ORCID Profile
0000-0002-6623-4964
Current Organisations
Massey University - Auckland Campus
,
University of St Andrews
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Publisher: BMJ
Date: 06-2021
DOI: 10.1136/BMJOPEN-2020-043906
Abstract: Clinical trials are the gold standard for testing interventions. COVID-19 has further raised their public profile and emphasised the need to deliver better, faster, more efficient trials for patient benefit. Considerable overlap exists between data required for trials and data already collected routinely in electronic healthcare records (EHRs). Opportunities exist to use these in innovative ways to decrease duplication of effort and speed trial recruitment, conduct and follow-up. The National Institute of Health Research (NIHR), Health Data Research UK and Clinical Practice Research Datalink co-organised a national workshop to accelerate the agenda for ‘data-enabled clinical trials’. Showcasing successful ex les and imagining future possibilities, the plenary talks, panel discussions, group discussions and case studies covered: design/feasibility recruitment conduct/follow-up collecting benefits/harms and analysis/interpretation. Some notable studies have successfully accessed and used EHR to identify potential recruits, support randomised trials, deliver interventions and supplement/replace trial-specific follow-up. Some outcome measures are already reliably collected others, like safety, need detailed work to meet regulatory reporting requirements. There is a clear need for system interoperability and a ‘route map’ to identify and access the necessary datasets. Researchers running regulatory-facing trials must carefully consider how data quality and integrity would be assessed. An experience-sharing forum could stimulate wider adoption of EHR-based methods in trial design and execution. EHR offer opportunities to better plan clinical trials, assess patients and capture data more efficiently, reducing research waste and increasing focus on each trial’s specific challenges. The short-term emphasis should be on facilitating patient recruitment and for postmarketing authorisation trials where research-relevant outcome measures are readily collectable. Sharing of case studies is encouraged. The workshop directly informed NIHR’s funding call for ambitious data-enabled trials at scale. There is the opportunity for the UK to build upon existing data science capabilities to identify, recruit and monitor patients in trials at scale.
Publisher: Informa UK Limited
Date: 09-2003
Publisher: Wiley
Date: 06-2001
DOI: 10.1046/J.1464-5491.2001.00509.X
Abstract: To define the number of people in Tayside, Scotland (population 349 303) with Type 2 diabetes who use metformin, the incidence of contraindications to its continued use in these people and the proportion that discontinued metformin treatment following the development of a contraindication. Retrospective cohort study of the incidence of contraindications to metformin in all patients with Type 2 diabetes using metformin from January 1993 to June 1995. The contraindications of acute myocardial infarction, cardiac failure, renal impairment and chronic liver disease were identified by: the regional diabetes information system, biochemistry database and hospital admissions database and a database of all encashed community prescriptions. One thousand eight hundred and forty seven subjects (26.3% of those with Type 2 diabetes) redeemed prescriptions for metformin. Of these, 3.5% were admitted with an acute myocardial infarction (71 episodes) 4.2% were admitted with cardiac failure (114 episodes) 21.0% received metformin and loop diuretics for cardiac failure concurrently 4.8% developed renal impairment and 2.8% developed chronic liver disease. The development of contraindications rarely resulted in discontinuation of metformin, for ex le only 17.5% and 25% stopped metformin after admission with acute myocardial infarction and development of renal impairment, respectively. In total, 24.5% of subjects receiving metformin, 6.4% of all people with Type 2 diabetes, had contraindications to its use. There was one episode of lactic acidosis in 4600 patient years. This population-based study shows that 24.5% of patients prescribed metformin have contraindications to its use. Development of contraindications rarely results in discontinuation of metformin therapy. Despite this, lactic acidosis remains rare. Diabet. Med. 18, 483-488 (2001)
Publisher: Oxford University Press (OUP)
Date: 07-01-2019
Publisher: Informa UK Limited
Date: 03-2004
Publisher: Public Library of Science (PLoS)
Date: 10-09-2015
Publisher: American Medical Association (AMA)
Date: 28-04-2003
Publisher: WHO Press
Date: 05-2012
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 07-2019
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.JCLINEPI.2016.07.008
Abstract: Intervention Modeling Experiments (IMEs) are a way of developing and testing behavior change interventions before a trial. We aimed to test this methodology in a Web-based IME that replicated the trial component of an earlier, paper-based IME. Three-arm, Web-based randomized evaluation of two interventions (persuasive communication and action plan) and a "no intervention" comparator. The interventions were designed to reduce the number of antibiotic prescriptions in the management of uncomplicated upper respiratory tract infection. General practitioners (GPs) were invited to complete an online questionnaire and eight clinical scenarios where an antibiotic might be considered. One hundred twenty-nine GPs completed the questionnaire. GPs receiving the persuasive communication did not prescribe an antibiotic in 0.70 more scenarios (95% confidence interval [CI] = 0.17-1.24) than those in the control arm. For the action plan, GPs did not prescribe an antibiotic in 0.63 (95% CI = 0.11-1.15) more scenarios than those in the control arm. Unlike the earlier IME, behavioral intention was unaffected by the interventions this may be due to a smaller s le size than intended. A Web-based IME largely replicated the findings of an earlier paper-based study, providing some grounds for confidence in the IME methodology.
Publisher: Royal College of General Practitioners
Date: 04-12-2020
Abstract: Several new classes of glucose-lowering medications have been introduced in the past two decades. Some, such as sodium-glucose cotransporter 2 inhibitors (SGLT2s), have evidence of improved cardiovascular outcomes, while others, such as dipeptidyl peptidase-4 inhibitors (DPP4s), do not. It is therefore important to identify their uptake in order to find ways to support the use of more effective treatments. To analyse the uptake of these new classes among patients with type 2 diabetes. This was a retrospective repeated cross-sectional analysis in primary care. Rates of medication uptake in Australia, Canada, England, and Scotland were compared. Primary care Electronic Medical Data on prescriptions (Canada, UK) and dispensing data (Australia) from 2012 to 2017 were used. In iduals aged ≥40 years on at least one glucose-lowering drug class in each year of interest were included, excluding those on insulin only. Proportions of patients in each nation, for each year, on each class of medication, and on combinations of classes were determined. Data from 238 619 patients were included in 2017. The proportion of patients on sulfonylureas (SUs) decreased in three out of four nations, while metformin decreased in Canada. Use of combinations of metformin and new drug classes increased in all nations, replacing combinations involving SUs. In 2017, more patients were on DPP4s (between 19.1% and 27.6%) than on SGLT2s (between 10.1% and 15.3%). New drugs are displacing SUs. However, despite evidence of better outcomes, the adoption of SGLT2s lagged behind DPP4s.
Publisher: BMJ
Date: 06-2020
DOI: 10.1136/BMJOPEN-2019-033424
Abstract: Urinary tract infections (UTIs) are the second most common type of infection worldwide, accounting for a large number of primary care consultations and antibiotic prescribing. Current diagnosis is based on an empirical approach, relying on symptoms and occasional use of urine dipsticks. The diagnostic reference standard is still urine culture, although it is not routinely recommended for uncomplicated UTIs in the community, due to time to diagnosis (48 hours). Faster point-of-care tests have been developed, but their diagnostic accuracy has not been compared. Our objective is to systematically review and meta-analyse the diagnostic accuracy of currently available point-of-care tests for UTIs. Studies evaluating the diagnostic accuracy of point-of-care tests for UTIs will be included. PubMed, Web of Science, Embase and Cochrane Database of Systematic Reviews were searched from inception to 1 June 2019. Data extraction and risk-of-bias assessment will be assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Meta-analysis will be performed depending on data availability and heterogeneity. This is a systematic review protocol and therefore formal ethical approval is not required, as no primary, identifiable, personal data will be collected. Patients or the public were not involved in the design of our research. However, the findings from this review will be shared with key stakeholders, including patient groups, clinicians and guideline developers, and will also be presented and national and international conferences. CRD42018112019.
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1016/J.JCLINEPI.2011.11.010
Abstract: To evaluate which of two invitation methods, e-mail or post, was most effective at recruiting general practitioners (GPs) to an online trial. Randomized controlled trial. Participants were GPs in Scotland, United Kingdom. Two hundred and seventy GPs were recruited. Using e-mail did not improve recruitment (risk difference=0.7% [95% confidence interval -2.7% to 4.1%]). E-mail was, however, simpler to use and cheaper, costing £3.20 per recruit compared with £15.69 for postal invitations. Reminders increased recruitment by around 4% for each reminder sent for both invitation methods. In the Scottish context, inviting GPs to take part in an online trial by e-mail does not adversely affect recruitment and is logistically easier and cheaper than using postal invitations.
Publisher: Emerald
Date: 03-2002
DOI: 10.1108/13563280210416017
Abstract: This article originated as a contribution to informed debate on public policy issues surrounding a review of New Zealand broadcasting policy. The issue, however, has implications well beyond the New Zealand market. Public debate on broadcasting has frequently centered on calls to: improve the quality of programming overall improve children’s programming in particular and ban advertising in children’s television programmes. This narrow focus ignores the impact of the wider viewing environment. A major focus of this article is on the potential detrimental effects on children of exposure to violence and negative values in the electronic media environment. The literature relating to this is reviewed the presumed linkages between exposure to violence and the propensity for children to act aggressively are examined the findings of a study of parental perceptions regarding the impact of violence and of negative values on their children are then reported. Concludes with a discussion of the role of marketing communication in this environment.
Publisher: Elsevier BV
Date: 06-2019
Publisher: Informa UK Limited
Date: 09-2010
Publisher: SAGE Publications
Date: 07-2007
DOI: 10.1258/135763307781645112
Abstract: We are conducting a multicentre, mixed methods study to examine the attitudes of health professionals to e-health in order to identify strategies to support increased uptake and utilization of e-health services. The first part of the work is a systematic literature review. After searching five electronic databases, a total of 66 review papers were identified which concerned barriers and facilitators to the implementation of e-health. Examination of the main themes from these reviews identified three major types of barriers/facilitators: (1) technology design factors, (2) health professional interactions, and (3) organizational factors. The utilization of e-health technologies by health-care professionals is complex, as demonstrated by the preliminary findings of the literature review.
Publisher: Wiley
Date: 30-10-2003
DOI: 10.1046/J.1365-2753.2003.00390.X
Abstract: Failure to engage in user-informed evaluation of emergent health informatics tools can have negative consequences for future implementation, related both to poor usability or clinical utility and to suboptimal stakeholder buy-in. This paper describes a formative evaluation in primary care of a multifaceted, web-based resource for diabetes management. The primary aims were to assess the usability and utility of the prototype in order to inform system refinements prior to implementation, and to investigate barriers and facilitators to system use so as to aid the development of a tailored implementation plan. A mixed-method approach involving survey, remote observation, semi-structured interviews and electronic feedback. One Scottish local health care cooperative comprising five general practice surgeries and their staff. A survey following temporary exposure to a dummy site revealed high levels of computer familiarity, welcoming attitudes and positive ratings of usability, format and utility. Comments mainly addressed content accuracy, feature suggestions and usability issues. Key barriers and facilitators to use included time and training. Remote observation following access to live clinical data enabled profiling of usage by in idual and professional group. In the 3 month observation period administrators were the most frequent users, followed by GPs and nurses, with clinical and data entry screens accessed most often. Semi-structured interviews with key respondents s led by professional group and usage frequency provided richer qualitative information on barriers and facilitators to use, patterns of system integration into work routines and system usability, content and utility. Content analysis of electronic feedback revealed mainly technical queries and general expressions of satisfaction. Evaluation informed a number of important and unforeseen improvements to the prototype and helped refine the implementation plan. Engagement in the process of evaluation has led to high levels of stakeholder ownership and widespread implementation.
Publisher: Springer Science and Business Media LLC
Date: 13-02-2017
Publisher: BMJ
Date: 02-2022
DOI: 10.1136/BMJOPEN-2021-054376
Abstract: Develop a novel algorithm to categorise alcohol consumption using primary care electronic health records (EHRs) and asses its reliability by comparing this classification with self-reported alcohol consumption data obtained from the UK Biobank (UKB) cohort. Cross-sectional study. The UKB, a population-based cohort with participants aged between 40 and 69 years recruited across the UK between 2006 and 2010. UKB participants from Scotland with linked primary care data. Create a rule-based multiclass algorithm to classify alcohol consumption reported by Scottish UKB participants and compare it with their classification using data present in primary care EHRs based on Read Codes. We evaluated agreement metrics (simple agreement and kappa statistic). Among the Scottish UKB participants, 18 838 (69%) had at least one Read Code related to alcohol consumption and were used in the classification. The agreement of alcohol consumption categories between UKB and primary care data, including assessments within 5 years was 59.6%, and kappa was 0.23 (95% CI 0.21 to 0.24). Differences in classification between the two sources were statistically significant (p .001) More in iduals were classified as ‘sensible drinkers’ and in lower alcohol consumption levels in primary care records compared with the UKB. Agreement improved slightly when using only numerical values (k=0.29 95% CI 0.27 to 0.31) and decreased when using qualitative descriptors only (k=0.18 % CI 0.16 to 0.20). Our algorithm classifies alcohol consumption recorded in Primary Care EHRs into discrete meaningful categories. These results suggest that alcohol consumption may be underestimated in primary care EHRs. Using numerical values (alcohol units) may improve classification when compared with qualitative descriptors.
Publisher: Informa UK Limited
Date: 11-04-2005
Publisher: Elsevier BV
Date: 11-2013
Publisher: Emerald
Date: 31-07-2007
DOI: 10.1108/03090560710752474
Abstract: This research paper aims to examine the theoretical and practical applicability of integrated marketing communications. Presents the findings from a two‐country qualitative study concerning the phenomenon. The research used survey methodology to assess the views of advertising agency members of the Institute of Advertising Practitioners (UK) and the Communications Agencies Association of New Zealand (CAANZ) The findings show that practitioners appear to be constructing and applying IMC concepts that are situation‐specific. Nonetheless, a search for a single empirically testable theory of IMC ignores evidence that practitioners are committed to IMC concepts while at the same time resisting the development of “rigid rules”. Additionally, external factors may be forcing reconsideration of marketing communications and accountability. The research is limited to a study of ad agency perceptions in two countries. While implications of the findings for other countries are discussed, a major direction for the future is the need for research to be conducted in organisations themselves, not necessarily the agencies which service their needs. Practical implications include variability in terms of the application of IMC principles. This leads to the idea of differential application with – as stated above – some rejection of “rigid rules” in this dynamic area. The value of the paper lies in its use of a comparative approach using members of clearly identifiable and relevant s les in two countries in relation to IMC. The notion of differentiation in relation to IMC application, the perceived rejection of rigid rules, and the need for further research to be focused in‐company (rather than in‐agency) assist in moving this emergent paradigm forward in an academic and practitioner sense.
Publisher: Springer Science and Business Media LLC
Date: 03-03-2011
Publisher: Royal College of General Practitioners
Date: 28-07-2014
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.JCLINEPI.2013.09.015
Abstract: To evaluate the robustness of the intervention modeling experiment (IME) methodology as a way of developing and testing behavioral change interventions before a full-scale trial by replicating an earlier paper-based IME. Web-based questionnaire and clinical scenario study. General practitioners across Scotland were invited to complete the questionnaire and scenarios, which were then used to identify predictors of antibiotic-prescribing behavior. These predictors were compared with the predictors identified in an earlier paper-based IME and used to develop a new intervention. Two hundred seventy general practitioners completed the questionnaires and scenarios. The constructs that predicted simulated behavior and intention were attitude, perceived behavioral control, risk perception/anticipated consequences, and self-efficacy, which match the targets identified in the earlier paper-based IME. The choice of persuasive communication as an intervention in the earlier IME was also confirmed. Additionally, a new intervention, an action plan, was developed. A web-based IME replicated the findings of an earlier paper-based IME, which provides confidence in the IME methodology. The interventions will now be evaluated in the next stage of the IME, a web-based randomized controlled trial.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-11-2022
DOI: 10.1212/WNL.0000000000201164
Abstract: Corticosteroids are used to treat the early stages of idiopathic facial paralysis (Bell palsy) in children, but their effectiveness is uncertain. We set out to determine whether prednisolone improves the proportion of children with Bell palsy with complete recovery at 1 month. We conducted a double-blind, placebo-controlled, randomized trial of prednisolone in children presenting to emergency departments with Bell palsy. Patients aged 6 months to younger than 18 years were recruited within 72 hours after the symptom onset and were randomly assigned to receive 10 days of treatment with oral prednisolone (approximately 1 mg/kg) or placebo. The primary outcome was complete recovery of facial function at 1 month rated on the House-Brackmann scale. Secondary outcomes included facial function, adverse events, and pain up to 6 months. Target recruitment was n = 540 (270 per group). Between October 13, 2015, and August 23, 2020, 187 children were randomized (94 to prednisolone and 93 to placebo) and included in the intention-to-treat analysis. At 1 month, the proportions of patients who had recovered facial function were 49% (n = 43/87) in the prednisolone group compared with 57% (n = 50/87) in the placebo group (risk difference −8.1%, 95% CI −22.8 to 6.7 adjusted odds ratio [aOR] 0.7, 95% CI 0.4 to 1.3). At 3 months, these proportions were 90% (n = 71/79) for the prednisolone group vs 85% (n = 72/85) for the placebo group (risk difference 5.2%, 95% CI −5.0 to 15.3 aOR 1.2, 95% CI 0.4 to 3.0) and, at 6 months, 99% (n = 77/78) and 93% (n = 76/82), respectively (risk difference 6.0%, 95% CI −0.1 to 12.2 aOR 3.0, 95% CI 0.5 to 17.7). There were no serious adverse events and little evidence for group differences in secondary outcomes. In children with Bell palsy, the vast majority recover without treatment. This study, although underpowered, does not provide evidence that early treatment with prednisolone improves complete recovery. Registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000563561, registered June 1, 2015. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368505& isReview=true. This study provides Class I evidence that for children with Bell palsy, prednisolone does not significantly change recovery of complete facial function at 1 month. However, this study lacked the precision to exclude an important harm or benefit from prednisolone.
Publisher: Elsevier BV
Date: 2019
Publisher: Elsevier BV
Date: 07-2019
Publisher: Springer Science and Business Media LLC
Date: 06-2021
Publisher: Public Library of Science (PLoS)
Date: 31-07-2014
Publisher: Emerald
Date: 11-10-2011
DOI: 10.1108/20426761111170722
Abstract: The purpose of this paper is to argue that integrated marketing communications (IMC) must be used in social marketing, like it is in commercial marketing, by illustrating that IMC principles are effective in social marketing contexts within an education setting. Specifically, the paper provides evidence of IMC being successfully used in the communication of school‐based health promotion activities within health promoting schools (HPS). Depth interviews with principals and teachers at three case schools were conducted to investigate the communication of health promotion programmes within HPS. In total, 19 people participated in this study. A key finding was that IMC principles are evident in the HPS philosophy of health promotion. That is, the extent to which health concepts are customer focused and integrated into school life and, communication which is synergistic and based on stakeholder needs, has a significant impact upon achieving desired health promotion outcomes. This research explored communication within the specific context of HPS. To further explore the application of IMC in social marketing, the authors recommend that other social marketing contexts or cases be investigated. The fact that IMC principles are relevant and effective when facilitating school‐based health promotion programmes implies that IMC would offer value to other social marketing contexts too. The paper is unique in that we provide evidence of IMC used in a school‐based social marketing context. The context of an education setting for this research broadens existing understanding of how IMC can and should be used in social marketing. The research offers insights for social marketing practitioners seeking to improve their communications efforts.
Publisher: Oxford University Press (OUP)
Date: 14-03-2022
Abstract: The Early CDT®-Lung antibody blood test plus serial computed tomography scans for test-positives (TPGs) reduces late-stage lung cancer presentation. This study assessed the psychological outcomes of this approach. Randomized controlled trial (n = 12 208) comparing psychological outcomes 1–12 months post-recruitment in a subs le (n = 1032) of TPG, test-negative (TNG) and control groups (CG). Compared to TNG, TPG had lower positive affect (difference between means (DBM), 3 months (3m: −1.49 (−2.65, − 0.33)), greater impact of worries (DBM 1m: 0.26 (0.05, 0.47) 3m: 0.28 (0.07, 0.50)), screening distress (DBM 1m: 3.59 (2.28, 4.90) 3m: 2.29 (0.97, 3.61) 6m: 1.94 (0.61, 3.27)), worry about tests (odds ratio (OR) 1m: 5.79 (2.66, 12.63) and more frequent lung cancer worry (OR 1m: 2.52 (1.31, 4.83) 3m: 2.43 (1.26, 4.68) 6m: 2.87 (1.48, 5.60)). Compared to CG, TPG had greater worry about tests (OR 1m: 3.40 (1.69, 6.84)). TNG had lower negative affect (log-transformed DBM 3m: −0.08 (−0.13, −0.02)), higher positive affect (DBM 1m: 1.52 (0.43, 2.61) 3m: 1.43 (0.33, 2.53) 6m: 1.27 (0.17, 2.37)), less impact of worries (DBM 3m: −0.27 (−0.48, −0.07)) and less-frequent lung cancer worry (OR 3m: 0.49 (0.26, 0.92)). Negative psychological effects in TPG and positive effects in TNG were short-lived and most differences were small.
Publisher: Springer Science and Business Media LLC
Date: 12-07-2017
Publisher: SAGE Publications
Date: 07-2004
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Frank Sullivan.