scholarly journals Assessing the extent of drug interactions among patients with multimorbidity in primary and secondary care in the West Midlands (UK): a study protocol for the Mixed Methods Multimorbidity Study (MiMMS)

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e016713 ◽  
Author(s):  
Ruth Backman ◽  
Philip Weber ◽  
Alice M Turner ◽  
Mark Lee ◽  
Ian Litchfield
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Secondary Care ◽  
Theoretical Domains Framework ◽  
Research Network ◽  
Normalisation Process Theory ◽  
The West ◽  
West Midlands ◽  
The Uk ◽  
The University

IntroductionThe numbers of patients with three or more chronic conditions (multimorbidity) are increasing, and will rise to 2.9 million by 2018 in the UK alone. Currently in the UK, conditions are mainly managed using over 250 sets of single-condition guidance, which has the potential to generate conflicting recommendations for lifestyle and concurrent medication for individual patients with more than one condition. To address some of these issues, we are developing a new computer-based tool to help manage these patients more effectively. For this tool to be applicable and relevant to current practice, we must first better understand how existing patients with multimorbidity are being managed, particularly relating to concerns over prescribing and potential polypharmacy.Methods and analysisUp to four secondary care centres, two community pharmacies and between four and eight primary care centres in the West Midlands will be recruited. Interviewees will be purposively sampled from these sites, up to a maximum of 30. In this mixed methods study, we will perform a dual framework analysis on the qualitative data; the first analysis will use the Theoretical Domains Framework to assess barriers and enablers for healthcare professionals around the management of multimorbid patients; the second analysis will use Normalisation Process Theory to understand how interventions are currently being successfully implemented in both settings. We will also extract quantitative anonymised patient data from primary care to determine the extent of polypharmacy currently present for patients with multimorbidity in the West Midlands.DiscussionWe aim to combine these data so that we can build a useful, fully implementable tool which addresses the barriers most amenable to change within both primary and secondary care contexts.Ethics and disseminationFavourable ethical approval has been granted by The University of Birmingham Research Ethics Committee (ERN_16–0074) on 17 May 2016. Our work will be disseminated through peer-reviewed literature, trade journals and conferences. We will also use the dedicated web page hosted by the University to serve as a central point of contact and as a repository of our findings. We aim to produce a minimum of three articles from this work to contribute to the international scientific literature.Protocol registration numberNIHR Clinical Research Network Portfolio Registration CPMS ID 30613.

scholarly journals Implementing a new clinical pathway in a non-receptive context: Mixed methods evaluation of a new fracture pathway for older people in a hospital Trust in the West Midlands, UK

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247455
Author(s):  
Gill Combes ◽  
Gareth Owen ◽  
Sarah Damery ◽  
Sarah Flanagan ◽  
Celia Brown ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Older People ◽  
Research Network ◽  
Control Group ◽  
The West ◽  
Internal Factors ◽  
Hospital Trust ◽  
Mixed Methods Evaluation ◽  
West Midlands ◽  
The Way

Objectives This paper reports a mixed methods evaluation of a new pathway to improve clinical outcomes for older people with fractures treated at a hospital Trust in the West Midlands, UK. The paper focuses specifically on the context surrounding the translation of the new pathway into practice and the way that external and internal factors influenced its adaptation and implementation. Methods Quantitative analysis used a controlled Interrupted Time Series (ITS) to estimate the effect of the new pathway on patient complication rate, median length of hospital stay and 30-day mortality by comparing the pre- and post-intervention periods. ITS data were extracted from the UK Trauma Audit and Research Network (TARN) database and a patient-level control group identified using propensity score matching. Parallel qualitative analysis aimed to examine the context surrounding the new pathway and how external and internal factors might influence its adaption and implementation into clinical practice. Data were collected via semi-structured interviews (n = 16) undertaken with staff and clinical stakeholders within the Trust and were analysed using the COM-B (Capability, Opportunity, Motivation) model of behaviour. Results No statistically significant effects were found for any of the patient outcomes studied in the controlled ITS analysis. Qualitative data suggest that the lack of effectiveness of the new initiative can be explained with reference to the capability, opportunity and motivation of internal Trust stakeholders to engage with the pathway, which created a non-receptive environment within the Trust. Conclusions Successfully implementing new care pathways in environments that may be non-receptive to change requires efforts to be put into winning ‘hearts and minds’ within the organisation to ensure engagement from key stakeholders during intervention development. Evidence must be provided internally of the way that a given intervention will alleviate the problematic issues being experienced within the organisation, and external dissemination of results should be avoided until there is evidence of a positive effect within the organisation where the new care pathway is first implemented.

Centre of IT Excellence for SMEs in the West Midlands, UK

2005 ◽  
Vol 19 (5) ◽  
pp. 385-391
Author(s):  
Diana Thompson ◽  
Garry Homer
Keyword(s):  
Technology Transfer ◽  
Government Policy ◽  
Quantitative Data ◽  
State Of The Art ◽  
The West ◽  
West Midlands ◽  
Uk Government ◽  
The Uk ◽  
The University ◽  
European Technology

This paper presents an analysis of the IT Futures Centre, a European technology transfer project based at the University of Wolverhampton in the UK. After reviewing UK government policy in technology transfer, the authors highlight the project's two key elements – a new state-of-the-art building and an IT consultancy team – both of which are dedicated to providing advice, consultancy, training and demonstration facilities for small and medium-sized companies in the West Midlands region of England. The paper addresses the systems and methodology used for delivery and the quantitative data available which indicate the progress companies have made as a result of this intervention. Finally, issues that have arisen during the operation of the project to date are discussed, especially the problems that academics face in the delivery process.

scholarly journals Referrals to Urgent Dental Centres During the COVID-19 Pandemic: A Multi-Site Analysis Research Project

2021 ◽  
Vol 10 (1) ◽  
pp. 40-45
Author(s):  
Adam Shathur ◽  
Samuel Reeves ◽  
Faizal Sameja ◽  
Vishal Patel ◽  
Allan Jones
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Easy Access ◽  
Dental Services ◽  
Care Services ◽  
Dental Practitioners ◽  
Consultation And Referral ◽  
Care Systems ◽  
Access To Primary Care ◽  
The Uk

Introduction: The COVID-19 pandemic enforced the cessation of routine dentistry and the creation of local urgent dental care systems in the UK. General dental practices are obligated by NHS guidance to remain open and provide remote consultation and referral where appropriate to patients having pain or problems. Aims: To compare two urgent dental centres with different triage and referral systems with regard to quality and appropriateness of referrals, and patient management outcomes. Methods: 110 consecutive referrals received by a primary care urgent dental centre and a secondary care urgent dental centre were assessed. It was considered whether the patients referred had access to remote primary care dental services, fulfilled the criteria required to be deemed a dental emergency as mandated by NHS guidance, and what the outcomes of referrals were. Results: At the primary care centre, 100% of patients were referred by general dental practitioners and had access to remote primary care dental services. 95.5% of referrals were deemed appropriate and were seen for treatment. At the secondary care site, 94.5% of referrals were direct from the patient by contacting NHS 111. 40% had received triaging to include ‘advice, analgesia and antimicrobial’ from a general dental practitioner, and 25.5% were deemed appropriate and resulted in treatment. Conclusion: Urgent dental centres face many issues, and it would seem that easy access to primary care services, collaboration between primary care clinicians and urgent dental centres, and training of triaging staff are important in operating a successful system.

THUR 121 Identifying participants with parkinson’s disease in uk biobank

2018 ◽  
Vol 89 (10) ◽  
pp. A13.2-A13
Author(s):  
Bush Kathryn ◽  
Rannikmae Kristiina ◽  
Schnier Christian ◽  
Wilkinson Timothy ◽  
Nolan John ◽  
...  
Keyword(s):  
Primary Care ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Secondary Care ◽  
Large Population ◽  
Free Text ◽  
Uk Biobank ◽  
Predictive Values ◽  
Diagnostic Codes ◽  
The Uk

BackgroundLinkage to routinely collected NHS data from primary, secondary care and death certificates enables identification of participants with Parkinson’s Disease (PD) within the UK Biobank cohort of 5 00 000 adults. Validation of the accuracy of this data is required prior to their use in research studies.MethodIn this validation study participants (n=125) with a code indicating PD were identified from a sample of 17 000 participants in the cohort. Diagnoses were validated by expert adjudicators, based on free text electronic medical records. Positive predictive values (PPV,% of cases identified that are true cases) were calculated.ResultsPrimary care diagnostic codes identified 93% of PD cases, with a PPV of 95%. Combined secondary care and death data identified 42% of PD cases with a PPV of 84%.Combining diagnostic and medication codes identified more participants, but did not increase the PPV.ConclusionsThis study suggests that linkage to routinely collected healthcare data is a reliable method for identifying participants with PD in the UK Biobank cohort.Primary care diagnostic codes identified the highest proportion of participants and had the highest PPV, demonstrating the value of using primary care data to identify cases of disease in large population based cohort studies.

scholarly journals Cross-sectional observation study to investigate the impact of risk-based stratification on care pathways for patients with chronic kidney disease: protocol paper

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e027315 ◽  
Author(s):  
Harjeet Kaur Bhachu ◽  
Paul Cockwell ◽  
Anuradhaa Subramanian ◽  
Krishnarajah Nirantharakumar ◽  
Derek Kyte ◽  
...  
Keyword(s):  
Primary Care ◽  
Kidney Disease ◽  
Secondary Care ◽  
Health Improvement ◽  
Cross Sectional ◽  
Risk Equation ◽  
Failure Risk ◽  
The Health Improvement Network ◽  
The Uk ◽  
The Impact

IntroductionChronic kidney disease (CKD) management in the UK is usually primary care based, with National Institute for Health and Care Excellence (NICE) guidelines defining criteria for referral to secondary care nephrology services. Estimated glomerular filtration rate (eGFR) is commonly used to guide timing of referrals and preparation of patients approaching renal replacement therapy. However, eGFR lacks sensitivity for progression to end-stage renal failure; as a consequence, the international guideline group, Kidney Disease: Improving Global Outcomes has recommended the use of a risk calculator. The validated Kidney Failure Risk Equation may enable increased precision for the management of patients with CKD; however, there is little evidence to date for the implication of its use in routine clinical practice. This study will aim to determine the impact of the Kidney Failure Risk Equation on the redesignation of patients with CKD in the UK for referral to secondary care, compared with NICE CKD guidance.Method and analysisThis is a cross-sectional population-based observational study using The Health Improvement Network database to identify the impact of risk-based designation for referral into secondary care for patients with CKD in the UK. Adult patients registered in primary care and active in the database within the period 1 January 2016 to 31 March 2017 with confirmed CKD will be analysed. The proportion of patients who meet defined risk thresholds will be cross-referenced with the current NICE guideline recommendations for referral into secondary care along with an evaluation of urinary albumin–creatinine ratio monitoring.Ethics and disseminationApproval was granted by The Health Improvement Network Scientific Review Committee (Reference number: 18THIN061). Study outcomes will inform national and international guidelines including the next version of the NICE CKD guideline. Dissemination of findings will also be through publication in a peer-reviewed journal, presentation at conferences and inclusion in the core resources of the Think Kidneys programme.

scholarly journals Analysis of failed appointments in a genitourinary department in the West Midlands of the UK.

1993 ◽  
Vol 69 (4) ◽  
pp. 322-323
Author(s):  
A A Opaneye ◽  
E Parker ◽  
J Bailey ◽  
M Walzman ◽  
A A Wade
Keyword(s):  
The West ◽  
West Midlands ◽  
The Uk

Hominid colonisation and the Lower and Middle Palaeolithic of the West Midlands

2005 ◽  
Vol 71 ◽  
pp. 63-83 ◽  
Author(s):  
A.T.O. Lang ◽  
D.H. Keen
Keyword(s):  
Raw Materials ◽  
Middle Pleistocene ◽  
The West ◽  
Oxygen Isotope Record ◽  
West Midlands ◽  
Early Humans ◽  
Isotope Record ◽  
The University ◽  
Palaeolithic Archaeology ◽  
New Time

The recognition over the last 20 years that the Quaternary deposits of the West Midlands cover a longer period of time than previously envisaged has led to a re-analysis of their contained Palaeolithic archaeology. Stone tools have been found in the region for over a hundred years and cover most periods of hominid colonisation from the time of the earliest occupants of the country over half a million years ago. Twentieth century research in the West Midlands, often led by Professor F. W. Shotton at the University of Birmingham, correlated the Palaeolithic of the region with the Quaternary geological sequence as it was then understood. Shotton identified the ‘Wolstonian’ glaciation as the key event of the Midlands Pleistocene, around which a chronology for the Palaeolithic could be built and gave an age of less than 250 kyr for this episode. Work since 1985 has compared the Midlands sequence with the oxygen isotope record of the ocean basins and shown that the concept of a relatively recent ‘Wolstonian’ is now untenable and that the former chronology built around it is too short for the observed events in the area. This new time paradigm, with the earliest occupation of the area thought to be c. 500 kyr, has made necessary a reconsideration of the chronology of the Palaeolithic and Middle Pleistocene of the area. This new time framework brings into critical focus the issue of reworking of the archaeology and its true age. The tools themselves present complications of analysis compared to many other areas containing a Palaeolithic record, perhaps most notably through the use of largely non-flint raw materials, some which may have been introduced into the area by early humans or an hither-to unidentified glacial event. This opportunity to present a new chronology of occupation comes out of the work carried out by the ‘Shotton Project’ based at the University of Birmingham, and by the University of Liverpool.

Language variation in the West Midlands

English Today ◽  
2015 ◽  
Vol 31 (2) ◽  
pp. 59-60
Author(s):  
Natalie Braber
Keyword(s):  
Hong Kong ◽  
New Zealand ◽  
Newfoundland And Labrador ◽  
Language Variation ◽  
The West ◽  
Indian English ◽  
North Eastern ◽  
West Midlands ◽  
The Uk ◽  
Hong Kong English

West Midlands English: Birmingham and The Black Country forms part of the series Dialects of English which has so far included volumes on varieties such as: Urban North-Eastern English, Hong Kong English, Newfoundland and Labrador English, Irish English, Indian English, New Zealand English, Singapore English and Northern and Insular Scots. As such, it follows the general format of the series which covers the history and geography of a region, chapters on phonetics and phonology, grammar, lexis and a survey of previous works and bibliography. This contribution to the series follows this same general format and makes it applicable to the West Midlands region of the UK.

scholarly journals No Evidence for Reduced Hospital Admissions or Increased Deaths from Stroke or Heart Attack During COVID-19

2020 ◽  
Author(s):  
Katharine Reeves ◽  
Samuel Watson ◽  
Tanya Pankhurst ◽  
Kamlesh Khunti ◽  
Suzy Gallier ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Attack ◽  
Hospital Admissions ◽  
Ambulance Service ◽  
St Elevation Myocardial Infarction ◽  
University Hospital ◽  
The West ◽  
West Midlands ◽  
St Elevation ◽  
The Uk

Articles in the UK press have claimed that hospital admissions for heart attack and stroke have declined during the COVID-19 pandemic. However, data from the West Midlands Ambulance Service have not shown any reduction in call-outs for patients with stroke or ST-Elevation Myocardial Infarction. This study examined data from University Hospital Birmingham NHS Foundation Trust, comparing admissions from week 1 of 2016 to week 17 of 2019, with the same period in 2020, pre- and post-lockdown. The results showed that there was no evidence of a reduction in the overall mean number of admissions of patients with these conditions in the post-lockdown period.

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