Juliet Wright

Professor Juliet Wright

Founding Dean of Medicine



Rebecca Winter, Muna Al-Jawad, Juliet Wright, Duncan Shrewsbury, Harm Van Marwijk, Helen Johnson, Tom Levett (2021)What is meant by "frailty" in undergraduate medical education? A national survey of UK medical schools, In: European geriatric medicine12pp. 355-362 Springer Nature

Purpose All UK medical schools are required to include frailty in their curriculum. The term is open to interpretation and associated with negative perceptions. Understanding and recognising frailty is a prerequisite for consideration of frailty in the treatment decision-making process across clinical specialities. The aim of this survey was to describe how frailty has been interpreted and approached in UK undergraduate medical education and provide examples of educational strategies employed. Methods All UK medical schools were invited to complete an electronic survey. Schools described educational strategies used to teach and assess frailty and provided frailty-related learning outcomes. Learning Outcomes were grouped into categories and mapped to the domains of Outcomes for Graduates (knowledge, skills and values). Results 25/34 Medical schools (74%) participated. The interpretation of what frailty is vary widely and the diversity of teaching strategies reflect this. The most common Learning outcomes included as “Frailty” are about the concept of frailty, Comprehensive Geriatric Assessments and Roles of the MDT. Frailty teaching is predominantly opportunistic and occurred within geriatric medicine rotations in all medical schools. Assessments focus on frailty syndromes such as falls and delirium. Conclusion There is variation regarding how frailty has been interpreted and approached by medical schools. Frailty is represented in an array of teaching and assessment methods, with a lack of constructive alignment to related learning outcomes. Consensus should be agreed as to what frailty means in medical education. Further research is required to explore which frailty-specific educational strategies in undergraduate medical education enhance learning.

Laura Gallaher, Ceri Butler, Sube Banerjee, Juliet Wright, Ann White, Stephanie Daley (2023)Medical student perceptions of autism education: A qualitative study, In: Frontiers in Rehabilitation Sciences Frontiers Media

Background The global prevalence of autism is reported to be at least 1% and is rising. Autistic people have a range of comorbidities resulting in a high use of health services. Doctors of nearly all specialties are likely to encounter autistic people in their practice. Autistic people report dissatisfactory care and encounter disproportionately worse health-related outcomes than non-autistic people, which in part has been attributed to a lack of skill and awareness in the medical workforce. At present, autism education is not always included in undergraduate medical curricula. In England, the Department of Health and Social Care has mandated that autism education should be included in all undergraduate medical curricula but current evidence relating to the delivery and receipt of autism education is poor. A greater understanding of medical student perceptions of autism education is required to inform curriculum development. This qualitative study sought to explore the perceptions of autism education in final year medical students at a medical school in South-East England by 1) assessing their perceived preparedness to care for autistic people once they have graduated from medical school , post-qualification and 2) determining their perceived acceptability of a new undergraduate 18 education programme, Time for Autism (TfA). Materials and methods A purposeful sample of ten final-year medical students were recruited. Students completed in-depth, individual interviews. Data was analysed using thematic analysis. Results Four key themes were identified: Learning environment, Exposure, Relevance and Curricular priority. The findings of this study indicate that medical students perceived that greatest value in autism education was when it was directly relevant to developing preparedness for practice. Value was influenced by the perceived curricular priority attached to autism education. The new autism programme, Time for Autism was perceived to add relevance and priority to autism education in the existing curriculum in this medical school setting. Discussion The study findings shed new light on medical education literature, emphasising the importance of congruence between the provision of autism education and the prioritisation of autism education within the curriculum. Consideration of relevance and curricular priority can be used to support the development of autism education in future medical curricula.

Erica R M Pool, Vanessa Cooper, Elaney Youssef, Juliet Wright, Jordan Skittrall, Ola Blach, Martin Fisher, Helen Smith (2019)Use of a Retrospective Methodology to Examine the Process of Care Surrounding Serious Medical Events in HIV-Positive Patients: A Feasibility Study, In: Journal of the International Association of Providers of AIDS Care18 SAGE Publications

Introduction: Comorbidities are increasingly common among people living with HIV (PLWH) as they age. There is no evidence regarding models of care. We aimed to assess feasibility of a novel methodology to investigate care processes for serious medical events in PLWH. Method: The method was based on the National Confidential Enquiry into Patient Outcome and Death (NCEPOD). Data were extracted from medical records and questionnaires completed by general practitioners (GPs), HIV physicians, and non-HIV specialist physicians. A panel reviewed anonymized cases and gave feedback on the review process. Results: Eleven of 13 patients consented to the study. Questionnaires were completed by 64% of HIV physicians, 67% of non-HIV specialist physicians, and 55% of GPs. The independent review panel (IRP) advised improvement in the methodology including data presentation and timing. Conclusion: This method was acceptable to patients and secondary care physicians. Further work is needed to the improve GP responses and facilitate IRP.

Stephanie Daley, Molly Hebditch, Christopher Jones, Stephen Bremner, Yvonne Feeney, Georgia Towson, Juliet Wright, Sube Banerjee (2023)Time for Dementia: Quantitative evaluation of a dementia education programme for healthcare students, In: International Journal of Geriatric Psychiatry38(5)e5922 Wiley

Objectives The future healthcare workforce needs the skills, attitudes, and empathy to better meet the needs of those with dementia. Time for Dementia (TFD) is an educational programme in which healthcare students from a range of professional groups visit a person with dementia and their family carer over a two-year period. The aim of this study was to evaluate its impact on student attitudes, knowledge and empathy towards dementia. Methods Measures of dementia knowledge, attitudes and empathy were administered to healthcare students at five universities in the south of England before and after (24 months) they completed the TFD programme. Data were also collected at equivalent time points for a control group of students who had not taken part in the programme. Outcomes were modelled using multilevel linear regression models. Results 2,700 intervention group students, and 562 control group students consented to participate. Students undertaking the TFD programme had higher levels of knowledge and positive attitudes at follow-up compared to equivalent students who did not undertake the programme. Our findings indicate a positive relationship between the number of visits undertaken and increasing dementia knowledge and attitudes. No substantial differences in the development of empathy was observed between groups. Conclusion Our findings suggest that TFD may be effective across professional training programmes and universities. Further research into the mechanisms of action is needed.

Anthony Fauci, Andrew Hill, Linda-Gail Bekker, Julio Montaner, Jens Lundgren, Pablo Rojo, Kamilla Grønborg Laut, Leah Shepherd, Roxana Radoi, Igor Karpov, Milosz Parczewski, Cristina Mussini, Fernando Maltez, Marcelo Losso, Nikoloz Chkhartishvili, Hila Elinav, Helen Kovari, Anders Blaxhult, Robert Zangerle, Tatiana Trofimora, Brygida Knysz, Kai Zilmer, Elena Kuzovatova, Therese Staub, Dorthe Raben, Amanda Mocroft, Ole Kirk, Roberta Gagliardini, Massimiliano Fabbiani, Eugenia Quiros Roldan, Alessandra Latini, Gabriella D Ettorre, Andrea Antinori, Antonella Castagna, Giancarlo Orofino, Daniela Francisci, Pierangelo Chinello, Giordano Madeddu, Pierfrancesco Grima, Stefano Rusconi, Barbara Del Pin, Annalisa Mondi, Alberto Borghetti, Emanuele Focà, Manuela Colafigli, Roberto Cauda, Simona Di Giambenedetto, Andrea Luca, Laura Ciaffi, Sinata Koulla-Shiro, Adrien Sawadogo, N. Fatou Ngom Gueye, Vincent Le Moing, Sabrina Eymard-Duvernay, Suzanne Izard, Jacques Zoungrana, Pretty Mbouyap, Mamadou Diallo, Guillaume Bado, Koumba Toure Kane, Avelin Aghokeng, Martine Peeters, Jacques Reynes, Eric Delaporte, Nicolas Margot, Renee Ram, Moupali Das, Marshall Fordyce, Scott Mccallister, Michael Miller, Christian Callebaut, Chloe Orkin, Edwin Dejesus, Moti Ramgopal, Gordon Crofoot, Peter Ruane, Anthony Lamarca, Anthony Mills, Bernard Cam, Joseph Wet, Jurgen Rockstroh, Adriano Lazzarin, Bart Rijnders, Daniel Podzamczer, Anders Thalme, Marcel Stoeckle, Danielle Porter, Hui Liu, Andrew Cheng, Erin Quirk, Devi Sengupta, Huyen Cao, Francois Raffi, Amanda Clarke, Laurence Slama, Joel Gallant, Eric Daar, Mingjin Yan, Michael E. Abram, Sandra Friborg, Martin Rhee, Cheryl Johnson, Patrick S. Sullivan, Jeffrey V. Lazarus, Helen Bygrave, Edouard Battegay, Fabrice Bonnet, Fabien Le Marec, Olivier Leleux, Charles Cazanave, Estibaliz Lazaro, Pierre Duffau, Marie-Anne Vandenhende, Patrick Mercie, Didier Neau, François Dabis, Gemma Sanchez, Ana Gonzalez-Cordon, Jhon Rojas, Jose Blanco, Jordi Blanch, Montserrat Lonca, Berta Torres, Maria Martinez-Rebollar, Montserrat Laguno, Amparo Tricas, Ana Rodriguez, Josep Mallolas, Jose Gatell, Judit Peñafiel, Elisa Lazzari, Esteban Martinez, Michael Sabranski, Christoph Wyen, Christian Hoffmann, Tanya Welz, Michael Kolb, Eva Wolf, Hans-Juergen Stellbrink, Davide Francesco, Jonathan Underwood, Marta Boffito, Frank Post, Patrick Mallon, Jaime Vera, Ian Williams, Jane Anderson, Margaret Johnson, Caroline Sabin, Alan Winston, Andri Rauch, Deborah Konopnicki, Jean-Philippe Spano, Lene Ryom, Matthew Law, Camilla Hatleberg, Stephane Wit, Antonella D Armini Monforte, Manuel Battegay, Andrew Phillips, Peter Reiss, Christian Pradier, Andrew Grulich, Sheena Mccormack, Valentina Cambiano, Jean-Michel Molina, Staci Bush, Keith Rawlings, David Magnuson, Patty Martin, Olga Lugo-Torres, Robertino Mera-Giler, Xinzhu Wang, Nneka Nwokolo, Roxanna Korologou-Linden, Gary Whitlock, Isaac Day-Weber, Myra Mcclure, Teymur Noori, Bruno Spire, Steven G. Deeks, Roy M. Gulick, Federico Pulido, Esteban Ribera, Maria Lagarde, Ignacio Pérez-Valero, Jesús Santos, Jose Iribarren, Antonio Payeras, Pere Domingo, José Sanz, Miguel Cervero, Adrian Curran, Francisco Rodriguez, María Téllez, Pablo Ryan, Pilar Barrufet, Hernando Knobel, Antonio Rivero, Belén Alejos, María Yllescas, José Arribas, Anne-Genevieve Marcelin, Maxime Grude, Charlotte Charpentier, Pantxika Bellcave, Audrey Rodallec, Coralie Pallier, Stephanie Raymond, Audrey Mirand, Laurence Bocket, Laurence Morand-Joubert, Constance Delaugerre, Brigitte Montes, Helene Jeulin, Thomas Mourez, Samira Fafi-Kremer, Corrine Amiel, Catherine Roussel, Julia Dina, Marie-Anne Trabaud, Helene Le Guillou-Guillemette, Sophie Valet, Anne Signori-Schmuck, Anne Maillard, Anne Krivine, Philippe Flandre, Diane Descamps, Vincent Calvez, Ingeborg Wijting, Casper Rokx, Charles Boucher, Jeroen Kampen, Dorine Vries-Sluijs, Karin Schurink, Hannelore Bax, Maarten Derksen, Elrozy Andrinopoulou, Ineke Ende, Eric Gorp, Jan Nouwen, Annelies Verbon, Wouter Bierman, Pedro Cahn, Richard Kaplan, Paul Sax, Kathleen Squires, Jean-Michel Molina, Anchalee Avihingsanon, Winai Ratanasuwan, Evelyn Rojas, Mohammed Rassool, Xia Xu, Anthony Rodgers, Sandy Rawlins, Bach-Yen Nguyen, Randi Leavitt, Hedy Teppler, Enrique Rafael Granados-Reyes, Louis Sloan, Jerome Ernst, Mey León, David Stock, Cyril Llamoso, Samit Joshi, George Hanna, Max Lataillade, Johannes Bogner, Larissa Afonina, Alexey Yakovlev, Hao Wu, Cheng Yao, Tong Zhang, Qingxia Zhao, Weiping Cai, Min Wang, Hongzhou Lu, Hui Wang, Yuhuang Zheng, Biao Zhu, Jianhua Yu, Yongtao Sun, Min Zhao, Wenhui Lun, Wei Xia, Qingshan Zheng, Haiyan Peng, Rongjian Lu, Jianhua Hu, Hui Xing, Yiming Shao, Meixia Wang, Dong Xie, Karoline Aebi-Popp, Tracy Glass, Christoph Rudin, Begoña Martinez Tejada, Irene Hoesli, Claudia Grawe, Tina Fischer, Andrea Duppenthaler, Christian Kahlert, Christie Noble, Emily Adland, Vanessa Naidoo, Thumbi Ndung U, Philip Goulder, Melissa Soares Medeiros, Henrique Pires Moreira, Erico Antonio Gomes Arruda, Eduardo Austregesilo Correa, Yasmin Camelo Sales, Gisele Facanha Diogenes Teixeira, Ederson Aragao Ribeiro, Raquel Silveira Dantas, Carmen Manciuc, Andrei Vata, Cristina Nicolau, Alexandra Largu, Eyasu Ejeta Duken, Dabsu Regea, Obsa Siyum, Funmi Awosusi, Maha Al-Harbi, Elsa Campoa, Liliana Pedro, Filipa Azevedo, Raquel Pinho, Manuela Simão, Conceição Santos, Domitilia Faria, Carlos Santos, Luisa Arez, Svitlana Posokhova, Sergey Petrovych, Svitlana Shevchenko, Carmen Doina Manciuc, Liviu Prisacariu, Stéphane Wit, Agnès Libois, Pierre Mols, Stefano Malinverni, Vinh-Kim Nguyen, Helen Trottier, Hermione Gbego Tossa, Louise Charest, Danièle Longpré, Stéphane Lavoie, Martha Cadieux, Réjean Thomas, Stefano Boccino, Ushaa Kanagalinghan, Lan-Hsin Chang, Wen-Chun Liu, Cheng-Hsin Wu, Yi-Chieh Lee, Hsin-Yun Sun, Chien-Ching Hung, Shan-Chwen Chang, Tarandeep Anand, Stephen Kerr, Tanakorn Apornpong, Chattiya Nitpolprasert, Jintanat Ananworanich, Praphan Phanuphak, Nittaya Phanuphak, Jacek Kolodziej, Tomasz Mikula, Alicja Wiercinska-Drapalo, John Peel, Nathan Lachowsky, David Moore, Shahab Jabbari, Wendy Zhang, Silvia Guillemi, Marianne Harris, Troy Grennan, Jason Wong, Val Montessori, Gina Ogilvie, Julio Gonzalez Montaner, Mark Hull, Paula Meireles, Miguel Rocha, Maria José Campos, Henrique Barros, Gisela Leierer, Ard Sighem, Mario Sarcletti, Maria Kitchen, Martin Gisinger, Michaela Rappold, Bruno Ledergerber, Abiola Adepoju, Ginika Egesemba, Umar Kangiwa, Peace Igene, Justyna Kowalska, Magdalena Ankiersztejn-Bartczak, Ewa Firlag-Burkacka, Andrzej Horban, Antonella D Arminio Monforte, Patrizia Lorenzini, Alessandro Cozzi-Lepri, Franco Baldelli, Massimo Puoti, Francesco Mazzotta, Nicola Abrescia, Sergio Lo Caputo, Nicola Gianotti, Mark Krystal, David Wensel, Yongnian Sun, Jonathan Davis, Thomas Mcdonagh, Zhufang Li, Sharon Zhang, Matt Soars, Mark Cockett, Fabienne Caby, Rachid Agher, Roland Tubiana, Christine Blanc, Marie Jaspard, Yasmine Dudoit, Ruxandra Calin, Anne Simon, Marc-Antoine Valantin, Christine Katlama, Alexey Kravchenko, Elena Orlova-Morozova, Fiyara Nagimova, Oleg Kozirev, Tatyana Shimonova, Vadim Bichko, Natalya Vostokova, Olga Zozulya, Kirsten White, Anita Majka, Nikolai Novikov, Manuel Tsiang, Ellen Eaton, Ashutosh Tamhane, Girish Prajapati, Bridgett Goodwin, Michael Saag, Brian Conway, Ghazaleh Kiani, Rajvir Shahi, Tyler Raycraft, Arpreet Singh, Syune Hakobyan, Arshia Alimohammadi, Ntombenhle Gama, Kamlesh Kumar, Janette Reader, Bhavna Gordhan, Lyn-Marie Birkholtz, Bhavesh Kana, James Darkwa, Debra Meyer, Karen Pereira, Sara Dias Grazina, Ana Cláudia Miranda, Teresa Baptista, Fernando Borges, Jaime Nina, Susana Peres, Isabel Aldir, Isabel Antunes, João Pereira, Fernando Ventura, Kamal Mansinho, Sandra Soeria-Atmadja, Emma Österberg, Lars Gustafsson, Marja-Liisa Dahl, Jaran Eriksen, Johanna Rubin, Lars Navér, Herta Crauwels, Nico Goyvaerts, Simon Vanveggel, Rodica Solingen, German Contreras, Gilhen Rodriguez, Gabriela Del Bianco, Norma Perez, Laura Benjamins, James Murphy, Gloria Heresi, Olivier Lesens, Stéphane Blanche, Violaine Corbin, Christine Jacomet, Caroline Gatey, Weeraweet Manosuthi, Choy Man, Alicia Aylott, Annie Buchanan, Brian Wynne, Cindy Vavro, Michael Aboud, Kim Smith, Gundolf Schüttfort, Kathrin Philipp, Hans-Reinhard Brodt, Philipp Leuw, Siri Göpel, Eva Herrmann, Pavel Khaykin, Christoph Stephan, Timo Wolf, Annette Haberl, Katja Roemer, Susanne Usadel, Katrin Graefe, Michaela Steib-Bauert, Miriam Speer, Sarah Fischer, Nikola Hanhoff, Gaby Knecht, Sylwia Bilinski, Philipp Leuw, Angeliki Spanos, Dimitra Kavatha, Konstantinos Protopapas, Georgios Siakalis, Maria Argyropoulou, Charalampos Moschopoulos, Emmanouil Antalis, Paraskevi Fragkou, Nikolaos Melachrinopoulos, Sotirios Tsiodras, Anastasia Antoniadou, Antonios Papadopoulos, Catarina Oliveira Paulo, Frederico Duarte, Eduarda Ruiz Pena, Mário Guimarães, Ricardo Correia Abreu, Sofia Jordao, Isabel Neves, Michael Abram, Alexandre Brun, Isabelle Turpault, Pierre Sellier, Olivier Bouchaud, Olivier Patey, Valerie Garrait, Vincent Jeantils, Amelie Chabrol, Sylvain Diamantis, Valerie Gregoire-Faucher, Eric Froguel, Olivia Son, Sylvia Lamy, Corinne Routier, Hocine Ait-Mohand, Luc Turner, Gwenn Hamet, Willy Rozenbaum, Corevih Ile France, Shinichi Oka, Ploenchan Chetchotisakd, Khuanchai Supparatpinyo, Sasisopin Kiertiburanakul, Julie Ryu, David Piontkowsky, Susan Guo, Thai Nguyen-Cleary, Heribert Hillenbrand, Axel Baumgarten, Thomas Lutz, Siegfried Koeppe, Johannes Huelsenbeck, Mao-Song Tsai, Chia-Jui Yang, Jun-Yu Zhang, Pei-Ying Wu, Shang-Ping Yang, Yu-Zhen Luo, His-Yen Chang, Kuan-Yin Lin, Alessandro Cozzi Lepri, Sergio Lo Caputo, Antonio Di Biagio, Giulia Marchetti, Silvia Nozza, Antonella Cingolani, Study Group On Behalf Of Icona Foundation, Elena Knops, Eugen Schuelter, Nadine Luebke, Maria Neumann-Fraune, Eva Heger, Saleta Sierra-Aragon, Claudia Mueller, Mark Oette, Gerd Faetkenheuer, Martin Hower, Heribert Knechten, Niels Schuebel, Stefan Esser, Stefan Scholten, Dieter Haeussinger, Rolf Kaiser, Bjoern Jensen, David Nicolás Ocejo, Juan Ambrosioni, Christian Manzardo, Fernando Agüero, Mar Mosquera, Marta Parera, Sonsoles Sanchez-Palomino, Carmen Ligero, Emma Fernandez, Montserrat Plana, Jose Miró, Francisca Artigues, David Nicolás, Sonsoles Sánchez-Palomino, Maria Angeles Marcos, Jose Miro, Ramon Teira, Maria Galindo, Marta Montero, Raquel Portilla, Ana Ferrer, Elisa Martinez, Carmela Pinnetti, Isabella Abbate, Nicoletta Orchi, Caterina Gori, Alessandra Amendola, Raffaella Libertone, Gabriella Rozera, Maria Maddalena Plazzi, Gabriele Fabbri, Maria Rosaria Capobianchi, Adriana Ammassari, Rosario Palacios, Marisa Mayorga, Carmen-María González-Domenech, Carmen Hidalgo-Tenorio, Carmen Gálvez, Leopoldo Muñoz-Medina, Javier La Torre, Ana Lozano, Manuel Castaño, Mohamed Omar, Benjamin Schleenvoigt, Heiko Jessen, Michael Waizmann, Ramona Pauli, Ansgar Rieke, Nils Postel, Thomas Heuchel, Christian Schulz, Markus Mueller, Arend Moll, Christoph Spinner, Richard Haubrich, Marion Heinzkill, Carolin Wieszner, Giovanni Guaraldi, Andrea Malagoli, Giovanni Dolci, Federica Carli, Marianna Menozzi, Antonella Santoro, Stefano Zona, Elizabeth Etta, Cecile Manhaeve, Keanan Mcgonigle, David Rekosh, Marie-Louise Hammarskjold, Denis Tebit, Pascal Bessong, Neal Marshall, Marie Mcnulty, Colette Smith, Leonie Swaden, Fiona Burns, Giovanni Villa, Richard Odame Phillips, Alexander Stockdale, Apostolos Beloukas, Lambert Tetteh Appiah, David Chadwick, Alessandra Ruggiero, Fred Stephen Sarfo, Anna Maria Geretti, Johanna Boretzki, Carmen Wiese, Celia Oldenbuettel, Ivanka Krznaric, Anja Meurer, Alexander Zink, Christian Lersch, Annamaria Balogh, Dmytro Zhyvytsia, Vitali Kazeka, Seija Erica Peters, Kathryn Brown, Amanda Laird, Robert Gillespie, David Thomson, Catriona Milosevic, Brenda Bissett, Yvonne Cassells, Jennifer Paton, Celia Aitken, Kate Salters, Surita Parashar, Cathy Puskas, Lu Wang, Robert Hogg, Hasina Samji, Franco Maggiolo, Elisa Di Filippo, Annapaola Callegaro, Giorgio Colombo, Sergio Di Matteo, Daniela Valenti, Marco Rizzi, Isabelle Toupin, Kim Engler, David Lessard, Andràs Lènàrt, François Raffi, Bertrand Lebouché, Ferran Sala-Piñol, Angels Andreu-Crespo, Josep Llibre, Josep Coll, Jordi Grasa, Angels Calvet, Bonaventura Clotet, Xavier Bonafont-Pujol, Roman Shrestha, Pramila Karki, Tania Huedo-Medina, Michael Copenhaver, Donna Sweet, David Budd, Josh Cohen, Rebecca Hahn, Susan Hogue, Miranda Murray, Kimberly Davis, Catarina Rodrigues, Yohana Martins, Umbelina Caixas, Fatima Lampreia, Isabel Germano, Olga Tsachouridou, Eirini Christaki, Lemonia Skoura, Aadia Rana, Pantelis Zempekakis, Symeon Metallidis, Guido Kobbe, Gabor Dunay, Annemarie Wensing, Javier Martinez-Picado, Monique Nijhuis, Johannes Fischer, Falk Huettig, Rainer Haas, Didier Scherrer, Jean-Marc Steens, Paul Gineste, Noelie Campos, Aude Garcel, Erika Schlaefper, Roberto Speck, Jamal Tazi, Hartmut Ehrlich, Gnaneshwer Jadav, Nadia Meftah, Jean Claude Alvarez, Pierre Truchis, Emuri Abe, Lambert Assoumou, Roland Landman, Dominique Mathez, Karine Amat, Pierre Marie Girard, Damien Le Du, Martin Duracinsky, Dominique Costagliola, Jonathan Bellet, Christian Perronne, Juan Pasquau, Samantha Elizabeth Jesús, Coral García-Vallecillos, Roberto Gulminetti, Layla Pagnucco, Margherita Digaetano, Simone Benatti, Diego Ripamonti, María Teresa Cruces-Moreno, Samantha Elizabeth Jesus, Georgette Fatoul Del Pino, David Vinuesa-García, Miguel Ángel López-Ruz, José Hernández-Quero, José Ramón Santos, Pablo Peláez Ibañez, Isabel Bravo, Josep Maria Llibre, Roger Paredes, José Moltó, Alessandra Bandera, Mauro Zaccarelli, Gaetana Sterrantino, Alessandro D Avino, Chiara Picarelli, Giuseppe Lapadula, Andrea Gori, Ángela Gutiérrez Liarte, Ana Gómez Berrocal, Rosa Miguel Buckley, Jesús Sanz Sanz, Samantha Jesus, Piedad Arazo, Maria Jose Crusells, Maria Jose Rios, Fernando Lozano, Carlos Tornero, Guillermo Verdejo, Zaira Palacios, Gloria Samperiz, Maria Jose Galindo, Jose Alberto Terron, Miguel Garcia-Deltoro, Antonio Mastroianni, Elisabetta Briganti, Francesco Allegrini, Carmela Grosso, Sandra Brighi, Gianfranco Ravaglia, Fabio Pieraccini, Claudio Cancellieri, Agostino Riva, Andrea Poli, Stefano Bonora, Anna Maria Cattelan, Micol Ferrara, Vincenzo Spagnuolo, Silvia Cavinato, Dario Cattaneo, Chien-Yu Cheng, Shu-Hsing Cheng, Shu-Yin Chang, Mei-Hui Lin, Shin-Yen Ku, Hui-Ting Shieh, Na-Lee Sun, Sergio Maria Ferrara, Alessandra Tartaglia, Salvatore Sica, Teresa Antonia Santantonio, Yazdan Yazdanpanah, Gabriel Schembri, Cecilia Tran-Muchowski, Laura Dickinson, Margherita Bracchi, Emilie Elliot, Laura Else, Saye Khoo, David Back, Mark Nelson, Gilles Peytavin, Véronique Joly, Ornella Cabras, Marine Perrier, Minh Lê, Bao Phung, Mafalda Guimarães, Inês Vaz Pinto, Catarina Santos, Sara Alves, Amedeo Ferdinando Capetti, Maria Vittoria Cossu, Giovanni Cenderello, Serena Cima, Gianmaria Baldin, Annamaria Cattelan, Giuseppe Vittorio Socio, Niccolò Riccardi, Giancarlo Orofino, Benedetto Maurizio Celesia, Fosca Niero, Lolita Sasset, Vanessa Silebi, Barbara Argenteri, Giorgio Barbarini, Giuliano Rizzardini, Esther Merlini, Federico Cazzaniga, Anna Casabianca, Chiara Orlandi, Giuseppe Ancona, Viola Cogliandro, Camilla Tincati, Teresa Bini, Mauro Magnani, Pierluigi Viale, Antonio Chirianni, Laura Sighinolfi, Giustino Parruti, Antonella D Arminio Monforte, Sara La Fuente Moral, Alberto Diaz Santiago, Carlos Folguera, Carmen Mendoza Fernandez, Alfonso Angel-Moreno Maroto, María Fontecha-Ortega, Vanessa Muñoz-Mendoza, Cristina Gómez, Matilde Sánchez-Conde, Miguel Angel Rodríguez, Maria Jesús Vivancos, Jose Luis Casado, Volker Holzendorf, Barbara Rossetti, Lucia Lisi, Melissa Masini, Silvia Lamonica, Francesca Vignale, Andrea Tosti, Michele Trezzi, Ivano Mezzaroma, Pierluigi Navarra, Gianmaria Baldin, Amedeo Capetti, Andrea Giacometti, Mariangela Micale, Sara Veloci, Francesca Lombardi, Ramona Marco, Arianna Emiliozzi, Letizia Oreni, Tiziana Formenti, Andrea Giacomelli, Valentina Di Cristo, Angelica Lupo, Elisa Colella, Marco Franzetti, Anna Lisa Ridolfo, Massimo Galli, Luba Tau, Tomer Ziv-Baran, Ronit Cohen-Poradosu, Ari Leshno, Danny Alon, David Shasha, Steven Rapaport, Asaf Wasserman, Talya Finn, Eugene Katchman, David Hassin, Israel Yust, Tamar Brofman, Boaz Avidor, Dan Turner, Bernardino Roca, Paolo Pavone, Noemi Giustini, Gabriella D Ettorre, Sara Serafino, Ivan Schietroma, Giuseppe Corano Scheri, Mauro Andreotti, Andrea Mastrangelo, Claudio Maria Mastroianni, Vincenzo Vullo, Maria Vivancos-Gallego, Ana Moreno, Carmen Quereda, Jose Luis Casado, Cristina Gomez Ayerbe, Matilde Sanchez-Conde, Santos Del Campo, Santiago Moreno, Maria Perez Elias, Hsi-Yen Chang, Emmanuel Nwabueze, Nwokedi Ndulue, Ginika Egesimba, Med Makumbi, Zipporah Kpamor, Emeka Okechukwu, Joy Kolin, Antonio Diniz, Jose Loff, Helena Cortes-Martins, Amanda Häggblom, Stefan Lindbäck, Magnus Gisslén, Leo Flamholc, Bo Hejdeman, Andreas Palmborg, Amy Leval, Eva Herweijer, Sverrir Valgardsson, Veronica Svedhem, Maria J Vivancos-Gallego, Maria J Perez-Elias, Sergio Serrano Villar, Fernando Dronda, Enrique Navas, Miguel Angel Rodriguez, Celia Oldenbüttel, Ayla Ritter, Sebastian Noe, Silke Heldwein, Rita Pascucci, Ariane Von Krosigk, Eva Jägel-Guedes, Hans Jäger, Christine Kögl, Shanker Thiagarajah, David Dorey, Jenny Huang, Gilly Roberts, Britt Stancil, David Margolis, Josephine Tran, John White, Jianbin Mao, Felix Cao, Magdalena Leszczyszyn-Pynka, Adam Witor, Karolina Muller, Aleksandra Szymczak, Jacek Gasiorowski, Monika Bociaga-Jasik, Pawel Skwara, Anna Grzeszczuk, Elzbieta Jablonowska, Kamila Wójcik-Cichy, Juliusz Kamerys, Dariusz Bielec, Justyna Stempkowska, Aleksandra Kocbach, Wieslawa Bludzin, Armin Rieger, Brigitte Schmied, Maria Geit, Bernhard Haas, Ninon Taylor, Manfred Kanatschnig, Filipa Sequeira, Sara Grazina, João Alves, Ana Cláudia Miranda, Caroline Arnbjerg, Karin Pedersen, Sofie Jespersen, Barbara Fischer, Helle Johannesen, Eva Fallentin, Adam Hansen, Andreas Kjær, Marius Trøseid, Susanne Dam Nielsen, Josip Begovac, Šime Zekan, Snjezana Zidovec Lepej, Davorka Lukas, Jacquelyn Romaine, Clare Bradley, Sari Arponen, Alejandra Gimeno-García, Carmen Montero-Hernández, Laura Esteva, Marta Blasco, Elsa Gaspar-García, M. Jose García-Navarro, Marc Grant-Freemantle, Geoff Mccombe, Alan Macken, Willard Tinago, Gordana Avramovic, Jane O Halloran, Aoife Cotter, Gerard Sheehan, John Lambert, Oscar Luis Ferrero, Sofía Ibarra, Iñigo López-Azkarreta, Mireia La Peña, Miriam López-Martínez, Josu Mirena Baraia-Etxaburu, Josefina López Munain, M. 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Guschina, Zoya Suvorova, Oleg Yurin, Vadim Pokrovskiy, Wai Chi Ada Lin, Ka Hing Wong, Niklaus Daniel Labhardt, Isaac Ringera, Thabo Ishmael Lejone, Josephine Muhairwe, Christiane Fritz, Thomas Klimkait, Tracy Renee Glass, Bianca Ascenção, Nuno Pinto Luís, Ana Catarina Messias, Sá Joana, Benjamin Patterson, Jason Zucker, Tanya Ellman, Ellen Morrison, Magdalena Sobiesczcyk, Nadia Ahmed, Duncan Scott, Nashaba Matin, Grace Kolawole, Hannah Gilbert, Nancin Dadem, Patricia Agaba, Becky Genberg, Oche Agbaji, Prosper Okonkwo, Norma Ware, Pablo Belaunzarán-Zamudio, Bryan Shepherd, Yanink Caro-Vega, Claudia Cortés, Brenda Crabtree-Ramírez, Beatriz Grinsztejn, Eduardo Gotuzzo, Fernando Mejía, Denis Padgett, Jean Pape, Peter Rebeiro, Vanessa Rouzier, Valdilea Veloso, Sandra Wagner-Cardoso, Catherine Mcgowan, Juan Sierra-Madero, Loïc Lhopitallier, Estelle Moulin, Durba Raha, Callum Mutch, Clifford Leen, Fábio Cota-Medeiros, Cláudia Afonso, Alexandra Zagalo, Luís Caldeira, Rita Veiga Ferraz, Raquel Duro, Nuno Pereira, Carmela Pinero, Cátia Caldas, Marco Gelpi, Hans Jakob Hartling, Kristina Thorsteinsson, Jan Gerstoft, Henrik Ullum, Francesco Baldini, Maria Antonella Zingaropoli, Alessandra D Abramo, Marco Iannetta, Alessandra Oliva, Maria Rosa Ciardi, Valeria Belvisi, Edward Maina, Elizabeth Bukusi, Martha Sedegah, Margaret Lartey, William Ampofo, Matthias Döring, Pedro Borrego, Joachim Büch, Andreia Martins, Georg Friedrich, Ricardo Jorge Camacho, Josef Eberle, Nuno Taveira, Nico Pfeifer, Joseph Kirangwa, Deogratius Ssemwanga, Pontiano Kaleebu, Huldrych Günthard, Andrea Hauser, Alexandra Hofmann, Kirsten Hanke, Viviane Bremer, Barbara Bartmeyer, Claudia Kücherer, Norbert Bannert, Evangelia-Georgia Kostaki, Vana Sypsa, Georgios Nikolopoulos, Georgios Xylomenos, Marios Lazanas, Georgios Daikos, Georgios Chrysos, Malvina Lada, Periklis Panagopoulos, Efstratios Maltezos, Angelos Hatzakis, Dimitrios Paraskevis, Mark Wainberg, Thibault Mesplede, Brian Magambo, Emiliano Bissio, María Gabriela Barbás, María Belén Bouzas, Analía Cudolá, Carlos Falistocco, Horacio Salomón, Robert Ehret, Andrew Moritz, Marcel Schuetze, Jason Brunetta, Megan Acsai, Emmanouil Magiorkinis, Assimina Zavitsanou, Martha Oikonomopoulou, Stylianos Drimis, Dimitrios Pilalas, Dimitrios Chatzidimitriou, Alexander Zoufaly, Claudia Kraft, Caroline Schmidbauer, Elisabeth Puchhammer, Shirley Girshengorn, Adi Braun, Tal Pupko, Irena Zeldis, Natasha Matus, Simona Gielman, Svetlana Ahsanov, Inbal Schweitzer, Frank Wiesmann, Martin Däumer, Gudrun Naeth, Patrick Braun, Jörg-Andres Rump, Nadine Lübke, Alejandro Pironti, Björn Jensen, Ulrike Elisabeth Haars, Bjoern Erik Ole Jensen, Maria Ines Figueroa, Patricia Patterson, Jaime Andrade-Villanueva, José Gatell, Javier Lama, Michael Norton, Omar Sued, Maria Jose Rolon, Lissette Perez Santos, Liuber Yan Machado, Vivian Kouri Cardella, Hector Diaz, Carlos Aragones, Yoan Aleman, Eladio Silva, Consuelo Correa, Madelin Blanco Armas, Jorge Perez, Marta Dubed, Yudira Soto, Nancy Ruiz, Celia Limia, Carmen Nibot, Neysi Valdés, Maria Ortega, Dania Romay, Yohana Baños, Barbara Rivero, Jorge Campos, Fátima Monteiro, Gilberto Tavares, Marina Ferreira, Ana Amorim, Pedro Bastos, Carolina Rocha, Dina Hortelão, Claudia Vaz, Carmo Koch, Fernando Araujo, Paola Columpsi, Valentina Zuccaro, Paolo Sacchi, Isabel Viciana, Francisco Jarilla, Alfonso Del Arco, Ngar Sze Wong (2016)International Congress of Drug Therapy in HIV Infection 23-26 October 2016, Glasgow, UK, In: Journal of the International AIDS Society19(8Suppl 7)pp. 21487-n/a International AIDS Society

Scientific advances over the 35 years since AIDS was first recognized as a new disease, have put us on a clear path towards ending the HIV/AIDS pandemic. Scaling-up access to antiretroviral therapy (ART) and HIV prevention strategies, such as pre-exposure prophylaxis, could dramatically decrease HIV-related deaths and the rate of new HIV infections. Current and future scientific advances, notably in HIV vaccine and cure research, will accelerate this process. Two major directions in HIV vaccine development will be discussed: building on the results from RV 144, the clinical trial in Thailand that resulted in the first modest signal of efficacy for a HIV vaccine; and structure-based immunogen design to elicit broadly neutralizing antibodies. Cure research has accelerated greatly over the past few years in two areas. The first is the prospect of eradicating the HIV reservoir altogether (i.e. a classic cure), which might involve novel latency-reversing and immunotoxic regimens and gene editing techniques to create a host cellular environment that does not allow HIV replication. The second approach involves controlling viral rebound following discontinuation of ART to achieve sustained virological remission employing strategies, such as passive transfer of broadly neutralizing antibodies and therapeutic vaccination. In 2016, the arsenal of scientifically proven interventions available, as well as the hope of others to come, offer unprecedented opportunities to make major gains in the fight against HIV/AIDS. With a major global commitment to implement these scientific advances, the end of the HIV/AIDS pandemic is now achievable. Across Europe, high drug prices can limit access to treatment for hepatitis C, cancer and pre-exposure prophylaxis for HIV. Fifteen years ago, it was shown that antiretrovirals for HIV/AIDS could be mass produced at very low costs. This led to treatment programmes which now supply drugs to more than 17 million people with HIV worldwide. Similar analyses of drug production show that viral hepatitis, tuberculosis and certain cancers could also be treated at very low costs. Several key drugs will become generic in Europe within the next 5 years. There is a potential to expand treatment coverage for key diseases, while lowering overall costs of treatment. For mass treatment with low-cost generic drugs to be successful, five key conditions need to be met: 1. When any drug becomes generic, it should become available to publicly run health services at prices close to the cost of production, with an acceptable profit margin. These prices are freely available from India. 2. Pharmaceutical companies should not be able to inflate the prices of drugs after initial approval. 3. When a drug becomes generic and a low price is established, the effects of this lower price on the value of other drugs should be evaluated. Higher prices for newer drugs may no longer be justified. 4. Any secondary patent on a drug should be carefully evaluated for validity. 5. Pharmaceutical companies involved in bribery, false advertising or suppression of clinical trial results should pay significant fines, which are then used to sponsor national treatment access schemes. After 2000, we saw a remarkable era of HIV treatment roll out with consequent notable public health gains. This will be remembered as a treatment revolution. Most recently, with a number of important human trials marking at least partial efficacy with male circumcision, topical and systemic antiretroviral-based prophylaxis, HIV vaccines and other promising primary prevention modalities in the pipeline, this next decade could well be thought of as the prevention revolution. How the prevention revolution plays out in resource-constrained settings will depend on political will, resources and the competing need to reach the other half of the treatment pool effectively. Antiretroviral therapy (ART) has dramatically reduced progression to AIDS and premature death among people living with HIV (PLHIV). Furthermore, ART is highly effective in preventing HIV transmission. We refer to this combined effect of ART as treatment as prevention (TasP). HIV TasP has proven cost-effective, because beyond its impact on morbidity and mortality, TasP decreases HIV incidence, which acts as a multiplier on the return-on-investment. In 2014, under the Joint United Nations Programme on HIV/AIDS leadership, we developed the 90–90–90 target, a new TasP-inspired ambitious goal for global HIV treatment to “End the AIDS Pandemic” as a public health threat by 2030. The 90–90–90 target, proposes by 2020, ≥90% of all PLHIV will know their HIV status; ≥90% of them will have access to ART; and ≥90% of them will achieve sustained HIV viral suppression. The success of HIV-TasP has fuelled enthusiasm that this approach could be successfully exported and adapted to other infectious diseases, such as hepatitis C infection. Similarly, there is growing interest regarding a possible role TasP may play dealing with conditions where there is “social contagion” (i.e. any condition where increased prevalence is associated with increased incidence through behavioural contagion; including smoking, addiction or obesity-related diseases). We believe that TasP offers a unique means to optimize the management of selected high burden conditions, with a view to reduce morbidity and mortality, as well as prevalence and incidence within a highly cost-effective framework, and as such, to promote healthcare sustainability. The strategic question on when to initiate antiretroviral therapy (ART) was finally resolved in 2015: since all HIV-positive persons stand to benefit from ART, this treatment should be offered to all. The START study provided key evidence by demonstrating a substantial reduction in risk of disease progression by early versus deferred initiation of ART in early HIV infection (i.e. before the CD4 cell count had decreased below 500 cells/µL). A series of sub studies and secondary analysis from START has subsequently been reported. The key findings from this portfolio of research will be reviewed and will include the identification of key subgroups with varying absolute risk reduction from the early use of ART, immunological correlates of ART-induced clinical protection, ART-induced depletion of bone mineral density, the lack of benefit on arterial elasticity, pulmonary and neurocognitive function, beneficial effects from ART on opportunistic disease, invasive bacterial infections, cancer, and kidney and bone marrow function. Overall, the data demonstrate that the balance of benefits versus risks from early ART favours the benefit across a wide spectrum of pathophysiological processes. In conclusion, global consensus on evidence for universal access to ART now exists; implementation research is key, as only half of the infected population is currently receiving ART. The presentation is given by a Spanish paediatrician, who will be directing his presentation mainly to European adult HIV physicians. This presentation will refer to the situation of HIV-infected adolescents and young adults, mainly perinatally infected, being transferred from paediatric HIV clinics to adult HIV clinics in Europe. The presentation will focus specifically on three issues: 1) the special pattern of adolescence and young adulthood in relation to neurocognitive development, behaviour and chronic illness; 2) to review what are the main clinical, immunovirological, psychological and social characteristics of the adolescents and young adults who are being transferred currently and in the near future to the adult HIV clinics. Special attention will be on the differences between the children born before and after combined antiretroviral treatment, which was available in the paediatric population; and 3) the system where they come from: the insights of a paediatric HIV clinic in Europe. Introduction: Direct comparisons between countries in core HIV care parameters are often hampered by different data collection. We compared temporal changes in country-specific rates of the UNAIDS/WHO targets of >90% ART coverage and >90% ART-induced HIV RNA suppression for a given population. Materials and methods: EuroSIDA participants under follow-up between the periods 1 January 2004 to 31 December 2005 and 1 January 2014 to 31 December 2015 were followed from first visit until latest of CD4, HIV RNA or follow-up visit. Based on the included EuroSIDA centres, country-specific proportions of persons on ART (≥3 antiretrovirals) and HIV RNA suppression (

Catherine J Evans, Anna E Bone, Deokhee Yi, Myfanwy Morgan, Matthew Maddocks, Juliet Wright, Fiona Lindsay, Irene J Higginson (2022)Response to Zhou (2021) "Comment on Evans et al. (2021) 'Community-based short-term integrated palliative and supportive care reduces symptom distress for older people with chronic noncancer conditions compared with usual care'", In: International journal of nursing studies125pp. 104119-104119
Greg Scutt, Andrew Overall, Railton Scott, Bhavik Patel, Lamia Hachoumi, Mark Yeoman, Juliet Wright (2018)Does the 5-HT 1A rs6295 polymorphism influence the safety and efficacy of citalopram therapy in the oldest old?, In: Therapeutic advances in drug safety9(7)pp. 355-366

Major depressive disorder (MDD) in older people is a relatively common, yet hard to treat problem. In this study, we aimed to establish if a single nucleotide polymorphism in the 5-HT 1A receptor gene (rs6295) determines antidepressant response in patients aged > 80 years (the oldest old) with MDD. Nineteen patients aged at least 80 years with a new diagnosis of MDD were monitored for response to citalopram 20 mg daily over 4 weeks and genotyped for the rs6295 allele. Both a frequentist and Bayesian analysis was performed on the data. Bayesian analysis answered the clinically relevant question: ‘What is the probability that an older patient would enter remission after commencing selective serotonin reuptake inhibitor (SSRI) treatment, conditional on their rs6295 genotype?’ Individuals with a CC (cytosine–cytosine) genotype showed a significant improvement in their Geriatric Depression Score ( p = 0.020) and cognition ( p = 0.035) compared with other genotypes. From a Bayesian perspective, we updated reports of antidepressant efficacy in older people with our data and calculated that the 4-week relative risk of entering remission, given a CC genotype, is 1.9 [95% highest-density interval (HDI) 0.7–3.5], compared with 0.52 (95% HDI 0.1–1.0) for the CG (cytosine–guanine) genotype. The sample size of n = 19 is too small to draw any firm conclusions, however, the data suggest a trend indicative of a relationship between the rs6295 genotype and response to citalopram in older patients, which requires further investigation.

Geoffrey Wells, Carrie Llewellyn, Andreas Hiersche, Ollie Minton, David Barclay, Juliet Wright (2022)Care of the dying – medical student confidence and preparedness: mixed-methods simulation study, In: BMJ supportive & palliative care British Medical Journal Publishing Group

ObjectivesOf all doctors, Foundation Year 1 trainees spend the most time caring for dying patients yet report poor preparation and low confidence in providing this care. Despite documented effectiveness of simulation in teaching end-of-life care to undergraduate nurses, undergraduate medicine continues to teach this subject using a more theoretical, classroom-based approach. By increasing undergraduate exposure to interactive dying patient scenarios, simulation has the potential to improve confidence and preparedness of medical students to care for dying patients. The main study objective was to explore whether simulated experience of caring for a dying patient and their family can improve the confidence and preparedness of medical students to provide such care.MethodsA mixed-methods interventional study simulating the care of a dying patient was undertaken with serial measures of confidence using the Self Efficacy in Palliative Care (SEPC) tool. Significance testing of SEPC scores was undertaken using paired t-tests and analysis of variance. Post-simulation focus groups gathered qualitative data on student preparedness. Data were transcribed using NVivo software and interpreted using Thematic Analysis.ResultsThirty-eight 4th-year students participated. A statistically significant post-simulation increase in confidence was seen for all SEPC domains, with sustained confidence observed at 6 months. Focus group data identified six major themes: current preparedness, simulated learning environment, learning complex skills, patient centredness, future preparation and curriculum change.ConclusionUsing simulation to teach medical students how to care for a dying patient and their family increases student confidence and preparedness to provide such care.

P Bentham, Juliet Wright, R Gray, J Raftery, R Hills, E Sellwood, C Courtney, D Farrell, W Hardyman, P Crome, S Edwards, C Lendon, L Lynch, (2004)Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial, In: The Lancet (British edition)363(9427)pp. 2105-2115 Elsevier

Background Cholinesterase inhibitors produce small improvements in cognitive and global assessments in Alzheimer's disease. We aimed to determine whether donepezil produces worthwhile improvements in disability, dependency, behavioural and psychological symptoms, carers' psychological wellbeing, or delay in institutionalisation. If so, which patients benefit, from what dose, and for how long? Methods 565 community-resident patients with mild to moderate Alzheimer's disease entered a 12-week run-in period in which they were randomly allocated donepezil (5 mg/day) or placebo. 486 who completed this period were rerandomised to either donepezil (5 or 10 mg/day) or placebo, with double-blind treatment continuing as long as judged appropriate. Primary endpoints were entry to institutional care and progression of disability, defined by loss of either two of four basic, or six of 11 instrumental, activities on the Bristol activities of daily living scale (BADLS). Outcome assessments were sought for all patients and analysed by logrank and multilevel models. Findings Cognition averaged 0.8 MMSE (mini-mental state examination) points better (95% Cl 0.5-1.2; p

M Santillo, K Sivyer, A Krusche, F Mowbray, N Jones, T E A Peto, A S Walker, M J Llewelyn, L Yardley, Amy Lee, Catherine Sargent, Chris Butler, Chris Roseveare, Daniel Agranoff, Debbie Lockwood, Donald Lyon, Elizabeth Cross, Elizabeth Darwin, Gavin Barlow, Ian Setchfield, Jasmin Islam, Juliet Wright, Kieran Hand, Louella Vaughan, Mark Wilcox, Martin Wiselka, Mike Sharland, Nicola Jones, Nicola Fawcett, Paul Wade, R Martin Dachsel, Rachaeol Sierra, Richard Bellamy, Sacha Pires, Sally Curtis, Samantha Lippett, Sue Crossland, Susan Hopkins, Veronica Garcia-Arias, Vikesh Gudka, Will Hamilton, Clifford Gorton (2019)Intervention planning for Antibiotic Review Kit (ARK): a digital and behavioural intervention to safely review and reduce antibiotic prescriptions in acute and general medicine, In: Journal of antimicrobial chemotherapy74(11)pp. 3362-3370

Abstract Background Hospital antimicrobial stewardship strategies, such as ‘Start Smart, Then Focus’ in the UK, balance the need for prompt, effective antibiotic treatment with the need to limit antibiotic overuse using ‘review and revise’. However, only a minority of review decisions are to stop antibiotics. Research suggests that this is due to both behavioural and organizational factors. Objectives To develop and optimize the Antibiotic Review Kit (ARK) intervention. ARK is a complex digital, organizational and behavioural intervention that supports implementation of ‘review and revise’ to help healthcare professionals safely stop unnecessary antibiotics. Methods A theory-, evidence- and person-based approach was used to develop and optimize ARK and its implementation. This was done through iterative stakeholder consultation and in-depth qualitative research with doctors, nurses and pharmacists in UK hospitals. Barriers to and facilitators of the intervention and its implementation, and ways to address them, were identified and then used to inform the intervention’s development. Results A key barrier to stopping antibiotics was reportedly a lack of information about the original prescriber’s rationale for and their degree of certainty about the need for antibiotics. An integral component of ARK was the development and optimization of a Decision Aid and its implementation to increase transparency around initial prescribing decisions. Conclusions The key output of this research is a digital and behavioural intervention targeting important barriers to stopping antibiotics at review (see http://bsac-vle.com/ark-the-antibiotic-review-kit/ and http://antibioticreviewkit.org.uk/). ARK will be evaluated in a feasibility study and, if successful, a stepped-wedge cluster-randomized controlled trial at acute hospitals across the NHS.

Molly Hebditch, Stephanie Daley, Juliet Wright, Gina Sherlock, James Scott, Sube Banerjee (2020)Preferences of nursing and medical students for working with older adults and people with dementia: a systematic review, In: BMC medical education20(1)pp. 92-92

A current issue in workforce planning is ensuring healthcare professionals are both competent and willing to work with older adults with complex needs. This includes dementia care, which is widely recognised as a priority. Yet research suggests that working with older people is unattractive to undergraduate healthcare students. The aim of this systematic review and narrative synthesis is to explore the factors related to healthcare (medical and nursing) student preferences' for working with older people and people with dementia. Searches were conducted in five databases: MEDLINE, PsycINFO, CINHAL, BNI, ERIC. Screening, data extraction and quality appraisal were conducted by two independent reviewers. A narrative, data-based convergent synthesis was conducted. One thousand twenty-four papers were screened (139 full texts) and 62 papers were included for a narrative synthesis. Factors were grouped into seven categories; student characteristics, experiences of students, course characteristics, career characteristics, patient characteristics, work characteristics and the theory of planned behaviour. Health educators should review their role in cultivating student interest in working with older adults, with consideration of student preparation and the perceived value of this work. There is a lack of evidence about the career preferences of students in relation to dementia, and this warrants further research.

C. Rajkumar, M. Wilks, J. Islam, K. Ali, J. Raftery, K. A. Davies, J. Timeyin, E. Cheek, J. Cohen, JULIET WRIGHT (2020)Do probiotics prevent antibiotic-associated diarrhoea? Results of a multicentre randomized placebo-controlled trial, In: The Journal of hospital infection105(2)pp. 280-288 Elsevier

Background: Antibiotic-associated diarrhoea (AAD) is a side-effect of antibiotic consumption and probiotics have been shown to reduce AAD. Methods: A multicentre, double-blind, placebo-controlled, randomized trial was conducted to evaluate the role of Lactobacillus casei DN114001 (combined as a drink with two regular yoghurt bacterial strains) in reducing AAD and Clostridioides difficile infection in patients aged over 55 years. The primary outcome was the incidence of AAD during 2 weeks of follow-up. Results: A total of 1127 patients (mean age +/- standard deviation: 73.6 +/- 10.5) were randomized to the active group (N = 549) or placebo group (N = 577). Both groups were followed up as per protocol. The proportion of patients experiencing AAD during follow-up was 19.3% (106/549) in the probiotic group vs 17.9% (103/577) in the placebo group (unadjusted odds ratio 1.10, 95% confidence interval 0.82-1.49, P = 0.53). Conclusions: No significant evidence was found of a beneficial effect of the specific probiotic formulation in preventing AAD in this elderly population drawn from a number of different UK hospitals. However, in the UK and in many other healthcare systems there have, in recent years, been many changes in antibiotic stewardship policies, an overall decrease in incidence in C. difficile infection, as well as an increased awareness of infection prevention, and modifications in nursing practice. In light of these factors, it is impossible to conclude definitively from the current trial that the study-specific probiotic formulation has no role in preventing AAD, and it is our view that further trials may be indicated, controlling for these variables. (C) 2020 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.

R. Simcock, J. Wright (2020)Beyond Performance Status, In: Clinical oncology (Royal College of Radiologists (Great Britain))32(9)pp. 553-561 Elsevier

Oncologists should recognise the need to move beyond the Eastern Cooperative Oncology Group Performance Status (ECOG PS) score. ECOG PS is a longstanding and ubiquitous feature of oncology. It was evolved 40 years ago as an adaption of the 70-year-old Karnofsky performance score. It is short, easily understood and part of the global language of oncology. The wide prevalence of the ECOG PS attests to its proven utility and worth to help triage patient treatment. The ECOG PS is problematic. It is a unidimensional functional score. It is mostly physician assessed, subjective and therefore open to bias. It fails to account for multimorbidity, frailty or cognition. Too often the PS is recorded only once in wilful ignorance of a patient's changing physical state. As modern oncology offers an ever-widening array of therapies that are 'personalised' to tumour genotype, modern oncologists must strive to better define patient phenotype. Using a wider range of scoring and assessment tools, oncologists can identify deficits that may be reversed or steps taken to mitigate detrimental effects of treatment. These tools can function well to identify those patients who would benefit from comprehensive assessment. This overview identifies the strengths of ECOG PS but highlights the weaknesses and where these are supported by other measures. A strong recommendation is made here to move to routine use of the Clinical Frailty Score to start to triage patients and most appropriately design treatments and rehabilitation interventions. (C) 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Jenna L. Morgan, Geoff Holmes, Sue Ward, Charlene Martin, Maria Burton, Stephen J. Walters, Kwok Leung Cheung, Riccardo A. Audisio, Malcolm W. R. Reed, Lynda Wyld, JULIET WRIGHT (2021)Observational cohort study to determine the degree and causes of variation in the rate of surgery or primary endocrine therapy in older women with operable breast cancer, In: European journal of surgical oncology47(2)pp. 261-268 Elsevier

Background: In the UK there is variation in the treatment of older women with breast cancer, with up to 40% receiving primary endocrine therapy (PET), which is associated with inferior survival. Case mix and patient choice may explain some variation in practice but clinician preference may also be important. Methods: A multicentre prospective cohort study of women aged >70 with operable breast cancer. Patient characteristics (health status, age, tumour characteristics, treatment allocation and decision-making preference) were analysed to identify whether treatment variation persisted following case-mix adjustment. Expected case-mix adjusted surgery rates were derived by logistic regression using the variables age, co-morbidity, tumour stage and grade. Concordance between patients' preferred and actual decision-making style was assessed and associations between age, treatment and decision-making style calculated. Results: Women (median age 77, range 70-102) were recruited from 56 UK breast units between 2013 and 2018. Of 2854/3369 eligible women with oestrogen receptor positive breast cancer, 2354 were treated with surgery and 500 with PET. Unadjusted surgery rates varied between hospitals, with 23/56 units falling outside the 95% confidence intervals on funnel plots. Adjusting for case mix reduced, but did not eliminate, this variation between hospitals (10/56 units had practice outside the 95% confidence intervals). Patients treated with PET had more patient-centred decisions compared to surgical patients (42.2% vs 28.4%, p < 0.001). Conclusions: This study demonstrates variation in treatment selection thresholds for older women with breast cancer. Health stratified guidelines on thresholds for PET would help reduce variation, although patient preference should still be respected. (C) 2020 The Authors. Published by Elsevier Ltd.

L. Wyld, M. W. R. Reed, K. Collins, M. Burton, K. Lifford, A. Edwards, S. Ward, G. Holmes, J. Morgan, M. Bradburn, S. J. Walters, A. Ring, T. G. Robinson, C. Martin, T. Chater, K. Pemberton, A. Shrestha, A. Nettleship, C. Murray, M. Brown, P. Richards, K. L. Cheung, A. Todd, H. Harder, K. Brain, R. A. Audisio, J. Wright, R. Simcock, F. Armitage, M. Bursnall, T. Green, D. Revell, J. Gath, K. Horgan, C. Holcombe, M. Winter, J. Naik, R. Parmeshwar, M. Gosney, M. Hatton, A. M. Thompson (2021)Bridging the age gap in breast cancer: cluster randomized trial of two decision support interventions for older women with operable breast cancer on quality of life, survival, decision quality, and treatment choices, In: British journal of surgery108(5)pp. 499-510 Oxford Univ Press

Background: Rates of surgery and adjuvant therapy for breast cancer vary widely between breast units. This may contribute to differences in survival. This cluster RCT evaluated the impact of decision support interventions (DESIs) for older women with breast cancer, to ascertain whether DESIs influenced quality of life, survival, decision quality, and treatment choice. Methods: A multicentre cluster RCT compared the use of two DESIs against usual care in treatment decision-making in older women (aged at least >= 70 years) with breast cancer. Each DESI comprised an online algorithm, booklet, and brief decision aid to inform choices between surgery plus adjuvant endocrine therapy versus primary endocrine therapy, and adjuvant chemotherapy versus no chemotherapy. The primary outcome was quality of life. Secondary outcomes included decision quality measures, survival, and treatment choice. Results: A total of 46 breast units were randomized (21 intervention, 25 usual care), recruiting 1339 women (670 intervention, 669 usual care). There was no significant difference in global quality of life at 6 months after the baseline assessment on intention-to-treat analysis (difference -0.20, 95 per cent confidence interval (C.I.) -2.69 to 2.29; P = 0.900). In women offered a choice of primary endocrine therapy versus surgery plus endocrine therapy, knowledge about treatments was greater in the intervention arm (94 versus 74 per cent; P = 0.003). Treatment choice was altered, with a primary endocrine therapy rate among women with oestrogen receptor-positive disease of 21.0 per cent in the intervention versus 15.4 per cent in usual-care sites (difference 5.5 (95 per cent C.I. 1.1 to 10.0) per cent; P = 0.029). The chemotherapy rate was 10.3 per cent at intervention versus 14.8 per cent at usual-care sites (difference -4.5 (C.I. -8.0 to 0) per cent; P = 0.013). Survival was similar in both arms. Conclusion: The use of DESIs in older women increases knowledge of breast cancer treatment options, facilitates shared decision-making, and alters treatment selection.

Nicolò Matteo Luca Battisti, Matthew Q. Hatton, Malcolm W.R. Reed, Esther Herbert, Jenna L. Morgan, Michael Bradburn, Richard Simcock, Stephen J. Walters, Karen A. Collins, Sue E. Ward, Geoffrey R. Holmes, Maria Burton, Kate J. Lifford, Adrian Edwards, Thompson G. Robinson, Charlene Martin, Tim Chater, Kirsty J. Pemberton, Alan Brennan, Kwok Leung Cheung, Annaliza Todd, Riccardo A. Audisio, Juliet Wright, Tracy Green, Deirdre Revell, Jacqui Gath, Kieran Horgan, Chris Holcombe, Matthew C. Winter, Jay Naik, Rishi Parmeshwar, Margot A. Gosney, Alastair M. Thompson, Lynda Wyld, Alistair Ring (2021)Observational cohort study in older women with early breast cancer: Use of radiation therapy and impact on health-related quality of life and mortality, In: Radiotherapy and oncology161pp. 166-176 Elsevier B.V

Radiotherapy reduces in-breast recurrence risk in early breast cancer (EBC) in older women. This benefit may be small and should be balanced against treatment effect and holistic patient assessment. This study described treatment patterns according to fitness and impact on health-related quality-of-life (HRQoL). A multicentre, observational study of EBC patients aged ≥ 70 years, undergoing breast-conserving surgery (BCS) or mastectomy, was undertaken. Associations between radiotherapy use, surgery, clinico-pathological parameters, fitness based on geriatric parameters and treatment centre were determined. HRQoL was measured using the European Organisation for the Research and Treatment of Cancer (EORTC) questionnaires. In 2013–2018 2811 women in 56 UK study centres underwent surgery with a median follow-up of 52 months. On multivariable analysis, age and tumour risk predicted radiotherapy use. Among healthier patients (based on geriatric assessments) with high-risk tumours, 534/613 (87.1%) having BCS and 185/341 (54.2%) having mastectomy received radiotherapy. In less fit individuals with low-risk tumours undergoing BCS, 149/207 (72.0%) received radiotherapy. Radiotherapy effects on HRQoL domains, including breast symptoms and fatigue were seen, resolving by 18 months. Radiotherapy use in EBC patients ≥ 70 years is affected by age and recurrence risk, whereas geriatric parameters have limited impact regardless of type of surgery. There was geographical variation in treatment, with some fit older women with high-risk tumours not receiving radiotherapy, and some older, low-risk, EBC patients receiving radiotherapy after BCS despite evidence of limited benefit. The impact on HRQoL is transient.

Balamurugan Tangiisuran, Greg Scutt, Jennifer Stevenson, Juliet Wright, G Onder, M Petrovic, T J van der Cammen, Chakravarthi Rajkumar, Graham Davies (2014)Development and validation of a risk model for predicting adverse drug reactions in older people during hospital stay: Brighton Adverse Drug Reactions Risk (BADRI) model, In: PloS one9(10) PLOS

BACKGROUNDOlder patients are at an increased risk of developing adverse drug reactions (ADR). Of particular concern are the oldest old, which constitute an increasingly growing population. Having a validated clinical tool to identify those older patients at risk of developing an ADR during hospital stay would enable healthcare staff to put measures in place to reduce the risk of such an event developing. The current study aimed to (1) develop and (2) validate an ADR risk prediction model. METHODSWe used a combination of univariate analysis and multivariate binary logistic regression to identify clinical risk factors for developing an ADR in a population of older people from a UK teaching hospital. The final ADR risk model was then validated in a European population (European dataset). RESULTSSix-hundred-ninety patients (median age 85 years) were enrolled in the development stage of the study. Ninety-five reports of ADR were confirmed by independent review in these patients. Five clinical variables were identified through multivariate analysis and included in our final model; each variable was attributed a score of 1. Internal validation produced an AUROC of 0.74, a sensitivity of 80%, and specificity of 55%. During the external validation stage the AUROC was 0.73, with sensitivity and specificity values of 84% and 43% respectively. CONCLUSIONSWe have developed and successfully validated a simple model to use ADR risk score in a population of patients with a median age of 85, i.e. the oldest old. The model is based on 5 clinical variables (≥8 drugs, hyperlipidaemia, raised white cell count, use of anti-diabetic agents, length of stay ≥12 days), some of which have not been previously reported.

Fabio Gomes, Anna Lewis, Rob Morris, Ruth Parks, Tania Kalsi, Gordana Babic-Illamn, Mark Baxter, Kirsty Colquhoun, Lisa Rodgers, Eleanor Smith, Alastair Greystoke, Neil Bayman, Anthea Cree, Cassandra Ng, Nicola de Liguori Carino, Simone Basile, John Moore, Zoe Merchant, Daniel Swinson, Anita Parbhoo, Rachel Jones, Eleri Davies, Sarah J Danson, Robin Young, Jenna Morgan, Lynda Wyld, Pippa G Corrie, Gary J Doherty, Kyle Crawford, Juliet Wright, Malcolm Reed, Fiammetta Ugolini, Michael Lind, Kwok-Leung Cheung, Danielle Harari, Richard Simcock (2020)The care of older cancer patients in the United Kingdom, In: Ecancermedicalscience141101 Cancer Intelligence

The ageing population poses new challenges globally. Cancer care for older patients is one of these challenges, and it has a significant impact on societies. In the United Kingdom (UK), as the number of older cancer patients increases, the management of this group has become part of daily practice for most oncology teams in every geographical area. Older cancer patients are at a higher risk of both under- and over-treatment. Therefore, the assessment of a patient’s biological age and effective organ functional reserve becomes paramount. This may then guide treatment decisions by better estimating a prognosis and the risk-to-benefit ratio of a given therapy to anticipate and mitigate against potential toxicities/difficulties. Moreover, older cancer patients are often affected by geriatric syndromes and other issues that impact their overall health, function and quality of life. Comprehensive geriatric assessments offer an opportunity to identify and address health problems which may then optimise one’s fitness and well-being. Whilst it is widely accepted that older cancer patients may benefit from such an approach, resources are often scarce, and access to dedicated services and research remains limited to specific centres across the UK. The aim of this project is to map the current services and projects in the UK to learn from each other and shape the future direction of care of older patients with cancer.

Anna E. Bone, Myfanwy Morgan, Matthew Maddocks, Katherine E. Sleeman, Juliet Wright, Shamim Taherzadeh, Clare Ellis-Smith, Irene J. Higginson, Catherine J. Evans (2016)Developing a model of short-term integrated palliative and supportive care for frail older people in community settings: perspectives of older people, carers and other key stakeholders, In: Age and ageing45(6)pp. 863-873 Oxford Univ Press

Background: understanding how best to provide palliative care for frail older people with non-malignant conditions is an international priority. We aimed to develop a community-based episodic model of short-term integrated palliative and supportive care (SIPS) based on the views of service users and other key stakeholders in the United Kingdom. Method: transparent expert consultations with health professionals, voluntary sector and carer representatives including a consensus survey; and focus groups with older people and carers were used to generate recommendations for the SIPS model. Discussions focused on three key components of the model: potential benefit of SIPS, timing of delivery and processes of integrated working between specialist palliative care and generalist practitioners. Content and descriptive analysis was employed and findings were integrated across the data sources. Findings: we conducted two expert consultations (n = 63), a consensus survey (n = 42) and three focus groups (n = 17). Potential benefits of SIPS included holistic assessment, opportunity for end of life discussion, symptom management and carer reassurance. Older people and carers advocated early access to SIPS, while other stakeholders proposed delivery based on complex symptom burden. A priority for integrated working was the assignment of a key worker to co-ordinate care, but the assignment criteria remain uncertain. Interpretation: key stakeholders agree that a model of SIPS for frail older people with non-malignant conditions has potential benefits within community settings, but differ in opinion on the optimal timing and indications for this service. Our findings highlight the importance of consulting all key stakeholders in model development prior to feasibility evaluation.

Nicolo Matteo Luca Battisti, Juliet Wright, Malcolm W. R. Reed, Esther Herbert, Jenna L. Morgan, Karen A. Collins, Sue E. Ward, Geoffrey R. Holmes, Michael Bradburn, Stephen J. Walters, Maria Burton, Kate Lifford, Adrian Edwards, Thompson G. Robinson, Charlene Martin, Tim Chater, Kirsty J. Pemberton, Anne Shrestha, Alan Brennan, Kwok L. Cheung, Annaliza Todd, Riccardo A. Audisio, Richard Simcock, Tracey Green, Deirdre Revell, Jacqui Gath, Kieran Horgan, Chris Holcombe, Matthew C. Winter, Jay Naik, Rishi Parmeshwar, Margot A. Gosney, Matthew Q. Hatton, Alastair M. Thompson, Lynda Wyld, Alistair Ring (2020)Bridging the Age Gap in breast cancer: Impact of chemotherapy on quality of life in older women with early breast cancer, In: European journal of cancer (1990)144pp. 269-280 Elsevier

Introduction: Older patients with early breast cancer (EBC) derive modest survival benefit from chemotherapy but have increased toxicity risk. Data on the impact of chemotherapy for EBC on quality of life in older patients are limited, but this is a key determinant of treatment acceptance. We aimed to investigate its effect on quality of life in older patients enrolled in the Bridging the Age Gap study. Materials and methods: A prospective, multicentre, observational study of EBC patients >= 70 years old was conducted in 2013-2018 at 56 UK hospitals. Demographics, patient, tumour characteristics, treatments and adverse events were recorded. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaires (EORTC-QLQ) C30, BR23 and ELD 15 plus the Euroqol-5D (eq-5d) over 24 months and analysed at each time point using baseline adjusted linear regression analysis and propensity score-matching. Results: Three thousand and four hundred sixteen patients were enrolled in the study; 1520 patients undergoing surgery and who had high-risk EBC were included in this analysis. 376/ 1520 (24.7%) received chemotherapy. At 6 months, chemotherapy had a significant negative impact in several EORTC-QLQ-C30 domains, including global health score, physical, role, social functioning, cognition, fatigue, nausea/vomiting, dyspnoea, appetite loss, diarrhoea and constipation. Similar trends were documented on other scales (EORTC-QLQ-BR23, EORTC-QLQ-ELD15 and EQ-5D-5L). Its impact was no longer significant at 18-24 months in unmatched and matched cohorts. Conclusions: The negative impact of chemotherapy on quality-of-life is clinically and statistically significant at 6 months but resolves by 18 months, which is crucial to inform decisionmaking for older patients contemplating chemotherapy.

Rebecca Winter, Muna Al-Jawad, Richard Harris, Juliet Wright (2019)Learning to communicate with people with dementia: Exploring the impact of a simulation session for medical students (Innovative practice), In: Dementia (London, England)19(8)pp. 2919-2927 SAGE Publications

There is a recognised need to improve undergraduate education within dementia care. UK medical schools provide dementia-specific teaching, but this has previously been found to focus more on student knowledge and skills rather than behaviours and attitudes and does not often involve the wider multidisciplinary team. A simulation day was established, based on communicating with a person with dementia in a number of scenarios. This article aims to identify if this method of teaching within dementia care is successful. It is a qualitative study and draws on data from postcourse questionnaire responses and field notes of the simulation day. The data offered rich insights into how the session allowed participants to be challenged and taken to their perceived thresholds of capability. It highlights that behaviours and skills can be learnt via simulation and leads to a transformative change in the language learners used, suggesting that learning may happen through threshold concepts.

T. Levett, J. Wright, M. Fisher (2013)HIV and ageing: what the geriatrician needs to know, In: Reviews in clinical gerontology24(1)pp. 10-24 Cambridge Univ Press

The transformation of human immunodeficiency virus (HIV) from a rapidly fatal disease to a chronic manageable illness has resulted in annual increases in the numbers of people living with HIV. The HIV cohort is therefore ageing, with numbers of older adults with HIV climbing, through both prolonged survival and late acquisition of the disease. Associated with ageing is an accumulation of HIV-associated non-AIDS related comorbidities, creating a complex patient group affected by multi-morbidity along with polypharmacy, functional decline and complex social issues. With this in mind, this review seeks to explore areas where HIV (diagnosed or undetected) may impact on the work of clinical geriatricians.

Elaney Youssef, Vanessa Cooper, Valerie Delpech, Kevin Davies, Juliet Wright (2017)Barriers and facilitators to HIV testing in people age 50 and above: a systematic review, In: Clinical medicine (London, England)17(6)pp. 508-520 Royal College of Physicians

Approximately 13% of people living with HIV in the UK are unaware of their infection. New diagnoses among people ≥50 years is increasing. Unique factors may be associated with testing in this group. This systematic review aims to identify patient and clinician-related barriers/facilitators to HIV testing in people aged ≥50 years. A systematic electronic search was conducted. Papers were assessed for eligibility and data from eligible studies were extracted. Barriers/facilitators were grouped, and the number of times they were reported was noted. Because of considerable heterogeneity, a narrative approach has been undertaken to synthesise data. In total, 17 studies were included. Main barriers to testing were low perceived risk and clinicians' preconceptions about older people. Main facilitators were regular use of healthcare services or being offered/encouraged to test by a healthcare provider. Although being encouraged to test was a common facilitator, clinicians' preconceptions about older people was the biggest barrier. This shows a divide between clinicians' preconceptions and patients' expectations, which may impact on testing rates. This review is an important first step in identifying potential barriers/facilitators for further study or to be addressed in the design of future interventions.

E. Youssef, V. Cooper, E. Nixon, J. H. Vera, M. Fisher, J. Wright (2017)The management of comorbidities in older people living with HIV in England: a cross sectional survey, In: HIV medicine18(7)pp. 534-535 Wiley
Balamurugan Tangiisuran, Juliet Wright, Tischa Van der Cammen, Chakravarthi Rajkumar (2009)Adverse drug reactions in elderly: challenges in identification and improving preventative strategies, In: Age and ageing38(4)pp. 358-359 Oxford Univ Press
Anna E. Bone, Wei Gao, Barbara Gomes, Katherine E. Sleeman, Matthew Maddocks, Juliet Wright, Deokhee Yi, Irene J. Higginson, Catherine J. Evans (2016)Factors Associated with Transition from Community Settings to Hospital as Place of Death for Adults Aged 75 and Older: A Population-Based Mortality Follow-Back Survey, In: Journal of the American Geriatrics Society (JAGS)64(11)pp. 2210-2217 Wiley

ObjectivesTo identify factors associated with end-of-life (EoL) transition from usual place of care to the hospital as place of death for people aged 75 and older. DesignPopulation-based mortality follow-back survey. SettingDeaths over 6 months in 2012 in two unitary authorities in England covering 800 square miles with more than 1 million residents. ParticipantsA random sample of people aged 75 and older who died in a care home or hospital and all those who died at home or in a hospice unit (N = 882). Cases were identified from death registrations. The person who registered the death (a relative for 98.9%) completed the survey. MeasurementsThe main outcome was EoL transition to the hospital as place of death versus no EoL transition to the hospital. Multivariable modified Poisson regression was used to examine factors (illness, demographic, environmental) related to EoL transition to the hospital. ResultsFour hundred forty-three (50.2%) individuals responded, describing the care of the people who died. Most died from nonmalignant conditions (76.3%) at a mean age of 87.4 6.4. One hundred forty-six (32.3%) transitioned to the hospital and died there. Transition was more likely for individuals with respiratory disease than for those with cancer (prevalence ratio (PR) = 2.07, 95% confidence interval (CI) = 1.42-3.01) and for people with severe breathlessness (PR = 1.96, 95% CI = 1.12-3.43). Transition was less likely if EoL preferences had been discussed with a healthcare professional (PR = 0.60, 95% CI = 0.42-0.88) and when there was a key healthcare professional (PR = 0.74, 95% CI = 0.58-0.95). ConclusionTo reduce EoL transition to the hospital for older people, there needs to be improved management of breathlessness in the community and better access to a key healthcare professional skilled in coordinating care, communication, facilitating complex discussions, and in planning for future care.

Jonathan Sadler, Juliet Wright, Timothy Vincent, Thomas Kurka, David Howlett (2020)What is the impact of Apps in medical education? A study of CAPSULE, a case-based learning App, In: BMJ simulation & technology enhanced learning7(5)pp. 293-296 Bmj Publishing Group

Introduction Mobile applications (Apps) are popular in medical education; yet, the actual benefits for students are yet to be formally researched. Clinical And Professional Studies Unique Learning Environment (CAPSULE) is an App created by Brighton and Sussex Medical School. The App provides 650 cases offered to students in their final two years of the undergraduate programme. The App performed consistently well in student feedback, and therefore, a study into the educational benefits of the App was constructed. Methods A cross-sectional study was performed following two years of use by students to investigate the relationship between App usage and decile ranking. Results The study found that the students who completed more cases tended to score higher per case (p value=0.0037). The study also found a trend between having higher case scores and being part of a stronger decile (p value=0.019). Conclusions Greater App usage was linked with performing better in the App itself and this was further associated with being in a stronger decile rank. From a user perspective, the data generated from the App could help with identifying students who are underperforming or help students to recognise areas on which they need to focus.

Stephanie Daley, Yvonne Feeney, Wendy Grosvenor, Molly Hebditch, Leila Morley, Gillian Sleater, Juliet Wright, Sube Banerjee (2020)A qualitative evaluation of the effect of a longitudinal dementia education programme on healthcare student knowledge and attitudes, In: Age and ageing49(6)pp. 1080-1086 Oxford University Press

Background and objectives: There is a need to ensure that the future healthcare workforce has the necessary knowledge and skills to deliver high quality compassionate care to the increasing number of people with dementia. Our programme has been set up to address this challenge. In the programme, undergraduate healthcare students (nursing, medical and paramedic) visit a family (person with dementia and their carer) in pairs over a 2-year period. This qualitative study sought to understand the student experience of the programme. Methods: Participants were undergraduate healthcare students who were undertaking our programme at two universities. We sampled for variation in the student participants in order to generate a framework for understanding the student experience of the programme. Students were invited to take part in the qualitative study, and written consent was obtained. Interviews and focus group transcripts were analysed using thematic analysis. Results: Thirty-nine (nursing, medical and paramedic) student participants took part in individual in-depth qualitative interviews and 38 took part in five focus groups. Four key themes were identified from the analysis; relational learning, insight and understanding, challenging attitudes and enhanced dementia practice. Discussion: Student experience of our programme was shown to be positive. The relationship between the students and family was most impactful in supporting student learning, and the subsequent improvement in knowledge, attitudes and practice. Our model of undergraduate dementia education has applicability for other long-term conditions.

Adam de Belder, Aung Myat, Jonathan Blaxill, Peter Haworth, Peter O'Kane, Robert Hatrick, Rajesh Aggarwal, Andrew Davie, William Smith, Robert Gerber, Jonathan Byrne, Dawn Adamson, Fraser Witherow, Osama Alsanjari, Juliet Wright, Derek R. Robinson, David Hildick-Smith (2021)Revascularisation or medical therapy in elderly patients with acute anginal syndromes: the RINCAL randomised trial, In: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology17(1)pp. 67-74 Europa Edition

Background: Historically the elderly have been under-represented in non-ST-elevation myocardial infarction (NSTEMI) management trials. Aims: The aim of this trial was to demonstrate that an intervention-guided strategy is superior to optimal medical therapy (OMT) alone for treating NSTEMI in elderly individuals. Methods: Patients (>= 80 years, chest pain, ischaemic ECG, and elevated troponin) were randomised 1:1 to an intervention-guided strategy plus OMT versus OMT alone. The primary endpoint was a composite of all-cause mortality and non-fatal myocardial reinfarction at 1 year. Ethics approval was obtained by the institutional review board of every recruiting centre. Results: From May 2014 to September 2018, 251 patients (n=125 invasive vs n=126 conservative) were enrolled. Almost 50% of participants were female. The trial was terminated prematurely due to slow recruitment. A Kaplan-Meier estimate of event-free survival revealed no difference in the primary endpoint at 1 year (invasive 18.5% [23/124] vs conservative 22.2% [28/126]; p=0.39). No significant difference persisted after Cox proportional hazards regression analysis (hazard ratio 0.79, 95% confidence interval 0.45-1.35; p=0.39). There was greater freedom from angina at 3 months (p

Catherine J. Evans, Anna E. Bone, Deokhee Yi, Wei Gao, Myfanwy Morgan, Shamim Taherzadeh, Matthew Maddocks, Juliet Wright, Fiona Lindsay, Carla Bruni, Richard Harding, Katherine E. Sleeman, Barbara Gomes, Irene J. Higginson (2021)Community-based short-term integrated palliative and supportive care reduces symptom distress for older people with chronic noncancer conditions compared with usual care: A randomised controlled single-blind mixed method trial, In: International journal of nursing studies120pp. 103978-103978 Elsevier Ltd

Background Globally, a rising number of people live into advanced age and die with multimorbidity and frailty. Palliative care is advocated as a person-centred approach to reduce health-related suffering and promote quality of life. However, no evidence-based interventions exist to deliver community-based palliative care for this population. Aim To evaluate the impact of the short-term integrated palliative and supportive care intervention for older people living with chronic noncancer conditions and frailty on clinical and economic outcomes and perceptions of care. Design Single-blind trial with random block assignment to usual care or the intervention and usual care. The intervention comprised integrated person-centred palliative care delivered by multidisciplinary palliative care teams working with general practitioners and community nurses. Main outcome was change in five key palliative care symptoms from baseline to 12-weeks. Data analysis used intention to treat and complete cases to examine the mean difference in change scores and effect size between the trial arms. Economic evaluation used cost-effectiveness planes and qualitative interviews explored perceptions of the intervention. Setting/participants Four National Health Service general practices in England with recruitment of patients aged ≥75 years, with moderate to severe frailty, chronic noncancer condition(s) and ≥2 symptoms or concerns, and family caregivers when available. Results 50 patients were randomly assigned to receive usual care (n = 26, mean age 86.0 years) or the intervention and usual care (n = 24, mean age 85.3 years), and 26 caregivers (control n = 16, mean age 77.0 years; intervention n = 10, mean age 77.3 years). Participants lived at home (n = 48) or care home (n = 2). Complete case analysis (n = 48) on the main outcome showed reduced symptom distress between the intervention compared with usual care (mean difference -1.20, 95% confidence interval -2.37 to -0.027) and medium effect size (omega squared = 0.071). Symptom distress reduced with decreased costs from the intervention compared with usual care, demonstrating cost-effectiveness. Patient (n = 19) and caregiver (n = 9) interviews generated themes about the intervention of ‘Little things make a big difference’ with optimal management of symptoms and ‘Care beyond medicines’ of psychosocial support to accommodate decline and maintain independence. Conclusions This palliative and supportive care intervention is an effective and cost-effective approach to reduce symptom distress for older people severely affected by chronic noncancer conditions. It is a clinically effective way to integrate specialist palliative care with primary and community care for older people with chronic conditions. Further research is indicated to examine its implementation more widely for people at home and in care homes. Trial registration: Controlled-Trials.com ISRCTN 45837097 Tweetable abstract: Specialist palliative care integrated with district nurses and GPs is cost-effective to reduce symptom distress for older people severely affected by chronic conditions.

Philip Thompson, Juliet Wright, Chakravarthi Rajkumar (2011)Non-pharmacological treatments for orthostatic hypotension, In: Age and ageing40(3)pp. 292-293 Oxford Univ Press
Dilhara Karunaratne, Nisal Karunaratne, Jade Wilmot, Tim Vincent, Juliet Wright, Nadia Mahmood, Alice Tang, Amir H. Sam, Malcolm Reed, David Howlett (2021)An Online Teaching Resource to Support UK Medical Student Education During the COVID-19 Pandemic: A Descriptive Account, In: Advances in medical education and practice12pp. 1317-1327 Dove Medical Press Ltd

This paper describes the development and use of the bespoke digital learning resource CAPSULE (Clinical and Professional Studies Unique Learning Environment) which was launched UK wide in May 2020 to facilitate the delivery of core learning content for UK medical students during the COVID-19 pandemic. CAPSULE is a digital learning resource comprising case-based scenarios and multiple-choice questions, encompassing all undergraduate medical specialities and supported by a pan-speciality editorial board. Following the COVID-19 pandemic lockdown and loss of face-to-face learning opportunities, CAPSULE was made available to all UK medical schools in May 2020. Following a global content review and edit and UK wide rollout, over 41,000 medical students and 3200 faculty registered as users. Approximately 1.5 million cases were completed in the first 12 months of use by up to 4500 distinct monthly users. Feedback from both students and faculty has been highly positive. CAPSULE continues to be used within UK medical schools and has allowed an entire cohort of medical students to access core curriculum content and progress their studies during the COVID-19 pandemic. Future directions may include further integration into UK medical school curricula, enhancement of platform functionality and potential expansion on an international scale.

Elaney Youssef, Juliet Wright, Valerie Delpech, Kevin Davies, Alison Brown, Vanessa Cooper, Memory Sachikonye, Richard de Visser (2018)Factors associated with testing for HIV in people aged >= 50 years: a qualitative study, In: BMC public health18pp. 1204-1204 Springer Nature

Background: Despite a decline in the number of new HIV infections in the UK overall, the number and proportion of new HIV diagnoses in people aged >= 50 years continues to increase. People aged >= 50 years are disproportionately affected by late diagnosis, which is associated with poorer health outcomes, increased treatment complexity and increased healthcare costs. Late HIV diagnosis also has significant public health implications in terms of onward HIV transmission. It is not fully understood what factors affect the decision of an older person to test for HIV. The aim of this study was to identify factors associated with testing for HIV in people aged >= 50 years who tested late for HIV. Methods: We interviewed 20 people aged >= 50 years diagnosed late with HIV to identify factors associated with HIV testing. Interviews were audio recorded, transcribed verbatim and thematically analysed. Results: Seven themes associated with HIV testing in people aged >= 50 years were identified: experience of early HIV/AIDS campaigns, HIV knowledge, presence of symptoms and symptom attribution, risk and risk perception, generational approaches to health and sexual health, stigma, and type of testing and testing venue. Conclusion: Some factors associated with testing identified in this study were unique to older individuals. People aged >= 50 years often do not perceive themselves to be at risk of HIV. Further, stigma and a lack of knowledge of how to access HIV testing suggest a need for health promotion and suggest current sexual health services may need to adapt to better meet their needs.

Harriet Daultrey, Elaney Youseff, Juliet Wright, Kevin Davies, Ali J. Chakera, Tom Levett (2020)The investigation of diabetes in people living with HIV: A systematic review, In: Diabetic medicine38(4)pp. e14454-n/a Wiley

Aims HbA(1c) is reported to underestimate glycaemia in people living with HIV (PLHIV). There is not an internationally agreed screening method for diabetes. The primary aim was to identify which tests are performed to diagnose and monitor diabetes in PLHIV. Secondary aims were to identify whether prevalence or incidence of diabetes differs according to marker of glycaemia and how figures compare in PLHIV compared to people without. Methods Electronic databases were searched for studies investigating diabetes in PLHIV, not pregnant, aged >= 18 years. Narrative analysis and descriptive statistics were used to describe which markers of glycaemia, and their frequency, were employed in the diagnosis and monitoring of diabetes in PLHIV. Diagnostic studies provided prevalence or incidence of diabetes. Results In all, 45 of 1028 studies were included. Oral glucose tolerance test (OGTT), fasting glucose (FG), HbA(1c) and Fructosamine were used to investigate diabetes. In total, 27 studies described diagnosing diabetes, 14 using OGTT, 12 FG and 7 HbA1c. All 18 studies monitoring diabetes used HbA1c. Prevalence ranged from 1.3% to 26% and incidence 2.9% to 12.8%. Studies using glucose and HbA(1c) reported HbA(1c) to diagnose fewer people with diabetes, monitoring studies found HbA(1c) to underestimate glycaemia levels. Controlled studies demonstrate diabetes was more common in PLHIV. Conclusion OGTT was used most frequently to diagnose diabetes, and HbA(1c) to monitor known diabetes. Prevalence and incidence varied depending on marker of glycaemia used. Studies reported a discrepancy in accuracy of HbA(1c) in PLHIV, to address this, well-designed, prospective studies, providing individual-level data on HbA(1c) levels and an additional marker of glycaemia in PLHIV are needed.

Sube Banerjee, Christopher Jones, Juliet Wright, Wendy Grosvenor, Molly Hebditch, Leila Hughes, Yvonne Feeney, Nicolas Farina, Sophie Mackrell, Ramin Nilforooshan, Chris Fox, Stephen Bremner, Stephanie Daley (2021)A comparative study of the effect of the Time for Dementia programme on medical students, In: International journal of geriatric psychiatry36(7)pp. 1011-1019 Wiley

Background Traditional healthcare education typically focuses on short block clinical placements based on acute care, investigations and technical aspects of diagnosis and treatment. It may therefore fail to build the understanding, compassion and person-centred empathy needed to help those with long-term conditions, like dementia. Time for Dementia was developed to address this. Method Parallel group comparison of two cohorts of UK medical students from universities, one participating in Time for Dementia (intervention group) and one not (control group). In Time for Dementia students visit a person with dementia and their family in pairs for 2 hours three times a year for 2 years, the control group received their normal curriculum. Results In an adjusted multilevel model (intervention group n = 274, control n = 112), there was strong evidence supporting improvements for Time for Dementia participants in: total Approaches to Dementia Questionnaire score (coefficient: 2.19, p = 0.003) and its person-centredness subscale (1.32, p = 0.006) and weaker evidence in its hopefulness subscale (0.78, p = 0.070). There was also strong evidence of improvement in the Dementia Knowledge Questionnaire (1.63, p < 0.001) and Dementia Attitudes Scale (total score: 6.55, p < 0.001; social comfort subscale: 4.15, p < 0.001; dementia knowledge subscale: 3.38, p = 0.001) scores. No differences were observed on the Alzheimer's Disease Knowledge Scale, the Medical Condition Regard Scale or the Jefferson Scale of Empathy. Discussion Time for Dementia may help improve the attitudes of medical students towards dementia promoting a person-centred approach and increasing social comfort. Such patient-focused programmes may be a useful complement to traditional medical education.

Tom J. Levett, Fiona V. Cresswell, Muzaffar A. Malik, Martin Fisher, Juliet Wright (2016)Systematic Review of Prevalence and Predictors of Frailty in Individuals with Human Immunodeficiency Virus, In: Journal of the American Geriatrics Society (JAGS)64(5)pp. 1006-1014 Wiley

ObjectivesTo describe the prevalence and predictors of frailty in individuals with the human immunodeficiency virus (HIV) using systematic review methodology. DesignReview. SettingCommunity. ParticipantsOlder adults with HIV. MeasurementsMedline, CINAHL, EMBASE, PsychInfo, and PubMed were searched for original observational studies with populations including individuals with HIV in which frailty was assessed using the frailty phenotype or a variant thereof. Studies were examined for frailty prevalence and predictors of the syndrome in those with HIV. ResultsThirteen of 322 citations were included for full review. All demonstrated the presence of frailty in individuals with HIV, with prevalence ranging from 5% to 28.6% depending on population studied. HIV was a risk factor for frailty. Predictors of frailty included older age, comorbidities, diagnosis of acquired immunodeficiency syndrome, and low current CD4(+) cell count. ConclusionHIV appears to be an independent risk factor for frailty, with frailty occurring in individuals with HIV at rates comparable with older individuals without HIV. Heterogeneity in study populations and frailty assessment measures hamper accurate description of the problem. Future longitudinal work with standardized methodology is needed to describe prevalence accurately and confirm predictors.

Josephine Cashman, Juliet Wright, Alistair Ring (2010)The treatment of co-morbidities in older patients with metastatic cancer, In: Supportive care in cancer18pp. 651-655

The purpose of the study was to determine whether older patients with metastatic cancer continue to take medications for the treatment of pre-existing co-morbidities after the diagnosis of metastatic disease. Between November 2008 and June 2009, patients over the age of 65 with metastatic cancer were interviewed. Medical records were reviewed in order to ascertain current medication use and relevant past medical history. Classes of medication of interest were prospectively defined; these were anti-hypertensives, lipid-lowering drugs, anti-platelet agents, anti-coagulants and bisphosphonates. One hundred patients were recruited, with a median age of 73.5 years (range 65-88); 52% were women. The primary cancer sites were breast, 36%; prostate, 27%; colon, 14%; other, 23%. The median performance status of the patients was 2. The median number of medications was 7 (range 1-17). Eighty-one percent of patients were found to be taking one or more of the predefined medications for treatment of a long-term co-morbidity. Overall 52% of patients had side effects attributed to these medications. Patients with metastatic cancer continue to take drugs for prevention of co-morbidities which are associated with side effects and inconvenience. The benefits of these drugs are likely to be minimal, and medication reviews should be undertaken to address their appropriateness.

Tom Levett, Katie Alford, Jonathan Roberts, Zoe Adler, Juliet Wright, Jaime H. Vera (2020)Evaluation of a Combined HIV and Geriatrics Clinic for Older People Living with HIV: The Silver Clinic in Brighton, UK, In: Geriatrics (Basel)5(4) Mdpi

As life expectancy in people living with HIV (PLWH) has increased, the focus of management has shifted to preventing and treating chronic illnesses, but few services exist for the assessment and management of these individuals. Here, we provide an initial description of a geriatric service for people living with HIV and present data from a service evaluation undertaken in the clinic. We conducted an evaluation of the first 52 patients seen in the clinic between 2016 and 2019. We present patient demographic data, assessment outcomes, diagnoses given, and interventions delivered to those seen in the clinic. The average age of attendees was 67. Primary reasons for referral to the clinic included management of complex comorbidities, polypharmacy, and suspected geriatric syndrome (falls, frailty, poor mobility, or cognitive decline). The median (range) number of comorbidities and comedications (non-antiretrovirals) was 7 (2-19) and 9 (1-15), respectively. All attendees had an undetectable viral load. Geriatric syndromes were observed in 26 (50%) patients reviewed in the clinic, with frailty and mental health disease being the most common syndromes. Interventions offered to patients included combination antiretroviral therapy modification, further health investigations, signposting to rehabilitation or social care services, and in-clinic advice. High levels of acceptability among patients and healthcare professionals were reported. The evaluation suggests that specialist geriatric HIV services might play a role in the management of older people with HIV with geriatric syndromes.

Elaney Youssef, Juliet Wright, Kevin A. Davies, Valerie Delpech, Alison Brown, Vanessa Cooper, Memory Sachikonye, Richard de Visser (2022)Factors associated with offering HIV testing to people aged >= 50 years: A qualitative study, In: International journal of STD & AIDS33(3)pp. 1200-1211 Sage

Background Individuals aged >= 50 years continue to be disproportionately affected by late HIV diagnosis, which is associated with poorer health outcomes and onward transmission. Despite HIV testing guidelines and high acceptability of HIV testing among all patients, clinicians are less likely to offer a test to an older individual. The aim of this study was to identify clinician-related factors associated with offering HIV testing to patients aged >= 50 years. Methods Twenty clinicians who had been involved in the care of an older patient diagnosed late with HIV were interviewed. Results Thematic analysis identified seven factors associated with offering HIV testing to older people: knowledge, stigma, stereotyping and perception of risk, symptom attribution, discussing HIV with patients, consent procedures and practical issues. Conclusions Although some factors are not unique to older patients, some are unique to this group. Many clinicians lack up-to-date HIV-related knowledge, feel anxious discussing HIV with older patients and perceive asexuality in older age. In order to increase the offer of HIV testing to this group, we identified clinician-related barriers to test offer that need to be addressed.

Anne Shrestha, Alan Brennan, Kwok L. Cheung, Lynda Wyld, Annaliza Todd, Malcolm W.R. Reed, Riccardo Audisio, Jenna Morgan, Juliet Wright, Richard Simcock, Karen Collins, Tracy Green, Sue Ward, Deirdre Revell, Geoffrey R. Holmes, Jacqui Gath, Mike Bradburn, Kieran Horgan, Stephen Walters, Maria Burton, Chris Holcombe, Esther Herbert, Matt Winter, Kate Lifford, Jay Naik, Rishi Parmeshwar, Adrian Edwards, Julietta Patnick, Alistair Ring, Thompson Robinson, Margot Gosney, Matthew Hatton, Charlene Martin, Alastair M. Thomson, Tim Chater, Kirsty Pemberton (2021)Bridging the age gap in breast cancer. Impacts of omission of breast cancer surgery in older women with oestrogen receptor positive early breast cancer. A risk stratified analysis of survival outcomes and quality of life, In: European journal of cancer (1990)142pp. 48-62 Elsevier Ltd

Age-related breast cancer treatment variance is widespread with many older women having primary endocrine therapy (PET), which may contribute to inferior survival and local control. This propensity-matched study determined if a subgroup of older women may safely be offered PET. Multicentre, prospective, UK, observational cohort study with propensity-matched analysis to determine optimal allocation of surgery plus ET (S+ET) or PET in women aged ≥70 with breast cancer. Data on fitness, frailty, cancer stage, grade, biotype, treatment and quality of life were collected. Propensity-matching (based on age, health status and cancer stage) adjusted for allocation bias when comparing S+ET with PET. A total of 3416 women (median age 77, range 69–102) were recruited from 56 breast units—2854 (88%) had ER+ breast cancer: 2354 had S+ET and 500 PET. Median follow-up was 52 months. Patients treated with PET were older and frailer than patients treated with S+ET. Unmatched overall survival was inferior in the PET group (hazard ratio, (HR) 0.27, 95% confidence interval (CI) 0.23–0.33, P 85 with comorbidities or frailty) individualised decision making regarding PET versus S+ET may be appropriate and safe to offer. The Age Gap online decision tool may support this decision-making process (https://agegap.shef.ac.uk/). ISRCTN: 46099296.

Balamurugan Tangiisuran, J. Graham Davies, Juliet E. Wright, Chakravarthi Rajkumar (2012)Adverse Drug Reactions in a Population of Hospitalized Very Elderly Patients, In: Drugs & aging29(8)pp. 669-679 Springer International Publishing

Objectives The aims of the study were to determine the rates, types, severity and preventability of adverse drug reactions (ADRs) in a hospitalized population of very elderly patients (over 80 years of age) and to identify factors that predispose the very elderly to an ADR. Methods An observational study was conducted in patients over 80 years of age admitted to four care of the elderly wards in Brighton and Sussex University Hospitals NHS Trust. The main outcome measures were the incidence of ADRs during inpatient stay in older patients and the identification of the major drug classes involved and the risk factors contributing to the occurrence of ADRs. Results A total of 560 very elderly patients were recruited, 74 of whom experienced one or more ADR (83 in total), representing an incidence of 13.2% (95% CI 10.4, 16). Sixty-three percent of all ADRs were considered preventable, with 57 classified as serious and three as life threatening. The drug classes frequently implicated in ADRs were cardiovascular agents (34%), analgesic medications (18%) and anti-diabetic drugs (10%). Five variables were established as independent predictors of ADRs: number of medications, use of hypoglycaemic agents, history of hyperlipidaemia, raised white cell count on admission, and length of stay. Conclusions The ADR incidence reported in this population was no greater than that seen in other studies for both general medical patients and those elderly patients over 65 years of age. A significant proportion of ADRs were preventable, and this suggests that closer monitoring of high-risk elderly patients is needed to address this problem.

T. Chater, K. Pemberton, A. Brennan, K. L. Cheung, A. Todd, R. Audisio, J. L. Morgan, A. Shrestha, J. Wright, R. Simcock, M. W. R. Reed, A. M. Thomson, E. Herbert, M. Gosney, M. Bradburn, M. Hatton, S. J. Walters, C. Martin, T. Green, K. Collins, D. Revill, J. Gath, S. Ward, K. Horgan, G. Holmes, M. Burton, C. Holcombe, K. Lifford, M. C. Winter, A. Edwards, J. Naik, A. Ring, R. Parmeschwar, L. Wyld, T. Robinson (2021)Bridging the age gap in breast cancer: impact of omission of breast cancer surgery in older women with oestrogen receptor-positive early breast cancer on quality-of-life outcomes, In: British journal of surgery108(3)pp. 315-325 Oxford Univ Press

Background: Primary endocrine therapy may be an alternative treatment for less fit women with oestrogen receptor (ER)-positive breast cancer. This study compared quality-of-life (QoL) outcomes in older women treated with surgery or primary endocrine therapy. Methods: This was a multicentre, prospective, observational cohort study of surgery or primary endocrine therapy in women aged over 70 years with operable breast cancer. QoL was assessed using European Organisation for Research and Treatment of cancer QoL questionnaires QLQ-C30, BR23, and ELD14, and the EuroQol Five Dimensions 5L score at baseline, 6 weeks, and 6, 12, 18, and 24 months. Propensity score matching was used to adjust for baseline variation in health, fitness, and tumour stage. Results: The study recruited 3416 women (median age 77 (range 69-102) years) from 56 breast units. Of these, 2979 (87.2 per cent) had ER-positive breast cancer; 2354 women had surgery and 500 received primary endocrine therapy (125 were excluded from analysis due to inadequate data or non-standard therapy). Median follow-up was 52 months. The primary endocrine therapy group was older and less fit. Baseline QoL differed between the groups; the mean(s.d.) QLQ-C30 global health status score was 66.2(21.1) in patients who received primary endocrine therapy versus 77.1(17.8) among those who had surgery plus endocrine therapy. In the unmatched analysis, changes in QoL between 6 weeks and baseline were noted in several domains, but by 24 months most scores had returned to baseline levels. In the matched analysis, major surgery (mastectomy or axillary clearance) had a more pronounced adverse impact than primary endocrine therapy in several domains. Conclusion: Adverse effects on QoL are seen in the first few months after surgery, but by 24 months these have largely resolved. Women considering surgery should be informed of these effects.

T. Levett, J. Wright (2017)How to assess and manage frailty in patients with HIV, In: Sexually transmitted infections93pp. 476-477 Bmj Publishing Group
Geoffrey Wells, Elaney Youssef, Rebecca Winter, Juliet Wright, Carrie Llewellyn (2021)Medical student confidence in care of the dying and their family: a systematic review, In: BMJ supportive & palliative care11(3)pp. 233-241

BackgroundThe General Medical Council expects medical graduates to care for dying patients with skill, clinical judgement and compassion. UK surveys continually demonstrate low confidence and increasing distress amongst junior doctors when providing care to the dying.AimThis systematic review aims to determine what has been evidenced within worldwide literature regarding medical undergraduate confidence to care for dying patients.DesignA systematic electronic search was undertaken. Data extraction included measurements of baseline confidence, associated assessment tools and details of applied educational interventions. Pre/postintervention confidence comparisons were made. Factors influencing confidence levels were explored.Data sourcesMEDLINE, CINAHL, EMBASE, ISI Web of Science, ERIC, PsycINFO, British Education Index and Cochrane Review databases were accessed, with no restrictions on publication year. Eligible studies included the terms ‘medical student’, ‘confidence’ and ‘dying’, alongside appropriate MeSH headings. Study quality was assessed using the Mixed Methods Appraisal Tool.ResultsFifteen eligible studies were included, demonstrating a diversity of assessment tools. Student confidence was low in provision of symptom management, family support, and psycho-spiritual support to dying patients. Eight interventional studies demonstrated increased postinterventional confidence. Lack of undergraduate exposure to dying patients and lack of structure within undergraduate palliative care curricula were cited as factors responsible for low confidence.ConclusionThis review clarifies the objective documentation of medical undergraduate confidence to care for the dying. Identifying where teaching fails to prepare graduates for realities in clinical practice will help inform future undergraduate palliative care curriculum planning.PROSPERO registration numberCRD42019119057.

Molly Hebditch, Sube Banerjee, Juliet Wright, Stephanie Daley (2021)Preferences of newly qualified healthcare professionals for working with people with dementia: a qualitative study, In: Age and ageing51(1) Oxford Univ Press

Background there is little research on preferences in students and newly qualified healthcare professionals for working with people with dementia. Understanding the development of these preferences can help inform strategies to increase workforce capacity in response to current suboptimal dementia care and the increasing numbers of people with dementia. Objective to explore the factors that influence career preferences in relation to working with people with dementia. Specifically, to understand how these factors relate to early career doctors' and nurses' preferences and how they influence decisions and perspectives on their careers. Methods qualitative in-depth interviews were conducted with 27 newly qualified doctors and nurses within 2 years of graduation. This included a subset of participants that had taken part in a dementia educational intervention during their undergraduate training. Transcripts were analysed using grounded theory methods. Results the results present six main categories representing complex interlinked factors influencing preferences for working with people with dementia as well as exploring the definition of a career working with people with dementia. The factors include the importance of making a difference; seeing dementia care as a different type of care; its perceived alignment with personal characteristics; perceptions of people with dementia; care environments and career characteristics. Discussion this is the first study to explore the factors influencing preferences for working with people with dementia in newly qualified healthcare professionals. It provides useful data to inform workforce planning, and curriculum and practice development to stimulate interest and drive improved quality of care.