Publications by authors named "Chris Fox"

Background: Multimorbidity, the presence of two or more conditions in one person, is common but studies are often limited to observational data and single datasets. We address this gap by integrating large-scale primary-care and genetic data from multiple studies to interrogate multimorbidity patterns and producing digital resources to support future research.

Methods: We defined chronic, common, and heritable conditions in individuals aged ≥65 years, using two large primary-care databases [CPRD (UK) N = 2,425,014 and SIDIAP (Spain) N = 1,053,640], and estimated heritability using the same definitions in UK Biobank (N = 451,197).

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Background: Carotid artery stenosis is a significant contributor to ischemic strokes, and its surgical management includes carotid artery endarterectomy (CEA), transfemoral carotid artery stenting (TF-CAS), and transcarotid artery revascularization (TCAR). CEA has traditionally been preferred, but TF-CAS and TCAR are also excellent alternative options if the anatomy of the vessels allows them. This study reports our short- and mid-term outcomes after carotid artery revascularization in symptomatic patients at a stroke center.

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Objective: Nationwide there is a significant shortage of surgeons in rural communities, which has led to a growing interest in training more general surgeons specifically for entry into rural practice. Despite noble intentions, exactly how this training should be performed is unclear, and highly variable across programs. The Accreditation Council for Graduate Medical Education (ACGME) Surgery Residency Review Committee (RRC) sought to better understand the current state of rural focused training options in general surgery residencies.

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Background: Depression is common in people with dementia, and negatively affects quality of life.

Aims: This paper aims to evaluate the cost-effectiveness of an intervention for depression in mild and moderate dementia caused by Alzheimer's disease over 12 months (PATHFINDER trial), from both the health and social care and societal perspectives.

Method: A total of 336 participants were randomised to receive the adapted PATH intervention in addition to treatment as usual (TAU) ( = 168) or TAU alone ( = 168).

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This is the protocol for a Campbell systematic review. The objectives are as follows. The proposed systematic review is an update to, and extension of, Lipsey et al.

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Objectives: Post-diagnostic support is a significant factor in facilitating personal recovery following a diagnosis of dementia, but access is often inconsistent and insufficient. Recovery Colleges offer peer-led, co-produced courses that can support people to have meaningful lives and have been adapted for use in the context of dementia. A realist review was conducted to understand the application and sustainability of Recovery College dementia courses.

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Article Synopsis
  • Dementia presents significant challenges for individuals and their caregivers, often leading to social isolation and difficulty accessing necessary support, prompting the exploration of social prescribing (SP) as a means to enhance resource access.
  • The study will conduct a systematic review of existing SP interventions for people living with dementia and their caregivers, utilizing a thorough methodology across multiple scientific databases and an iterative logic model approach to understand current practices and needs.
  • No ethical approval is needed since the review will only analyze secondary data, and results will be shared through peer-reviewed publications and presentations to relevant stakeholders.
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Background: Sleep disturbance is a prevalent condition among people living with dementia (PLwD) or mild cognitive impairment (MCI). Its assessment and management within primary care is complex because of the comorbidities, older age, and cognitive impairment typical of this patient group.

Aim: To explore how primary care clinicians assess, understand, and manage sleep disturbance for PLwD or MCI; if and why such initiatives work; and how people and their carers experience sleep disturbance and its treatment.

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Article Synopsis
  • Patient and public involvement and engagement (PPIE) in healthcare research ensures that research is conducted "with" or "by" the public, emphasizing active participation in shaping research directions rather than being passive subjects.
  • The TIMES study, focused on improving sleep management for individuals with dementia, has effectively integrated PPIE by valuing the voices of participants and collaborating with various community organizations.
  • The editorial highlights the importance of inclusivity and shares practical experiences and tips for researchers, drawing on six key UK standards for public involvement and featuring a diverse advisory forum incorporating various community perspectives.
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Introduction: Trials of effectiveness of treatment options for depression in dementia are an important priority.

Methods: Randomized controlled trial to assess adapted Problem Adaptation Therapy (PATH) for depression in mild/moderate dementia caused by Alzheimer's disease.

Results: Three hundred thirty-six participants with mild or moderate dementia, >7 on Cornell Scale for Depression in Dementia (CSDD), randomized to adapted PATH or treatment as usual.

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  • People with dementia are more likely to fall, which can make them less confident and affect their daily lives.
  • A study in the UK is testing a new program to help prevent falls in these individuals by involving them and their caregivers.
  • The research will look at how well the program works, how many people agree to join, and its costs, while also checking in on the participants’ daily activities and quality of life.
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Introduction: Support following a dementia diagnosis in the UK is variable. Attending a Recovery College course with and for people with dementia, their supporters and healthcare professionals (staff), may enable people to explore and enact ways to live well with dementia. Recovery Colleges are established within mental health services worldwide, offering peer-supported short courses coproduced in partnership between staff and people with lived experience of mental illness.

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Article Synopsis
  • iWHELD is a digital care program for dementia patients in nursing homes, tested during the COVID-19 pandemic using a trial involving 149 UK nursing homes.
  • The trial showed that iWHELD improved the overall quality of life and reduced psychotropic medication use among participants without increasing agitation, especially benefitting those with pre-existing agitation or who contracted COVID-19.
  • iWHELD is highlighted as a valuable, safe tool for enhancing dementia care during challenging times and should be considered alongside other treatments for neuropsychiatric symptoms.
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Background: Agitation is common and impacts negatively on people with dementia and carers. Non-drug patient-centred care is first-line treatment, but we need other treatment when this fails. Current evidence is sparse on safer and effective alternatives to antipsychotics.

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Background: Several long-term chronic illnesses are known to be associated with an increased risk of dementia independently, but little is known how combinations or clusters of potentially interacting chronic conditions may influence the risk of developing dementia.

Methods: 447 888 dementia-free participants of the UK Biobank cohort at baseline (2006-2010) were followed-up until 31 May 2020 with a median follow-up duration of 11.3 years to identify incident cases of dementia.

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Background: Delivering care to growing numbers of patients with increasingly 'complex' needs is currently compromised by a system designed to treat patients within organizational clinical specialties, making this difficult to reconfigure to fit care to needs. Problematic experiences of people with cognitive impairment(s) admitted to hospitals with a hip fracture, exemplify the complex challenges that result if their care is not tailored. This study explored whether a flexible, multicomponent intervention, adapting services to the needs of this patient group, could be implemented in acute hospital settings.

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Objectives: To determine how, and under what circumstances, the PERFECT-ER intervention was implemented in five acute hospital wards and impacted on staff practices and perceptions.

Design: Mixed methods process evaluation (undertaken between 2016 and 2018).

Setting: Five acute hospital wards across three different UK regions.

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Objectives: This study aimed to determine the impact of the Covid-19 pandemic on neuropsychiatric symptoms and antipsychotic use in people with dementia living in nursing homes.

Methods: This was a comparative analysis of baseline data from two large nursing home studies, one conducted during (COVID-iWHELD study) and one prior (WHELD study) to the pandemic. It involves data from 69 and 149 nursing homes, and 1006 and 666 participants respectively.

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Background: falls in care homes are common, costly and hard to prevent.Multifactorial falls programmes demonstrate clinical and cost-effectiveness, but the heterogeneity of the care home sector is a barrier to their implementation. A fuller appreciation of the relationship between care home context and falls programme delivery will guide development and support implementation.

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Article Synopsis
  • The ageing population is leading to an increase in individuals living with dementia and mild cognitive impairment (MCI), resulting in a significant prevalence of sleep disturbances, yet there's no standardized management in UK primary care.
  • This realist review aims to explore definitions, assessments, diagnoses, and management of sleep disturbances among people with dementia or MCI by engaging a group of stakeholders, including patients and healthcare professionals.
  • The findings will contribute to developing a tailored sleep management tool and will follow ethical guidelines and reporting standards to ensure clarity and transparency in the results.*
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Background: many medications possess anticholinergic activity. Their use is associated with a number of serious adverse effects including cognitive effects. The cumulative anticholinergic effect of medications as assessed by tools such as the anticholinergic burden scale (AchB) can identify people particularly at risk of anticholinergic side-effects.

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Background: Guanfacine is a α2A adrenergic receptor agonist approved for treating attention deficit hyperactivity disorder (ADHD). It is thought to act via postsynaptic receptors in the prefrontal cortex, modulating executive functions including the regulation of attention. Attention is affected early in Alzheimer's disease (AD), and this may relate to pathological changes within the locus coeruleus, the main source of noradrenergic pathways within the brain.

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Objectives: The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students.

Methods: 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions.

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