Publications by authors named "Joanne Gray"

Introduction: The development and strengthening of midwifery education requires a focus on midwifery faculty as an important strategy to improve quality of care provision. Despite the need for high-quality midwifery educators in all-countries, preparation and development of faculty is challenging, particularly in low- and middle-income countries.

Aim: The aim was to explore the experiences of midwifery faculty in low- and middle-income countries in the Asia Pacific region regarding their pathway to being a faculty member, programs of development and/or factors that supported their transition to faculty.

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Tackling health inequalities demands whole systems strategies with reach beyond the traditional sphere of influence of health care systems. Practitioners and researchers have long recognised that wider social determinants, where people are born, the communities they live in, their built environment, access to education and resources and, most significantly for this discussion, their relationship to the labour market, profoundly shape health experiences and expectations over the lifecourse. At macro-level, economic structures and systems play a fundamental role in the distribution of good health and incidence of inequalities.

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Background: Surgical intervention for thoracic aortic aneurysms is high risk. Understanding changes in health-related quality of life before and after endovascular stent grafting and open surgical repair can aid treatment decision-making.

Methods: The Effective Treatments for Thoracic Aortic Aneurysms ('ETTAA') study (ISRCTN04044627) was a longitudinal, observational study.

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Article Synopsis
  • The study looked at how much it would cost and how it would affect people's health if England improved their endoscopy (a type of medical test) services to be the best they can be.
  • They used a model to compare three types of endoscopy services: high, middle, and low performing, by simulating the experience of 40-year-olds until they are 90 years old.
  • The findings suggest that if all lower-performing services were improved, it could provide significant health benefits and save the NHS around £5 million each year.
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  • The study used the UK's National Endoscopy Database to evaluate if feedback on polyp detection rates could improve endoscopists' performance during colonoscopies.
  • It involved a randomized trial with 541 endoscopists across 36 centers, where those in the intervention group received monthly performance reports based on behavior change theories.
  • Although there was no significant increase in the average number of polyps detected, there were notable improvements in overall polyp detection rates during the intervention, particularly among those who actively engaged with the feedback, but these gains did not carry over after the intervention.
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Background: The provision of high-quality midwifery education relies on well-prepared educators. Faculty members need professional development and support to deliver quality midwifery education.

Aim: To identify development needs of midwifery faculty in low- and middle-income countries of the Asia Pacific region, to inform program content and the development of guidelines for faculty development programs.

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Reading for Wellbeing (RfW) is a pilot initiative, aimed at improving mental health and well-being through supporting access and increasing opportunities to read for pleasure. RfW was implemented across six North-East local authorities in England and employed Community Reading Workers to support access to books and reading for targeted populations. The current study used realist methodology to understand context, potential mechanisms of action, acceptability and reported outcomes.

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Background: The onset of disability in bathing is particularly important for older adults as it can be rapidly followed by disability in other daily activities; this may represent a judicious time point for intervention in order to improve health, well-being and associated quality of life. An important environmental and preventative intervention is housing adaptation, but there are often lengthy waiting times for statutory provision. In this randomised controlled trial (RCT), we aim to evaluate the effectiveness and cost-effectiveness of bathing adaptations compared to no adaptations and to explore the factors associated with routine and expedited implementation of bathing adaptations.

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Article Synopsis
  • A review of literature on maternity care needs in Australia was conducted to understand what women want from their care.
  • The study analyzed 59 peer-reviewed articles and identified four key themes: continuity of care, being seen and heard, safety, and empowerment, with continuity of care being the most significant.
  • The findings suggest that improving access to midwifery continuity of care could greatly enhance the maternity care experience for women, prompting calls for policy and service changes in Australia.
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Background: Repair of thoracic aortic aneurysms with either endovascular repair (TEVAR) or open surgical repair (OSR) represents major surgery, is costly and associated with significant complications. The aim of this study was to establish accurate costs of delivering TEVAR and OSR in a cohort of UK NHS patients suitable for open and endovascular treatment for the whole treatment pathway from admission and to discharge and 12-month follow-up.

Methods: A prospective study of UK NHS patients from 30 NHS vascular/cardiothoracic units in England aged ≥18, with distal arch/descending thoracic aortic aneurysms (CTAA) was undertaken.

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Article Synopsis
  • Major surgery can be risky, especially for patients who might not be in the best health, so a program called Prepwell helps them get ready for surgery by improving their fitness.
  • When the pandemic hit, Prepwell switched to a digital format, offering patients online health coaching through a mobile app since April 2020.
  • After eight weeks of this coaching, many patients showed better health readiness scores, with less than half starting in a low activity level and most improving significantly by the end.
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Objective: To compare the health-related quality of life and cost-effectiveness of robot-assisted laparoscopic surgery (RALS) versus conventional 'straight stick' laparoscopic surgery (CLS) in women undergoing hysterectomy as part of their treatment for either suspected or proven gynaecological malignancy.

Design: Multicentre prospective observational cohort study.

Setting: Patients aged 16+ undergoing hysterectomy as part of their treatment for gynaecological malignancy at 12 National Health Service (NHS) cancer units and centres in England between August 2017 and February 2020.

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Background: Globally, there is a call for urgent investment in nursing and midwifery education as high-quality education leads to quality care provision. This call for investment includes a 'focus on faculty', that is, development of those who teach. However, challenges in the preparation and development of faculty have been identified and include lack of recognition of ongoing development, limited pathways for career progression, inadequate provision of, or access to, faculty development opportunities and a lack of research evaluating sustained impact of programs.

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Background: As part of an ongoing service improvement project, a digital 'joint school' (DJS) was developed to provide education and support to patients undergoing total hip (THR) and total knee (TKR) replacement surgery. The DJS allowed patients to access personalised care plans and educational resources using web-enabled devices, from being listed for surgery until 12 months post-operation. The aim of this study was to compare a cohort of patients enrolled into the DJS with a cohort of patients from the same NHS trust who received a standard 'non-digital' package of education and support in terms of Health-Related Quality of Life (HRQoL), functional outcomes and hospital length of stay (LoS).

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Background: The management of chronic thoracic aortic aneurysms includes conservative management, watchful waiting, endovascular stent grafting and open surgical replacement. The Effective Treatments for Thoracic Aortic Aneurysms (ETTAA) study investigates timing and intervention choice.

Objective: To describe pre- and post-intervention management of and outcomes for chronic thoracic aortic aneurysms.

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Aims: To observe, describe, and evaluate management and timing of intervention for patients with untreated thoracic aortic aneurysms.

Methods And Results: Prospective study of UK National Health Service (NHS) patients aged ≥18 years, with new/existing arch or descending thoracic aortic aneurysms of ≥4 cm diameter, followed up until death, intervention, withdrawal, or July 2019. Outcomes were aneurysm growth, survival, quality of life (using the EQ-5D-5L utility index), and hospital admissions.

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Background: The COVID-19 pandemic has taken a heavy toll on the care home sector, with residents accounting for up to half of all deaths in Europe. The response to acute illness in care homes plays a particularly important role in the care of residents during a pandemic. Digital recording of a National Early Warning Score (NEWS), which involves the measurement of physical observations, started in care homes in one area of England in 2016.

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Background: Ventilator-associated pneumonia (VAP) is an important diagnosis in critical care. VAP research is complicated by the lack of agreed diagnostic criteria and reference standard test criteria. Our aim was to review which reference standard tests are used to evaluate novel index tests for suspected VAP.

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Objective: To review comparisons of the effectiveness of endovascular stent grafting (ESG) against open surgical repair (OSR) for treatment of chronic arch or descending thoracic aortic aneurysms (TAA).

Design: Systematic review and meta-analysis DATA SOURCES: MEDLINE, EMBASE, CENTRAL, WHO International Clinical Trials Routine data collection, current controlled trials, clinical trials and the NIHR portfolio were searched from January 1994 to March 2020.

Eligibility Criteria For Selective Studies: All identified studies that compared ESG and OSR, including randomised controlled trials (RCTs), quasi-randomised and non-RCTs, comparative cohort studies and case-control studies matched on main outcomes were sought.

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Ensuring students develop person-centred practice for diverse groups of people across health care settings is an important outcome of undergraduate nursing education. This paper presents the development and evaluation of a learning innovation, an integrated virtual patient case study and complementary online resources for person-centred nursing practice. The virtual patient case study of an Australian Aboriginal woman diagnosed with breast cancer was integrated within four core subjects of a Bachelor of Nursing program, for a total of 600 second-year students.

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Aims: The primary aim is to estimate the current and potential number of patients on NHS England orthopaedic elective waiting lists by November 2020. The secondary aims are to model recovery strategies; review the deficit of hip and knee arthroplasty from National Joint Registry (NJR) data; and assess the cost of returning to pre-COVID-19 waiting list numbers.

Methods: A model of referral, waiting list, and eventual surgery was created and calibrated using historical data from NHS England (April 2017 to March 2020) and was used to investigate the possible consequences of unmet demand resulting from fewer patients entering the treatment pathway and recovery strategies.

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Colonoscopists with low polyp detection have higher post colonoscopy colorectal cancer incidence and mortality rates. The United Kingdom's National Endoscopy Database (NED) automatically captures patient level data in real time and provides endoscopy key performance indicators (KPI) at a national, endoscopy center, and individual level. Using an electronic behavior change intervention, the primary objective of this study is to assess if automated feedback of endoscopist and endoscopy center-level optimal procedure-adjusted detection KPI (opadKPI) improves polyp detection performance.

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Optimising health and well-being before elective major surgery via prehabilitation initiatives is important for good postoperative outcomes. In a busy tertiary centre in North East England, the lack of a formal prehabilitation service meant that opportunities were being missed to optimise patients for surgery. This quality improvement project aimed to implement and evaluate a community-based prehabilitation service for people awaiting elective major surgery: PREP-WELL.

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Background: Rapid evaluation was at the heart of National Health Service England's evaluation strategy of the new models of care vanguard programme. This was to facilitate the scale and spread of successful models of care throughout the health & social care system. The aim of this paper is to compare the findings of the two evaluations of the Enhanced health in Care Homes (EHCH) vanguard in Gateshead, one using a smaller data set for rapidity and one using a larger longitudinal data set and to investigate the implications of the use of rapid evaluations using interrupted time series (ITS) methods.

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Objectives: To understand approaches to priority setting for healthcare service resource allocation at an operational level in a nationally commissioned but regionally delivered service.

Design: Qualitative study using semistructured interviews and a Framework analysis.

Setting: National Health Service dentistry commissioning teams within subregional offices in England.

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