Grace Turner - Academia.edu (original) (raw)
Papers by Grace Turner
BMC Health Services Research, 2022
Background Follow-up care after transient ischaemic attack (TIA) and minor stroke has been found ... more Background Follow-up care after transient ischaemic attack (TIA) and minor stroke has been found to be sub-optimal, with individuals often feeling abandoned. We aimed to explore factors influencing holistic follow-up care after TIA and minor stroke. Methods Qualitative semi-structured interviews with 24 healthcare providers (HCPs): 5 stroke doctors, 4 nurses, 9 allied health professionals and 6 general practitioners. Participants were recruited from three TIA clinics, seven general practices and one community care trust in the West Midlands, England. Interview transcripts were deductively coded using the Theoretical Domains Framework and themes were generated from coded data. Results There was no clear pathway for supporting people with TIA or minor stroke after rapid specialist review in hospital; consequently, these patients had limited access to HCPs from all settings (‘Environmental context and resources’). There was lack of understanding of potential needs post-TIA/minor stroke...
Supplemental material, sj-pdf-1-jrs-10.1177_01410768211032850 for Symptoms, complications and man... more Supplemental material, sj-pdf-1-jrs-10.1177_01410768211032850 for Symptoms, complications and management of long COVID: a review by Olalekan Lee Aiyegbusi, Sarah E Hughes, Grace Turner, Samantha Cruz Rivera, Christel McMullan, Joht Singh Chandan, Shamil Haroon, Gary Price, Elin Haf Davies, Krishnarajah Nirantharakumar, Elizabeth Sapey, Melanie J Calvert and on behalf of the TLC Study Group in Journal of the Royal Society of Medicine
Additional file 2. Demographic questionnaire. Demographic questionnaire for patient participants
Additional file 4: Table S1. Characteristics of TIA and minor stroke participants. Table S2. Char... more Additional file 4: Table S1. Characteristics of TIA and minor stroke participants. Table S2. Characteristics of healthcare provider participants. Table S3. Residual impairments post-TIA and minor stroke: subthemes and example quotes. Table S4. Impact of TIA and minor stroke on patients' lives: subthemes and example quotes. Table S5. Experience of follow-up care and sources of support post-TIA and minor stroke: subthemes and example quotes
Semi-structured interview prompts for RAPID-TIA Qualitative Study. (DOCX 21 kb)
Stroke Review Checklist. (DOCX 137 kb)
Medline search strategy, (DOCX 42 kb)
PRISMA checklist. (DOCX 62 kb)
A systematic review investigating fatigue, psychological and cognitive impairment following tocol... more A systematic review investigating fatigue, psychological and cognitive impairment following tocol paper
International Journal of Stroke, 2021
Background Traumatic brain injury is a global health problem; worldwide, >60 million people ex... more Background Traumatic brain injury is a global health problem; worldwide, >60 million people experience a traumatic brain injury each year and incidence is rising. Traumatic brain injury has been proposed as an independent risk factor for stroke. Aims To investigate the association between traumatic brain injury and stroke risk. Summary of review We undertook a systematic review of MEDLINE, EMBASE, CINAHL, and The Cochrane Library from inception to 4 December 2020. We used random-effects meta-analysis to pool hazard ratios for studies which reported stroke risk post-traumatic brain injury compared to controls. Searches identified 10,501 records; 58 full texts were assessed for eligibility and 18 met the inclusion criteria. The review included a large sample size of 2,606,379 participants from four countries. Six studies included a non-traumatic brain injury control group, all found traumatic brain injury patients had significantly increased risk of stroke compared to controls (poo...
BackgroundPeople who experience a stroke or transient ischaemic attack (TIA) have greater risks o... more BackgroundPeople who experience a stroke or transient ischaemic attack (TIA) have greater risks of complications from contracting COVID-19. Vaccine uptake in this vulnerable population is important to reduce the burden of COVID-19 on healthcare services and society. To prevent vaccine hesitancy and maximise compliance, we need to better understand individuals’ views on the vaccine. We aimed to explore perspectives of people with stroke/TIA on the COVID-19 vaccine and influences on its uptake.MethodWe conducted a cross-sectional, electronic open survey comprising multiple choice and free text questions. Convenience sampling was used to recruit people who have experienced a stroke and/or TIA, and were residents in the UK or Ireland.ResultsThe survey was completed by 377 stroke/TIA survivors. 87% (328/377) had either received the first vaccine or were booked to have it. The vaccine was declined by 2% (7/377) and 3% (11/377) had been offered the vaccine but not yet taken it up. 8% (30/3...
Background: Patient reported outcome measures (PROMs) are increasingly used to assess impact of d... more Background: Patient reported outcome measures (PROMs) are increasingly used to assess impact of disease and treatment on quality of life and symptoms; however, their use in primary care is fragmented. We aimed to understand how PROMs are currently being used in primary care, the barriers and facilitators of this use and if appropriate how it might be optimised. Methods: Cross-sectional survey and semi-structured interviews among general practitioners (GPs) in England. GPs’ opinions were explored using an electronic, self-completed questionnaire disseminated to 100 GPs via an online doctors’ community and semi-structured qualitative interviews with 25 GPs. Results: Most GPs surveyed (77/100; 77%) reported using one or more PROM, primarily to aid clinical management (n = 66) or as screening/diagnostic tools (n = 62). Qualitative interviews highlighted challenges in identifying and selecting PROMs; however, some GPs valued PROMs for shared decision making and to direct patient discussi...
Introduction Patient-reported outcomes (PROs) are measures of a person’s own views of their healt... more Introduction Patient-reported outcomes (PROs) are measures of a person’s own views of their health, functioning and quality of life. They are typically assessed using validated, self-completed questionnaires known as patient-reported outcome measures (PROMs). PROMs are used in healthcare settings to support care planning, clinical decision-making, patient–practitioner communication and quality improvement. PROMs have a potential role in the delivery of social care where people often have multiple and complex long-term health conditions. However, the use of PROMs in this context is currently unclear. The objective of this scoping review is to explore the evidence relating to the use of PROMs in adult social care. Methods and analyses The electronic databases Medline (Ovid), PsychInfo (Ovid), ASSIA (ProQuest), Social Care Online (SCIE), Web of Science and EMBASE (Ovid) were searched on 29 September 2020 to identify eligible studies and other publically available documents published si...
BMJ Open
Patient-reported outcomes (PROs) are used in clinical trials to provide valuable evidence on the ... more Patient-reported outcomes (PROs) are used in clinical trials to provide valuable evidence on the impact of disease and treatment on patients’ symptoms, function and quality of life. High-quality PRO data from trials can inform shared decision-making, regulatory and economic analyses and health policy. Recent evidence suggests the PRO content of past trial protocols was often incomplete or unclear, leading to research waste. To address this issue, international, consensus-based, PRO-specific guidelines were developed: the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT)-PRO Extension. The SPIRIT-PRO Extension is a 16-item checklist which aims to improve the content and quality of aspects of clinical trial protocols relating to PRO data collection to minimise research waste, and ultimately better inform patient-centred care. This SPIRIT-PRO explanation and elaboration (E&E) paper provides information to promote understanding and facilitate uptake of the reco...
Journal of the Royal Society of Medicine
Globally, there are now over 160 million confirmed cases of COVID-19 and more than 3 million deat... more Globally, there are now over 160 million confirmed cases of COVID-19 and more than 3 million deaths. While the majority of infected individuals recover, a significant proportion continue to experience symptoms and complications after their acute illness. Patients with ‘long COVID’ experience a wide range of physical and mental/psychological symptoms. Pooled prevalence data showed the 10 most prevalent reported symptoms were fatigue, shortness of breath, muscle pain, joint pain, headache, cough, chest pain, altered smell, altered taste and diarrhoea. Other common symptoms were cognitive impairment, memory loss, anxiety and sleep disorders. Beyond symptoms and complications, people with long COVID often reported impaired quality of life, mental health and employment issues. These individuals may require multidisciplinary care involving the long-term monitoring of symptoms, to identify potential complications, physical rehabilitation, mental health and social services support. Resilien...
BMC Family Practice
Background: National guidelines recommend patients with suspected transient ischaemic attack (TIA... more Background: National guidelines recommend patients with suspected transient ischaemic attack (TIA) should be seen by a specialist within 24 h. However, people with suspected TIA often present to non-specialised services, particularly primary care. Therefore, general practitioners (GPs) have a crucial role in recognition and urgent referral of people with suspected TIA. This study aims to explore the role of GPs in the initial management of suspected TIA in the United Kingdom (UK). Methods: One-to-one, semi-structured interviews with GPs, TIA clinic staff and patients with suspected TIA from two sites in the UK: Cambridge and Birmingham. Thematic analysis was undertaken to explore views on the role of the GP in managing suspected TIA. Thirty semi-structured interviews were conducted with stroke patients (n = 12), GPs (n = 9) and TIA clinic hospital staff (n = 9) from two hospitals and nine GP practices in surrounding areas. Results: Three overarching themes were identified: (1) multiple management pathways for suspected TIA; (2) uncertainty regarding suspected TIA as an emergency or routine situation; and (3) influences on the urgency of GP management. Conclusions: Guidelines on the primary care management of TIA describe only a small proportion of the factors which influence GP management and referral of suspected TIA. Efforts to improve treatment, appropriate referral and patient experience should use a real rather than idealised model of the GP role in managing suspected TIA.
Journal of the Royal Society of Medicine
Background Transient ischaemic attack (TIA) and minor stroke are often considered transient event... more Background Transient ischaemic attack (TIA) and minor stroke are often considered transient events; however, many patients experience residual problems and reduced quality of life. Current follow-up healthcare focuses on stroke prevention and care for other long-term problems is not routinely provided. We aimed to explore patient and healthcare provider (HCP) experiences of residual problems post-TIA/minor stroke, the impact of TIA/minor stroke on patients’ lives, and current follow-up care and sources of support. Methods This qualitative study recruited participants from three TIA clinics, seven general practices and one community care trust in the West Midlands, England. Semi-structured interviews were conducted with 12 TIA/minor stroke patients and 24 HCPs from primary, secondary and community care with framework analysis. Results A diverse range of residual problems were reported post-TIA/minor stroke, including psychological, cognitive and physical impairments. Consultants and ...
Background Patient reported outcome measures (PROMs) are increasingly used to assess impact of di... more Background Patient reported outcome measures (PROMs) are increasingly used to assess impact of disease and treatment on quality of life and symptoms; however, their use in primary care is fragmented. We aimed to understand the current use of PROMs in primary care, barriers and facilitators, and how their use might be optimised. Methods Cross-sectional survey and semi-structured interviews among general practitioners (GPs) in England. GPs’ opinions were explored using an electronic, self-completed questionnaire disseminated to 100 GPs via an online doctors’ community and semi-structured qualitative interviews with 25 GPs. Results Most GPs surveyed (77/100; 77%) reported using one or more PROM, primarily to aid clinical management (n=66) or as screening/diagnostic tools (n=62). Qualitative interviews highlighted challenges in identifying and selecting PROMs; however, some GPs valued PROMs for shared decision making and to direct patient discussions. The interviews identified key barri...
BMC Health Services Research, 2022
Background Follow-up care after transient ischaemic attack (TIA) and minor stroke has been found ... more Background Follow-up care after transient ischaemic attack (TIA) and minor stroke has been found to be sub-optimal, with individuals often feeling abandoned. We aimed to explore factors influencing holistic follow-up care after TIA and minor stroke. Methods Qualitative semi-structured interviews with 24 healthcare providers (HCPs): 5 stroke doctors, 4 nurses, 9 allied health professionals and 6 general practitioners. Participants were recruited from three TIA clinics, seven general practices and one community care trust in the West Midlands, England. Interview transcripts were deductively coded using the Theoretical Domains Framework and themes were generated from coded data. Results There was no clear pathway for supporting people with TIA or minor stroke after rapid specialist review in hospital; consequently, these patients had limited access to HCPs from all settings (‘Environmental context and resources’). There was lack of understanding of potential needs post-TIA/minor stroke...
Supplemental material, sj-pdf-1-jrs-10.1177_01410768211032850 for Symptoms, complications and man... more Supplemental material, sj-pdf-1-jrs-10.1177_01410768211032850 for Symptoms, complications and management of long COVID: a review by Olalekan Lee Aiyegbusi, Sarah E Hughes, Grace Turner, Samantha Cruz Rivera, Christel McMullan, Joht Singh Chandan, Shamil Haroon, Gary Price, Elin Haf Davies, Krishnarajah Nirantharakumar, Elizabeth Sapey, Melanie J Calvert and on behalf of the TLC Study Group in Journal of the Royal Society of Medicine
Additional file 2. Demographic questionnaire. Demographic questionnaire for patient participants
Additional file 4: Table S1. Characteristics of TIA and minor stroke participants. Table S2. Char... more Additional file 4: Table S1. Characteristics of TIA and minor stroke participants. Table S2. Characteristics of healthcare provider participants. Table S3. Residual impairments post-TIA and minor stroke: subthemes and example quotes. Table S4. Impact of TIA and minor stroke on patients' lives: subthemes and example quotes. Table S5. Experience of follow-up care and sources of support post-TIA and minor stroke: subthemes and example quotes
Semi-structured interview prompts for RAPID-TIA Qualitative Study. (DOCX 21 kb)
Stroke Review Checklist. (DOCX 137 kb)
Medline search strategy, (DOCX 42 kb)
PRISMA checklist. (DOCX 62 kb)
A systematic review investigating fatigue, psychological and cognitive impairment following tocol... more A systematic review investigating fatigue, psychological and cognitive impairment following tocol paper
International Journal of Stroke, 2021
Background Traumatic brain injury is a global health problem; worldwide, >60 million people ex... more Background Traumatic brain injury is a global health problem; worldwide, >60 million people experience a traumatic brain injury each year and incidence is rising. Traumatic brain injury has been proposed as an independent risk factor for stroke. Aims To investigate the association between traumatic brain injury and stroke risk. Summary of review We undertook a systematic review of MEDLINE, EMBASE, CINAHL, and The Cochrane Library from inception to 4 December 2020. We used random-effects meta-analysis to pool hazard ratios for studies which reported stroke risk post-traumatic brain injury compared to controls. Searches identified 10,501 records; 58 full texts were assessed for eligibility and 18 met the inclusion criteria. The review included a large sample size of 2,606,379 participants from four countries. Six studies included a non-traumatic brain injury control group, all found traumatic brain injury patients had significantly increased risk of stroke compared to controls (poo...
BackgroundPeople who experience a stroke or transient ischaemic attack (TIA) have greater risks o... more BackgroundPeople who experience a stroke or transient ischaemic attack (TIA) have greater risks of complications from contracting COVID-19. Vaccine uptake in this vulnerable population is important to reduce the burden of COVID-19 on healthcare services and society. To prevent vaccine hesitancy and maximise compliance, we need to better understand individuals’ views on the vaccine. We aimed to explore perspectives of people with stroke/TIA on the COVID-19 vaccine and influences on its uptake.MethodWe conducted a cross-sectional, electronic open survey comprising multiple choice and free text questions. Convenience sampling was used to recruit people who have experienced a stroke and/or TIA, and were residents in the UK or Ireland.ResultsThe survey was completed by 377 stroke/TIA survivors. 87% (328/377) had either received the first vaccine or were booked to have it. The vaccine was declined by 2% (7/377) and 3% (11/377) had been offered the vaccine but not yet taken it up. 8% (30/3...
Background: Patient reported outcome measures (PROMs) are increasingly used to assess impact of d... more Background: Patient reported outcome measures (PROMs) are increasingly used to assess impact of disease and treatment on quality of life and symptoms; however, their use in primary care is fragmented. We aimed to understand how PROMs are currently being used in primary care, the barriers and facilitators of this use and if appropriate how it might be optimised. Methods: Cross-sectional survey and semi-structured interviews among general practitioners (GPs) in England. GPs’ opinions were explored using an electronic, self-completed questionnaire disseminated to 100 GPs via an online doctors’ community and semi-structured qualitative interviews with 25 GPs. Results: Most GPs surveyed (77/100; 77%) reported using one or more PROM, primarily to aid clinical management (n = 66) or as screening/diagnostic tools (n = 62). Qualitative interviews highlighted challenges in identifying and selecting PROMs; however, some GPs valued PROMs for shared decision making and to direct patient discussi...
Introduction Patient-reported outcomes (PROs) are measures of a person’s own views of their healt... more Introduction Patient-reported outcomes (PROs) are measures of a person’s own views of their health, functioning and quality of life. They are typically assessed using validated, self-completed questionnaires known as patient-reported outcome measures (PROMs). PROMs are used in healthcare settings to support care planning, clinical decision-making, patient–practitioner communication and quality improvement. PROMs have a potential role in the delivery of social care where people often have multiple and complex long-term health conditions. However, the use of PROMs in this context is currently unclear. The objective of this scoping review is to explore the evidence relating to the use of PROMs in adult social care. Methods and analyses The electronic databases Medline (Ovid), PsychInfo (Ovid), ASSIA (ProQuest), Social Care Online (SCIE), Web of Science and EMBASE (Ovid) were searched on 29 September 2020 to identify eligible studies and other publically available documents published si...
BMJ Open
Patient-reported outcomes (PROs) are used in clinical trials to provide valuable evidence on the ... more Patient-reported outcomes (PROs) are used in clinical trials to provide valuable evidence on the impact of disease and treatment on patients’ symptoms, function and quality of life. High-quality PRO data from trials can inform shared decision-making, regulatory and economic analyses and health policy. Recent evidence suggests the PRO content of past trial protocols was often incomplete or unclear, leading to research waste. To address this issue, international, consensus-based, PRO-specific guidelines were developed: the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT)-PRO Extension. The SPIRIT-PRO Extension is a 16-item checklist which aims to improve the content and quality of aspects of clinical trial protocols relating to PRO data collection to minimise research waste, and ultimately better inform patient-centred care. This SPIRIT-PRO explanation and elaboration (E&E) paper provides information to promote understanding and facilitate uptake of the reco...
Journal of the Royal Society of Medicine
Globally, there are now over 160 million confirmed cases of COVID-19 and more than 3 million deat... more Globally, there are now over 160 million confirmed cases of COVID-19 and more than 3 million deaths. While the majority of infected individuals recover, a significant proportion continue to experience symptoms and complications after their acute illness. Patients with ‘long COVID’ experience a wide range of physical and mental/psychological symptoms. Pooled prevalence data showed the 10 most prevalent reported symptoms were fatigue, shortness of breath, muscle pain, joint pain, headache, cough, chest pain, altered smell, altered taste and diarrhoea. Other common symptoms were cognitive impairment, memory loss, anxiety and sleep disorders. Beyond symptoms and complications, people with long COVID often reported impaired quality of life, mental health and employment issues. These individuals may require multidisciplinary care involving the long-term monitoring of symptoms, to identify potential complications, physical rehabilitation, mental health and social services support. Resilien...
BMC Family Practice
Background: National guidelines recommend patients with suspected transient ischaemic attack (TIA... more Background: National guidelines recommend patients with suspected transient ischaemic attack (TIA) should be seen by a specialist within 24 h. However, people with suspected TIA often present to non-specialised services, particularly primary care. Therefore, general practitioners (GPs) have a crucial role in recognition and urgent referral of people with suspected TIA. This study aims to explore the role of GPs in the initial management of suspected TIA in the United Kingdom (UK). Methods: One-to-one, semi-structured interviews with GPs, TIA clinic staff and patients with suspected TIA from two sites in the UK: Cambridge and Birmingham. Thematic analysis was undertaken to explore views on the role of the GP in managing suspected TIA. Thirty semi-structured interviews were conducted with stroke patients (n = 12), GPs (n = 9) and TIA clinic hospital staff (n = 9) from two hospitals and nine GP practices in surrounding areas. Results: Three overarching themes were identified: (1) multiple management pathways for suspected TIA; (2) uncertainty regarding suspected TIA as an emergency or routine situation; and (3) influences on the urgency of GP management. Conclusions: Guidelines on the primary care management of TIA describe only a small proportion of the factors which influence GP management and referral of suspected TIA. Efforts to improve treatment, appropriate referral and patient experience should use a real rather than idealised model of the GP role in managing suspected TIA.
Journal of the Royal Society of Medicine
Background Transient ischaemic attack (TIA) and minor stroke are often considered transient event... more Background Transient ischaemic attack (TIA) and minor stroke are often considered transient events; however, many patients experience residual problems and reduced quality of life. Current follow-up healthcare focuses on stroke prevention and care for other long-term problems is not routinely provided. We aimed to explore patient and healthcare provider (HCP) experiences of residual problems post-TIA/minor stroke, the impact of TIA/minor stroke on patients’ lives, and current follow-up care and sources of support. Methods This qualitative study recruited participants from three TIA clinics, seven general practices and one community care trust in the West Midlands, England. Semi-structured interviews were conducted with 12 TIA/minor stroke patients and 24 HCPs from primary, secondary and community care with framework analysis. Results A diverse range of residual problems were reported post-TIA/minor stroke, including psychological, cognitive and physical impairments. Consultants and ...
Background Patient reported outcome measures (PROMs) are increasingly used to assess impact of di... more Background Patient reported outcome measures (PROMs) are increasingly used to assess impact of disease and treatment on quality of life and symptoms; however, their use in primary care is fragmented. We aimed to understand the current use of PROMs in primary care, barriers and facilitators, and how their use might be optimised. Methods Cross-sectional survey and semi-structured interviews among general practitioners (GPs) in England. GPs’ opinions were explored using an electronic, self-completed questionnaire disseminated to 100 GPs via an online doctors’ community and semi-structured qualitative interviews with 25 GPs. Results Most GPs surveyed (77/100; 77%) reported using one or more PROM, primarily to aid clinical management (n=66) or as screening/diagnostic tools (n=62). Qualitative interviews highlighted challenges in identifying and selecting PROMs; however, some GPs valued PROMs for shared decision making and to direct patient discussions. The interviews identified key barri...