Browsing by Author "Williams B"

Now showing 1 - 3 of 3
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    An informatics consult approach for generating clinical evidence for treatment decisions
    (BioMed Central Ltd, 2021-12) Lai AG; Chang WH; Parisinos CA; Katsoulis M; Blackburn RM; Shah AD; Nguyen V; Denaxas S; Davey Smith G; Gaunt TR; Nirantharakumar K; Cox MP; Forde D; Asselbergs FW; Harris S; Richardson S; Sofat R; Dobson RJB; Hingorani A; Patel R; Sterne J; Banerjee A; Denniston AK; Ball S; Sebire NJ; Shah NH; Foster GR; Williams B; Hemingway H
    BACKGROUND: An Informatics Consult has been proposed in which clinicians request novel evidence from large scale health data resources, tailored to the treatment of a specific patient. However, the availability of such consultations is lacking. We seek to provide an Informatics Consult for a situation where a treatment indication and contraindication coexist in the same patient, i.e., anti-coagulation use for stroke prevention in a patient with both atrial fibrillation (AF) and liver cirrhosis. METHODS: We examined four sources of evidence for the effect of warfarin on stroke risk or all-cause mortality from: (1) randomised controlled trials (RCTs), (2) meta-analysis of prior observational studies, (3) trial emulation (using population electronic health records (N = 3,854,710) and (4) genetic evidence (Mendelian randomisation). We developed prototype forms to request an Informatics Consult and return of results in electronic health record systems. RESULTS: We found 0 RCT reports and 0 trials recruiting for patients with AF and cirrhosis. We found broad concordance across the three new sources of evidence we generated. Meta-analysis of prior observational studies showed that warfarin use was associated with lower stroke risk (hazard ratio [HR] = 0.71, CI 0.39-1.29). In a target trial emulation, warfarin was associated with lower all-cause mortality (HR = 0.61, CI 0.49-0.76) and ischaemic stroke (HR = 0.27, CI 0.08-0.91). Mendelian randomisation served as a drug target validation where we found that lower levels of vitamin K1 (warfarin is a vitamin K1 antagonist) are associated with lower stroke risk. A pilot survey with an independent sample of 34 clinicians revealed that 85% of clinicians found information on prognosis useful and that 79% thought that they should have access to the Informatics Consult as a service within their healthcare systems. We identified candidate steps for automation to scale evidence generation and to accelerate the return of results. CONCLUSION: We performed a proof-of-concept Informatics Consult for evidence generation, which may inform treatment decisions in situations where there is dearth of randomised trials. Patients are surprised to know that their clinicians are currently not able to learn in clinic from data on 'patients like me'. We identify the key challenges in offering such an Informatics Consult as a service.
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    Feasibility study of the effects of art as a creative engagement intervention during stroke rehabilitation on improvement of psychosocial outcomes: Study protocol for a single blind randomized controlled trial: the ACES study
    (BioMed Central, 2014) Morris JH; Kelly C; Toma M; Kroll T; Joice S; Mead G; Donnan P; Williams B
    Background: Benefits of art participation after stroke are becoming increasingly recognized. Qualitative studies suggest that participation in visual arts creative engagement interventions (CEIs) during rehabilitation after stroke may improve mood, self-esteem, hope and some aspects of physical recovery. This study examines the feasibility of undertaking a randomized controlled trial of a CEI delivered by artists within in-patient stroke rehabilitation to test effectiveness. Methods/Design: This trial is a two arm, single-blind, randomized controlled feasibility trial within in-patient stroke rehabilitation. We will recruit 80 patients receiving stroke rehabilitation in two stroke units in a health board area of Scotland (40 patients in each arm). Intervention arm participants will receive a visual-arts based CEI facilitated by experienced artists. Artists will follow an intervention protocol with specific components that enable participants to set, achieve and review artistic goals. Participants will receive up to eight intervention sessions, four within a group and four one-to-one with the artist. Control group participants will receive usual care only. Data collection will occur at baseline, post-intervention and three-month follow-up. Stroke-related health status is the primary outcome; mood, self-esteem, self-efficacy, perceived recovery control and hope are secondary outcomes. Semi-structured interviews will be conducted with purposively selected patients, artists and healthcare staff to elicit views and experiences of the intervention and feasibility and acceptability of trial processes. Recruitment rates, retention rates and patient preference for art participation will also be collected. Data will indicate, with confidence intervals, the proportion of patients choosing or refusing participation in the CEI and will allow calculation of recruitment rates for a future definitive trial. Summary data will indicate potential variability, magnitude and direction of difference between groups. Findings will inform sample size calculations for a definitive trial. Thematic analysis of qualitative data will be managed using the Framework Approach. Framework is an analytical approach for qualitative data, commonly used in policy and medical research. Discussion: If shown to demonstrate effects, this intervention has the potential to address aspects of stroke recovery previously. Not routinely addressed in rehabilitation. Trial registration: Registered with Clinical Trials.Gov: NCT02085226 on 6th March 2014.
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    "Plaster Solutions" - Providing support for children residing in emergency housing in Hamilton, New Zealand
    (Elsevier B.V., 2024-07-23) Williams B; Murray L; Erueti B
    Since the COVID-19 pandemic, motels have become increasingly used as sites for emergency accommodation in Aotearoa New Zealand. Consequently, children now reside in motel rooms intended for seven day emergency stays for much longer periods of time. Ten key-informant interviews were conducted with service providers supporting children residing in motels in the Waikato region. Thematic analysis generated five themes relating to child wellbeing: 1.) Living conditions, 2.) Physical and psychological safety, 3.) Inappropriateness of existing service models, 4.) Disjointed collaboration between service providers, and 5.) Imagining emergency motels as a “site to build strengths”. The findings suggest the motel environment restricted children’s access to nutrition, safe physical activity and health care. In addition, proximity to adult residents could increase exposure to adverse experiences. Participants suggested creative ways to collaborate and use motel facilities to build family strengths. However ultimately, long stays in emergency housing motels create an environment where systemic barriers to child health, development and education are likely to be entrenched rather than alleviated. Initiatives that significantly reduce the time children spend in motels, and appropriate support for children in these contexts are urgently required to prevent widening health inequities for the “motel generation”.