The NHS generally performs well on measures of the management of long term conditions in adults. The UK Quality and Outcomes Framework is the largest primary care based pay

British Journal of General Practice, Apr 4, 2022

Background: Massive open online courses (MOOCs) have increased in popularity in recent years. The... more Background: Massive open online courses (MOOCs) have increased in popularity in recent years. They target a wide variety of learners and use novel teaching approaches, yet often exhibit low completion rates (10%). It is important to evaluate MOOCs to determine their impact and effectiveness, but little is known at this point about the methodologies that should be used for evaluation. Objective: The purpose of this paper is to provide a protocol for a systematic review on MOOC evaluation methods. Methods: We will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines for reporting this protocol. We developed a population, intervention, comparator, and outcome (PICO) framework to guide the search strategy, based on the overarching question, "What methods have been used to evaluate MOOCs?" The review will follow six stages: 1) literature search, 2) article selection, 3) data extraction, 4) quality appraisal, 5) data analysis, and 6) data synthesis. Results: The systematic review is ongoing. We completed the data searches and data abstraction in October and November 2018. We are now analyzing the data and expect to complete the systematic review by March 2019. Conclusions: This systematic review will provide a useful summary of the methods used for evaluation of MOOCs and the strengths and limitations of each approach. It will also identify gaps in the literature and areas for future work.

EBioMedicine, Mar 1, 2016

Thrombus formation leading to vaso-occlusive events is a major cause of death, and involves compl... more Thrombus formation leading to vaso-occlusive events is a major cause of death, and involves complex interactions between coagulation, fibrinolytic and innate immune systems. Leukocyte recruitment is a key step, mediated partly by chemotactic complement activation factors C3a and C5a. However, mechanisms mediating C3a/C5a generation during thrombosis have not been studied. In a murine venous thrombosis model, levels of thrombin-antithrombin complexes poorly correlated with C3a and C5a, excluding a central role for thrombin in C3a/C5a production. However, clot weight strongly correlated with C5a, suggesting processes triggered during thrombosis promote C5a generation. Since thrombosis elicits fibrinolysis, we hypothesized that plasmin activates C5 during thrombosis. In vitro, the catalytic efficiency of plasmin-mediated C5a generation greatly exceeded that of thrombin or factor Xa, but was similar to the recognized complement C5 convertases. Plasmin-activated C5 yielded a functional membrane attack complex (MAC). In an arterial thrombosis model, plasminogen activator administration increased C5a levels. Overall, these findings suggest plasmin bridges thrombosis and the immune response by liberating C5a and inducing MAC assembly. These new insights may lead to the development of strategies to limit thrombus formation and/or enhance resolution.

Quality of Life Research, Jan 29, 2011

Purpose Measurement and reporting of health-related quality of life (HRQL) data have evolved cons... more Purpose Measurement and reporting of health-related quality of life (HRQL) data have evolved considerably over the past 10 years. Our goal was to identify the current barriers to, and enablers of, the effective translation of HRQL outcome data from randomized clinical trials by investigating physician attitudes, knowledge, and education needs. Methods We undertook a mixed qualitative and quantitative study of 33 oncologists' attitudes and educational needs around the value, interpretation, and application of HRQL data from cancer clinical trials. The approach was designed to identify barriers and enablers relating to the characteristics of the knowledge itself, to the potential users of the knowledge, and to the environment in which the knowledge is used. Results The majority of barriers and enablers identified were ''second order'', i.e., related to the understandability and generalizability of the data, its presentation, its accessibility within the medical literature, and its relevance to specific patient populations. Conclusions Our results suggest knowledge translation (KT) of HRQL results would improve if the clinical trial HRQL data were easily accessible to clinicians, and presented in a comprehensible and clinically applicable format, which includes discussion of the relevance of the measurement domains and implications of the findings. We recommend that standards of clinical trial HRQL reporting be implemented in clinical journals. Keywords Quality of life Á Patient-reported outcomes Á HRQL Á Knowledge translation Á Randomized clinical trials Abbreviations QOL Quality of life HRQL Health-related quality of life RCT Randomized clinical trial KT Knowledge translation

European Journal for Person Centered Healthcare, Dec 4, 2018

Background: We previously developed a questionnaire to assess the quality of personal care in pro... more Background: We previously developed a questionnaire to assess the quality of personal care in prostate cancer radiotherapy. Patients are asked to rate the importance of 143 elements of their care and to rate the quality of their care for each element. In order to improve the quality of care delivered to patients, the elements of care most in need of improvement must be identified.Objective: To develop a method of integrating ratings of importance and ratings of quality to identify elements of care that should become targets for quality improvement.Methods: We surveyed 108 patients undergoing radiotherapy for prostate cancer. We developed 3 methods to identify elements of care to target for quality improvement that were important to the patient(s) and suboptimal in quality. Spearman correlation was used to compare ranking of priorities across all 3 methods. Generalized estimating equations were used to assess the statistical ability of the methods to discriminate between priorities for quality improvement.Results: Integrating importance and quality ratings identified different priorities than using quality ratings alone. Two of the integrated methods identified priorities for quality improvement and their ranks similarly (r=0.91, p<0.0001). All methods identified elements related to communication of information about the disease and its treatment as priorities.Conclusions: Two methods produced similar results although one is easier to understand and theoretically superior since the ratings for importance and quality are linked for each individual. Further consultation with stakeholders will determine how to use these results as part of a quality improvement program.

Radiotherapy and Oncology, Apr 1, 2011

To develop a set of indicators of the quality of radiotherapy (RT) for localized prostate cancer.... more To develop a set of indicators of the quality of radiotherapy (RT) for localized prostate cancer. Methods and materials: Following a comprehensive review of the literature to identify candidate quality indicators, we utilized a modified Delphi technique to develop a set of indicators of the quality of RT for localized prostate cancer. The first Delphi round consisted of an online survey in which radiation oncologists were asked to rate the importance of the candidate quality indicators. The second round was a face-to-face meeting of a smaller group of radiation oncologists to discuss, rate, and rank a final set of quality indicators. Results: The literature review identified 57 candidate quality indicators. After the two rounds of the Delphi process, a final set of 25 indicators was agreed upon. The set includes quality indicators covering all aspects of prostate cancer radical RT management: pre-treatment assessment, external beam RT, brachytherapy, androgen deprivation therapy, and follow-up. Conclusions: This new set of quality indicators is more comprehensive than others described in the literature, and can be applied to patterns of care studies that assess the quality of RT for prostate cancer. The process used to develop this set of indicators can be readily adapted for use in other contexts.