Heather Gage graduated with a BA (Hons) Economics and an MSc in Urban and Regional Planning Studies from the University of Reading. Subsequently, she gained a PhD in Health Services Research from the University of Surrey and became Professor of Health Economics in 2012. As Director of Surrey Health Economics Centre, Heather oversees a varied portfolio of applied health and social care projects. She has held visiting positions at the Boston University School of Public Health and the Centre for Health Quality, Outcomes and Economic Research of the US Veterans Healthcare Administration.
Heather's research interests encompass many aspects of health service delivery, but particularly focus on evaluative studies and outcomes measurement. She is currently involved as economist in a variety of multidisciplinary projects funded by NHS, EU, industry and the voluntary sector. Recent work has been published in a range of health, clinical and medical journals.
Heather is a research adviser, and leads on health economics, for the NHS Research Design Service in Kent Surrey and Sussex.
People living with dementia often develop distressing behavioural and psychological symptoms (BPSD) that can affect their quality of life and the capacity of family carers and staff providing support at home. This systematic review of qualitative studies considers the views and experiences of people living with dementia and care providers about these symptoms and what helps to reduce their impact.
The two-stage review involved (a) An initial mapping of the literature to understand the range of BPSD, and how it is operationalised by different groups, to develop a search strategy; (b) A search of electronic databases from January 2000 to March 2015, updated in October 2016. Included studies focused on people living in their own homes. Data extraction and thematic analysis were structured to provide a narrative synthesis of the evidence.
We retrieved 17, 871 records and included relevant qualitative papers (n = 58) targeting community-dwelling people with dementia and family carers around the management of BPSD. Five key themes were identified: (1) Helpful interventions/support for BPSD management, (2) Barriers to support services for BPSD management, (3) Challenges around recognition/diagnosis of BPSD, (4) Difficulties in responding to aggression and other BPSD, and (5) Impact of BPSD on family carers and people living with dementia.
Family carers sometimes feel that their experiences of BPSD may not be evident to professionals until a crisis point is reached. Some helpful services exist but access to support, lack of knowledge and skills, and limited information are consistently identified as barriers to their uptake. The lack of common terminology to identify and monitor the range of BPSD that people with dementia living at home may experience means that closer attention should be paid to family carer accounts. Future research should include qualitative studies to evaluate the relevance of interventions.
Background: As more men survive a diagnosis of prostate cancer, alternative models of follow-up care that address men?s enduring unmet needs and are economical to deliver are needed. This paper describes the protocol for an ongoing evaluation of a nurse-led supported self-management and remote surveillance programme implemented within the secondary care setting.
Methods/design: The evaluation is taking place within a real clinical setting, comparing the outcomes of men enrolled in the Programme with the outcomes of a pre-service change cohort of men, using a repeated measures design. Men are followed up at four and eight months post recruitment on a number of outcomes, including quality of life, unmet need, psychological wellbeing and activation for self-management. An embedded health economic analysis and qualitative evaluation of implementation processes are being undertaken.
Discussion: The evaluation will provide important information regarding the effectiveness, cost effectiveness and implementation of an integrated supported self-management follow-up care pathway within secondary care.
physician assistants) are new to the NHS
and there is little evidence concerning their
contribution in general practice.
This study aimed to compare outcomes and
costs of same-day requested consultations by
PAs with those of GPs.
Older people living in care homes often have
limited life expectancy. Practitioners and
policymakers are increasingly questioning
the appropriateness of many acute hospital
admissions and the quality of end-of-life care
provided in care homes.Aim
To describe care home residents? trajectories
to death and care provision in their final weeks
of life.Design and setting
Prospective study of residents in six residential
care homes in three sociodemographically varied
English localities: Hertfordshire, Essex, and
Case note reviews and interviews with residents,
care home staff, and healthcare professionals.Results
Twenty-three out of 121 recruited residents
died during the study period. Four trajectories
to death were identified: ?anticipated dying?
with an identifiable end-of-life care period and
death in the care home (n = 9); ?unexpected
dying? with death in the care home that was not
anticipated and often sudden (n = 3); ?uncertain
dying? with a period of diagnostic uncertainty
or difficult symptom management leading to
hospital admission and inpatient death (n = 7);
and ?unpredictable dying? with an unexpected
event leading to hospital admission and
inpatient death (n = 4). End-of-life care tools
were rarely used. Most residents who had had
one or more acute hospital admission were still
alive at the end of the study.Conclusion
For some care home residents there was an
identifiable period when they were approaching
the end-of-life and planned care was put in
place. For others, death came unexpectedly
or during a period of considerable uncertainty,
with care largely unplanned and reactive to
M (2016) Understanding the impact of legislation on ?reduction of disease risk? claims on food and drinks: the REDICLAIM project, Agro Food Industry Hi-Tech 27 (3) pp. 30-32 Teknoscienze
Aim: To assess the impact of a rapid response hospice at home service (intervention) on people dying in their preferred place, and carer quality of life, compared to usual care (control).
Design: Quasi-experimental multi-centred controlled evaluation. Patient data were collected from hospice records; carers completed postal questionnaires to report quality of life, anxiety and depression.
Setting and participants: Community served by one hospice (three contiguous sites) in South East England; 953 patients who died with a preferred place of death recorded and 64 carers who completed questionnaires.
Results: There was no significant difference between control and intervention groups in proportions achieving preferred place of death (61.9% vs 63.0% (odds ratio: 0.949; 95% confidence interval: 0.788?1.142)). People living at home alone were less likely to die where they wanted (0.541; 95% confidence interval: 0.438?0.667). Carers in the intervention group reported worse mental health component summary scores (short form-12, p = 0.03) than those in the control group; there were no differences in other carer outcomes.
Conclusion: The addition of a rapid response hospice at home service did not have a significant impact on helping patients to die where they wanted in an area already well served by community palliative care. Recording preferences, and changes over time, is difficult and presented challenges for this study.
Background/Objectives: Several factors affect the mental performance of children. The importance that parents attribute to food-related determinants, compared with genetic, socio-economic and school environment, was investigated.
Subjects/Methods: Parents of school children (aged 4?11) were recruited through state primary schools in four European countries. Interviews were conducted in which participants were asked to sort 18 cards representing possible determinants of four elements of mental performance (attention, learning, mood and behaviour) according to perceived strength of effect. Determinants were identified from the literature and grouped in six categories: food-related, school environment, physical, social, psychological and biological. Effects were scored: 0=none; 1=moderate; and 2=strong. Views were compared between and within countries.
Results: Two hundred parents took part (England: 53; Germany: 45; Hungary: 52; Spain: 50). Differences existed between countries in the proportions reporting university education and being in employment. Taking all countries together, parents consider the food category (mean 1.33) to have a lower impact on a child?s mental performance than physical (activity and sleep, 1.77), psychological (mood and behaviour, 1.69) and school environment (1.57). Social (1.12) and biological (0.91) determinants were ranked lower than food. Of determinants in the food category, parents thought regularity of meals had more influence on mental performance (1.58) than what a child eats now (1.36), food at school (1.35), nutrition as a baby/infant (1.02).
Conclusion: Scope exists to improve parental awareness of the repercussions of their dietary choices for the mental performance of their children.
Physician associates [PAs] (also known as
physician assistants) are new to the NHS
and there is little evidence concerning their
contribution in general practice. Aim
This study aimed to compare outcomes and
costs of same-day requested consultations by
PAs with those of GPs. Design and setting
An observational study of 2086 patient records
presenting at same-day appointments in 12
general practices in England. Method
PA consultations were compared with those
of GPs. Primary outcome was re-consultation
within 14 days for the same or linked problem.
Secondary outcomes were processes of care. Results
There were no significant differences in
the rates of re-consultation (rate ratio 1.24,
95% confidence interval [CI] = 0.86 to 1.79,
P = 0.25). There were no differences in rates
of diagnostic tests ordered (1.08, 95% CI = 0.89
to 1.30, P = 0.44), referrals (0.95, 95% CI = 0.63
to 1.43, P = 0.80), prescriptions issued (1.16,
95% CI = 0.87 to 1.53, P = 0.31), or patient
satisfaction (1.00, 95% CI = 0.42 to 2.36,
P = 0.99). Records of initial consultations of
79.2% (n = 145) of PAs and 48.3% (n = 99) of
GPs were judged appropriate by independent
GPs (P consultation was 5.8 minutes longer than the
GP consultation (95% CI = 2.46 to 7.1; P cost per consultation was GBP £6.22, (US$
10.15) lower (95% CI = ?7.61 to ?2.46, P The processes and outcomes of PA and GP
consultations for same-day appointment
patients are similar at a lower consultation
cost. PAs offer a potentially acceptable and
efficient addition to the general practice
Background/Aims: Use of placebo is the ideal for comparison in clinical trials to reduce biases. With digital technology being used more frequently in healthcare interventions, how do we determine the placebo effect where interventions exploit technology? If placebo in medicine is traditionally defined by a lack of pharmacological agents, how might we begin to move towards controlling for effects of digital technology?
Method: This paper explores the traditional placebo effect and discusses its impact in healthcare contexts with digital technology with reference to a particular trial. Different meanings of placebo in the context of evaluating technology suggest new challenges and positive consequences.
Results: Methodological considerations are discussed, which enabled the development of a placebo-controlled evaluation of a digital technology in healthcare and rehabilitation.
Conclusion: Digital placebo was controlled in our trial by employing technology across all groups in the absence of evidence-based practice and shows how to control for unknown and hidden effects of technology.
To identify information available in six European countries (England, France, Germany, Netherlands, Portugal, Sweden) that addresses the specific needs of people with young onset dementia (YOD) and their carers, and identify gaps.
Search of websites of organisations with potential interest in dementia. Narrative synthesis and comparative analysis.
21 sources of information were identified (Netherlands 6, England 6, France 3, Germany 2, Portugal 2, Sweden 2); 11 were from voluntary sector organisations. Sources dedicated to YOD were limited (4 websites, 4 books); all other YOD information was sub-entries in generic dementia sources, difficult to locate and with limited coverage of relevant topics. Gaps related to implications of living with YOD in Germany, Portugal and Sweden.
Availability of information varies among countries, some having no dedicated source and incomplete coverage of issues of importance to YOD.
Information is an important means of supporting carers; their needs change as the condition progresses. A comprehensive resource collating key information is needed so that the issues that differentiate the specific needs of people living with YOD from those of people with dementia in older age are available and easily located.
Objective: This randomized controlled trial compared low-, habitual-, and high-fiber diets for the prevention of gastrointestinal toxicity in patients undergoing pelvic radiotherapy.
Design: Patients were randomly assigned to low-fiber [d10 g nonstarch polysaccharide (NSP)/d], habitual-fiber (control), or high-fiber (e18 g NSP/d) diets and received individualized counseling at the start of radiotherapy to achieve these targets. The primary endpoint was the difference between groups in the change in the Inflammatory Bowel Disease Questionnaire?Bowel Subset (IBDQ-B) score between the starting and nadir (worst) score during treatment. Other measures included macronutrient intake, stool diaries, and fecal short-chain fatty acid concentrations.
Results: Patients were randomly assigned to low-fiber (n = 55), habitual-fiber (n = 55), or high-fiber (n = 56) dietary advice. Fiber intakes were significantly different between groups (P
Conclusions: Dietary advice to follow a high-fiber diet during pelvic radiotherapy resulted in reduced gastrointestinal toxicity both acutely and at 1 y compared with habitual-fiber intake. Restrictive, non?evidence-based advice to reduce fiber intake in this setting should be abandoned. This trial was registered at clinicaltrials.gov as NCT 01170299.
Background: Care homes are the institutional providers of long-term care for older people. The OPTIMAL
study argued that it is probable that there are key activities within different models of health-care provision
that are important for residents? health care.
Objectives: To understand ?what works, for whom, why and in what circumstances??. Study questions
focused on how different mechanisms within the various models of service delivery act as the ?active
ingredients? associated with positive health-related outcomes for care home residents.
Methods: Using realist methods we focused on five outcomes: (1) medication use and review; (2) use of
out-of-hours services; (3) hospital admissions, including emergency department attendances and length of
hospital stay; (4) resource use; and (5) user satisfaction. Phase 1: interviewed stakeholders and reviewed
the evidence to develop an explanatory theory of what supported good health-care provision for further
testing in phase 2. Phase 2 developed a minimum data set of resident characteristics and tracked their care
for 12 months. We also interviewed residents, family and staff receiving and providing health care to residents.
The 12 study care homes were located on the south coast, the Midlands and the east of England. Health-care
provision to care homes was distinctive in each site.
Findings: Phase 1 found that health-care provision to care homes is reactive and inequitable. The realist
review argued that incentives or sanctions, agreed protocols, clinical expertise and structured approaches to
assessment and care planning could support improved health-related outcomes; however, to achieve change NHS professionals and care home staff needed to work together from the outset to identify, co-design and
implement agreed approaches to health care. Phase 2 tested this further and found that, although there
were few differences between the sites in residents? use of resources, the differences in service integration
between the NHS and care homes did reflect how these institutions approached activities that supported
relational working. Key to this was how much time NHS staff and care home staff had had to learn how to
work together and if the work was seen as legitimate, requiring ongoing investment by commissioners
and engagement from practitioners. Residents appreciated the general practitioner (GP) input and, when
supported by other care home-specific NHS services, GPs reported that it wa
To explore the impact of price manipulation and healthy eating information on intended food choices
Health information was provided to a random half of subjects (vs. information on Saudi agriculture). Each subject chose from the same lunch menu, containing two healthy and two unhealthy entrees, deserts and beverages, on five occasions. Reference case prices were 5, 3 and 2 Saudi Arabian Reals (SARs). Prices of healthy and unhealthy items were manipulated up (taxed) and down (subsidised) by 1 SAR in four menu variations (random order); subjects were given a budget enabling full choice within any menu. The number of healthy food choices were compared with different price combinations, and between information groups. Linear regression modelling explored the effect of relative prices of healthy / unhealthy options and information on number of healthy choices controlling for dietary behaviours and hunger levels.
University campus, Saudi Arabia, 2013
99 women students
In the reference case, 49.5% of choices were for healthy items. When the price of healthy items was reduced, 58.5% of selections were healthy; 57.2% when the price of unhealthy items rose. In regression modelling, reducing the price of healthy items and increasing the price of unhealthy items increased the number of healthy choices by 5% and 6% respectively. Students reporting a less healthy usual diet selected significantly fewer healthy items. Providing healthy eating information was not a significant influence.
Price manipulation offers potential for altering behaviours to combat rising youth obesity in Saudi Arabia.
care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use.
a realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners.
context-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioners; (iii) care which ?wraps around? care homes; and (iv) access to specialist care for older people with dementia. Resource use was similar between sites despite differing approaches to healthcare. There was greater utilisation of GP resource where this was specifically commissioned but no difference in costs between sites.
Conclusion activities generating opportunities and an interest in healthcare and care home staff working together are integral to optimal healthcare provision in care homes. Outcomes are likely to be better where: focus and activities legitimise ongoing contact between healthcare staff and care homes at an institutional level; link with a wider system of healthcare; and provide access to dementia-specific expertise.
There are limited case-mix classification systems for primary care settings which are applicable when considering the optimal clinical skill mix to provide services.
To develop a case-mix classification system (CMCS) and test its impact on analyses of patient outcomes by clinician type, using example data from physician associates? (PAs) and GPs' consultations with same-day appointment patients.
Design & setting
Secondary analysis of controlled observational data from six general practices employing PAs and six matched practices not employing PAs in England.
Routinely-collected patient consultation records (PA n = 932, GP n = 1154) were used to design the CMCS (combining problem codes, disease register data, and free text); to describe the case-mix; and to assess impact of statistical adjustment for the CMCS on comparison of outcomes of consultations with PAs and with GPs.
A CMCS was developed by extending a system that only classified 18.6% (213/1147) of the presenting problems in this study's data. The CMCS differentiated the presenting patient?s level of need or complexity as: acute, chronic, minor problem or symptom, prevention, or process of care, applied hierarchically. Combination of patient and consultation-level measures resulted in a higher classification of acuity and complexity for 639 (30.6%) of patient cases in this sample than if using consultation level alone. The CMCS was a key adjustment in modelling the study?s main outcome measure, that is rate of repeat consultation.
This CMCS assisted in classifying the differences in case-mix between professions, thereby allowing fairer assessment of the potential for role substitution and task shifting in primary care, but it requires further validation.
Hospice at home (HAH) services aim to enable patients to be cared for and die in their place of choice, if that is at home, and to achieve a ?good death?. There is a considerable range of HAH services operating in England. The published evidence focuses on evaluations of individual services which vary considerably, and there is a lack of consistency in terms of the outcome measures reported. The evidence, therefore, does not provide generalisable information, so the question ?What are the features of hospice at home service models that work, for whom, and under what circumstances?? remains unanswered. The study aims to answer this question.
Methods and analysis
This is a mixed-methods study in three phases informed by realist evaluation methodology. All HAH services in England will be invited to participate in a telephone survey to enable the development of a typology of services. In the second phase, case study sites representing the different service types will collect patient data and recruit carers, service managers and commissioners to gather quantitative and qualitative data about service provision and outcomes. A third phase will synthesise and refine the results through consensus workshops.
Ethics and dissemination
The first survey phase has university ethics approval and the second phase, Integrated Research Application System (IRAS) and Health Research Authority (HRA) approval (IRAS ID:205986, REC:17/LO/0880); the third phase does not require ethics approval. Dissemination will be facilitated by project coapplicants with established connections to national policy-making forums, in addition to publications, conference presentations and reports targeted to service providers and commissioners.
Two-thirds of people living with dementia live at home in the UK and many experience distressing behavioural and psychological symptoms. This systematic review evaluates the effectiveness of non-pharmacological interventions for behavioural and psychological symptoms among community-dwelling people living with dementia.
This two-stage review undertook an initial mapping of the literature followed by a systematic review of relevant randomised controlled trials. We searched electronic databases for pertinent studies reporting outcomes from interventions from January 2000 to March 2015 and updated searches in October 2016. We included studies that considered behavioural and psychological symptom management for older people living with dementia who live at home and excluded studies conducted in long-term care settings. This paper presents findings from a narrative synthesis of 48 randomised controlled trials evaluating interventions for people living with dementia alone, family carers alone and patient-carer dyads.
We retrieved 17,871 de-duplicated records and screened them for potential inclusion. Evidence from 48 randomised controlled trials suggests that family carer training and educational programmes that target problem behaviours and potential triggers can improve outcomes. Nurses and occupational therapists appear to help people with dementia with behavioural and psychological symptoms, but professional comparisons are lacking and there is no shared language about or understanding of behavioural and psychological symptoms amongst professionals, or between professionals and family carers.
Future research should focus on the effectiveness of components of multi-faceted programmes and their cost effectiveness and include qualitative data to better target interventions for behavioural and psychological symptoms. It is important to consider family carer readiness to use non-pharmacological strategies and to develop a shared language about the inherent needs and communications of behavioural and psychological symptoms.
To appraise and synthesise research on the impact of physician assistants/associates (PA) in secondary care, specifically acute internal medicine, care of the elderly, emergency medicine, trauma and orthopaedics, and mental health.
Electronic databases (Medline, Embase, ASSIA, CINAHL, SCOPUS, PsycINFO, Social Policy and Practice, EconLit and Cochrane), reference lists and related articles.
Peer-reviewed articles of any study design, published in English, 1995?2017.
Blinded parallel processes were used to screen abstracts and full text, data extractions and quality assessments against published guidelines. A narrative synthesis was undertaken.
Impact on: patients? experiences and outcomes, service organisation, working practices, other professional groups and costs.
5472 references were identified and 161 read in full; 16 were included?emergency medicine (7), trauma and orthopaedics (6), acute internal medicine (2), mental health (1) and care of the elderly (0). All studies were observational, with variable methodological quality. In emergency medicine and in trauma and orthopaedics, when PAs are added to teams, reduced waiting and process times, lower charges, equivalent readmission rate and good acceptability to staff and patients are reported. Analgesia prescribing, operative complications and mortality outcomes were variable. In internal medicine outcomes of care provided by PAs and doctors were equivalent.
PAs have been deployed to increase the capacity of a team, enabling gains in waiting time, throughput, continuity and medical cover. When PAs were compared with medical staff, reassuringly there was little or no negative effect on health outcomes or cost. The difficulty of attributing cause and effect in complex systems where work is organised in teams is highlighted. Further rigorous evaluation is required to address the complexity of the PA role, reporting on more than one setting, and including comparison between PAs and roles for which they are substituting.
Younger people with dementia face significant challenges in gaining access to age- and needs-appropriate support. In this paper, we tell the story so far, of the ANGELA
Research Project, which seeks to develop guidance to improve the ?dementia journey? for younger people with dementia and their families/supporters.
Our story is one of a research group aiming to conduct clinically relevant research to achieve positive changes for younger people with dementia. Our research journey will last 3 years and is now almost one year in. In this article, we aim to convey some of the decisions we have made to date, and what lies ahead for a successful implementation.
So far, we have been forming as a research group and turning our initial ideas into plans that will work in the real world. Our methods for ensuring all elements of the project work well have involved internal and external aspects and processes. These have included involvement with and feedback from experts-by-experience and an advisory panel.
To date we have generated a protocol for all the key elements and have launched the Improving Support and Service Use Survey; a national survey gathering evidence from younger people with dementia and their supporters. In this article, we present how we aim to move forward to bring positive real-life changes to the lives of those affected by young onset dementia.
There is a cautiously happy ending to this first phase, as we are now collecting data. However, the judgement of whether the Angela Project is a success overall will depend on whether it makes a difference at its conclusion to younger people with dementia and their supporters.
Over 28,000 nurses in the UK can prescribe the same medicines as doctors provided that it is in their level of experience and competence. Over 30%, mostly in general practice, prescribe medicines for patients with diabetes.
A comparative case study.
Nurses managing care of people with Type 2 diabetes were recruited in twelve general practices in England; six could prescribe, six could not. Patients, recruited by nurses, were followed up for 6 months (2011?2012).
The patient sample comprised 131 in prescriber sites, 83 in non-prescriber sites. Patients of prescribers had been diagnosed and cared for by the nurse longer than those of non-prescribers. There were no differences in reported self-care activities or HbA1c test results between the patients of prescribers and non-prescribers. Mean HbA1c decreased significantly in both groups over 6 months. Patients of prescribers were more satisfied. Consultation duration was longer for prescribers (by average of 7·7 minutes). Non-prescribing nurses sought support from other healthcare professionals more frequently. Most prescribing nurses were on a higher salary band than non-prescribers.
Clinical outcomes of patients managed by prescribing and non-prescribing diabetes nurses are similar. Prescribing nurses had longer relationships with their patients and longer consultations, possibly contributing to higher satisfaction with care. Employment costs of prescribing nurses are potentially higher.
Physician associates are new to English general practice and set to expand
To investigate the patients? perspective on consulting with physician
associates in general practice.
A qualitative study, using semi-structured interviews, with thematic analysis.
Setting and participants:
Thirty volunteer patients of 430 who had consulted physician
associates for a same-day appointment and had returned a satisfaction survey, in six
general practices employing physician associates in England.
Some participants only consulted once with a physician associate and others
more frequently. The conditions consulted for ranged from minor illnesses to those
requiring immediate hospital admission. Understanding the role of the physician associate
varied from ?certain and correct? to ?uncertain?, to ?certain and incorrect?, where
the patient believed the physician associate to be a doctor. Most, but not all, reported
positive experiences and outcomes of their consultation, with some choosing to consult
the physician. Those with negative experiences described problems when the limits
of the role were reached, requiring additional GP consultations or prescription
delay. Trust and confidence in the physician associate was derived from trust in the
NHS, the general practice and the individual physician associate. Willingness to consult
a physician associate was contingent on the patient?s assessment of the severity
or complexity of the problem and the desire for provider continuity.
Patients saw physician associates as an appropriate general practitioner
substitute. Patients? experience could inform delivery redesign.
M. Fader, A. Cottenden, H.Gage, P. Williams, K. Getliffe, S. Clarke-O'Neill, K. Jamieson, N. Green. Individual budgets for people with incontinence: results from a 'shopping' experiment within the British National Health Service, Health Expectations, doi: 10.1111/j.1369-7625.2011.00750.x
L. Axelrod, K. Bryan, H.Gage,J.Kaye, S.Ting, P. Williams, P. Trend, D.Wade, Disease - specific training in Parkinson's disease for care assistants: a comparison of interactive and self study methods. Clinical Rehabilitation, 26(6):545-57, 2012
H.Gage, E. Erdal, P. Saigal, Y. Qiao, P. Williams, J. Ogden, M. Raats. Recognition and management of overweight and obese children: a questionnaire survey of General Practitioners and parents in England. Journal of Pediatrics and Child Health, 48(2):146-52; 2012
B. Brands, B. Egan, E. Gyorei, J-C Lopez-Robles, H. Gage, C. Campoy, T. Decsi, M. Raats. A qualitative interview study on effects of diet on children's mental state and performance. Evaluation of perceptions, attitudes and beliefs of parents in four European countries. Appetite; 58: 739-746, 2012
C. Goodman, E. Mathie, M. Cowe, A. Mendoza, D. Westwood, D. Munday, P. Wilson P, C. Crang, K. Froggatt, S. Iliffe, J. Manthorpe, H. Gage, S. Barclay. Talking about living and dying with the oldest old: public involvement in a study on end of life care in care homes. BMC Palliative Care; 10:20, 2011
H. Gage, S. Ting, P. Williams, K. Bryan, B. Castleton, P. Trend, D.Wade. A comparison of specialist rehabilitation and care assistant support with specialist rehabilitation alone and usual care for people with Parkinson's living in the community: study protocol for a randomised controlled trial, Trials, 12: 250, 2011
S.L. Davies, C. Goodman, F.Bunn, C. Victor, A. Dickenson, S. Iliffe, H.Gage, W. Martin, K. Frogatt. A systematic review of integrated working between care homes and health care services. BMC Health Services Research, 11; 320, 2011
L. Poltawski, C. Goodman, S. Iliffe, J. Manthorpe, H.Gage, D.Shah, V. Drennan. Frailty scales - their potential in interprofessional working with older people: a discussion paper. Journal of Interprofessional Care, 25(4): 280-286; 2011
C. Goodman, V. Drennan, F. Schiebl, D. Shah, J. Manthorpe, H. Gage, S. Iliffe. Models of inter professional working for older people living at home: a survey and review of the local strategies of English health and social care statutory organisations. BMC Health Services Research, 11;337, 2011
S. Iliffe, V. Drennan, J. Manthorpe, H.Gage, S. Davies, H. Massey, C. Scott, S. Brearley, C. Goodman. Nurse case management and General Practice: implications for GP consortia. British Journal of General Practice, 61(591): 658-665; 2011
V. Drennan, C. Goodman, J. Manthorpe, S. Davies, C. Scott, H.Gage, S. Iliffe. Establishing new nursing roles: a case study of the English community matron initiative. Journal of Clinical Nursing, 20(19-20):2948-2957; 2011
H.Gage, M. Raats, P. Williams, B.Egan,V. Jakobik, K. Laitinen, E. Martin-Bautista, M. Schmid, J. von Rosen-von Hoewel, C. Campoy, T. Decsi, J.Morgan, B. Koletzko. Developmental origins of health and disease: the views of first time mothers in five European countries on the importance of nutritional influences in the first year of life. American Journal of Clinical Nutrition; 94(suppl):2018S-24S, 2011
H.Gage, J. Morgan, P. Williams, M. Schmid, K. Laitenen, J.von Rosen, B. Koletzko, T. Decsi, V. Jacobi, E. Martin-Bautista, C. Campoy, M.M. Raats. Infant feeding intentions of new mothers in five European countries. Proceedings of the Nutrition Society, 69 (OCE1), E69, 2010
B. Egan, H. Gage, M. Raats, B. Anton, B. Koletzko, E. Gyorie, T. Decsi, E. Martin-Bautista, J.C. Lopez-Roberts, C. Campoy. The effect of diet on children's mental performance: a study of the attitudes, knowledge and perceptions of UK parents. Proceedings of the Nutrition Society, 69 (OCE1), E72, 2010
C. Goodman, K. Froggatt, E. Mathie, C. Craig, J. Wright, M. Handley, H.Gage, S. Iliffe, et al. The experiences and expectations of older people resident in care homes, their carers and professionals: a prospective study. Report for NIHR Research for Patient Benefit Programme, Sept. 2010
H.Gage, J. Kaye, A. Kimber, L. Storey, M. Egan, Y. Qiao, P. Trend. Correlates of constipation in people with Parkinson's. Parkinsonism and Related Disorders, 17 (2):106-111; 2011
S. Iliffe, D. Kendrick, R. Morris, D. Skelton, H. Gage, S. Dinan, Z. Stevens, M. Pearl, T. Masud T. Multi-centre cluster randomised trial comparing a community group exercise programme with home based exercise with usual care for people aged 65 and over in primary care: protocol of the ProAct 65+ trial, Trials, 11:6,2010
E. Martin-Bautista, H. Gage, J. von Rosen-von Hoewel, V. Jakobik, K. Laitinen, M. Schmid2, J. Morgan, P. Williams, T. Decsi, C. Campoy, B. Koletzko, M. Raats. Lifetime health outcomes of breast-feeding: a comparison of the policy documents of five European countries. Public Health Nutrition, 13(10), 1653-1662, 2010
L. Axelrod, H. Gage, J, Kaye, K, Bryan, P. Trend, D. Wade. Workloads of Parkinson's specialist nurses: implications for implementing national service guidelines in England. Journal of Clinical Nursing, 19, 3575-3580, 2010
H. Gage, C Goodman, S.L. Davies, C. Norton, M. Fader, M. Wells, J. Morris, P. Williams. Laxative use in care homes, Journal of Advanced Nursing, 66 (6), 1266-72, 2010
H.Gage, J. Evans, W. Knibb, P. Williams, N. Rickman, K. Bryan. Nursing homes: more on quality of care. British Medical Journal, 339, b3526, 2009
C. Goodman, V. Drennan, S. Davies, H. Masey, H. Gage, C. Scott, J. Manthorpe, S. Brearley, S. Iliffe. The nursing contribution to chronic disease management: nursing case management. Report for the National Coordinating Centre, NHS Service Delivery and Organisation, June 2009
S. Kendall, P. Wilson, S. Proctor, E. McNeilly, F. Bunn, F. Brooks, H. Gage. The nursing, midwifery and health visitor contribution to chronic disease management: a whole system approach. Report for the National Coordinating Centre, NHS Service Delivery and Organisation, May 2009
H.Gage, J. Evans, W. Knibb, P. Williams, N. Rickman, K. Bryan. Why are some care homes better than others? An empirical study of the factors associated with the quality of care for older people in residential homes in Surrey. Health and Social Care in the Community, 17(6), 599-609, 2009