Ashrafunnesa Khanom

Swansea University | SWAN · Medical School -Wales Centre for Primary and Emergency (including Unscheduled) Care Research

Introduction Research has found differences in processes and outcomes of care between people in ethnic minorities and White British populations in some clinical conditions, although findings have been mixed. The Building an understanding of Ethnic minority people’s Service Use Relating to Emergency care for injuries study is investigating differenc...

IntroductionPeople seeking sanctuary, including refugees and asylum seekers, face barriers and challenges in accessing high quality healthcare. In maternity care specifically, asylum-seeking and refugee women are less likely to access timely and adequate antenatal care and may be more likely to experience adverse perinatal outcomes. Objectives We a...

Objectives This study explored the views of young people from diverse backgrounds, with or without a history of self-harm, on the motivation and impacts of sharing self-harm imagery online and the use of their social media data for mental health research. Design Thematic analysis of 27 semi-structured one-to-one interviews. Setting Two workshops...

Background Healthcare and support workers play a pivotal role in delivering quality services and support to people seeking sanctuary who have experienced poor physical and mental health linked to previous trauma, relocation and loss of freedoms. However, they often encounter various challenges in their daily work, ranging from communication barrier...

Background UK Ambulance services use multidisciplinary cross-service case management in some areas to help meet the needs of people who call 999 frequently, known as ‘Frequent Callers’. We undertook a natural experiment comparing outcomes for people where this intervention is available with others in areas with standard care only. Methods We ident...

Background The increasing burden of injury is further exacerbated by the presence of ethnic disparities in emergency healthcare settings. This review aimed to describe the published literature reporting comparative mortality by ethnicity of adults presenting with injury to emergency healthcare in developed countries. Methods Five electronic databa...

Background Ambulance services use multidisciplinary cross-service case management in some areas to help meet the needs of people who call 999 frequently. The STRETCHED evaluation of case management for this group in four UK ambulance service areas included a qualitative component to explore experience of care, to identify challenges and opportuniti...

Introduction People who call emergency ambulances frequently are often vulnerable because of health and social circumstances, have unresolved problems or cannot access appropriate care. They have higher mortality rates. Case management by interdisciplinary teams can help reduce demand for emergency services and is available in some UK regions. We r...

Background It has long been noted that the chain from identification of need (research gap) to impact in the real world is both long and tortuous. This study aimed to contribute evidence about research ethics and governance arrangements and processes in the UK with a focus on: what works well; problems; impacts on delivery; and potential improvemen...

Introduction Injuries are a major public health problem which can lead to disability or death. However, little is known about the incidence, presentation, management and outcomes of emergency care for patients with injuries among people from ethnic minorities in the UK. The aim of this study is to investigate what may differ for people from ethnic...

Background Frequent use of emergency medical services (EMS) is recognised to be a global phenomenon, although paediatric frequent use is poorly understood. This systematic review aimed to understand how paediatric frequent use of EMS is currently defined, identify factors associated with paediatric frequent use of EMS and determine effectiveness of...

Introduction UK ambulance services have identified a concern with high users of the 999 service and have set up ‘frequent callers’ services, ranging from within-service management to cross-sectoral multidisciplinary case management approaches. There is little evidence about how to address the needs of this patient group. Aim To evaluate effectiven...

Background Multi-agency case management is being introduced by ambulance services and their partners in the UK to try to identify and address the needs of those who call 999 ambulance services frequently. However, there is a lack of evidence about what works well in this setting and how. Based on current nationally agreed definitions, calling frequ...

Background Asylum seekers and refugees often experience poor health in host countries. The United Nations High Commissioner for Refugees requires hosts to ensure these sanctuary seekers have access to basic health care. Aim To identify barriers and facilitators that affect access to health care by asylum seekers and refugees in Wales. Design & se...

Background The use of anonymised routine linked data in designing and conducting randomised controlled trials (RCTs) has great potential. Sample sizes can be large, inclusion rates high and follow up periods prolonged, while the disruption to participants’ usual routines may be minimised. However, challenges and limitations in using routine linked...

Background Emergency ambulance services are integral to providing a service for those with unplanned urgent and life-threatening health conditions. However, high use of the service by a small minority of patients is a concern. Aims and Objectives To describe: service-wide and local policies or pathways for people classified as Frequent Caller; cal...

Background Physical inactivity is the fourth leading cause of mortality worldwide. Early childhood is a critical period when healthy behaviours can be instilled for a future active lifestyle. We explored community, societal and environmental factors affecting child and family physical activity and sought parent recommendations to support physical a...

Background: Emergency ambulance services are integral to providing a service for those with unplanned urgent and life-threatening health conditions. However, high use of the service by a small minority of patients is a concern. Our objectives were to describe: service-wide and local policies or pathways for people classified as Frequent Caller; ca...

Objective: To explore patients' experience of receiving pain relief injection for suspected hip fracture from paramedics at the location of the injury. Design: Qualitative interviews within a feasibility trial about an alternative to routine prehospital pain management for patients with suspected hip fracture. Setting: Patients treated by para...

Background The use of anonymised routine linked data in designing and conducting randomised controlled trials (RCTs) has great potential. Sample sizes can be large, inclusion rates high and follow up periods prolonged, while the disruption to participants’ usual routines may be minimised. However, challenges and limitations in using routine linked...

Background People who frequently call the 999 ambulance service present an operational challenge to providers and their needs are inadequately met by current service provision. Aim of researchTo understand patterns and health outcomes of frequent calling and to work with stakeholders to co-produce guidance for formal testing in a future evaluation....

There are concerns that people seeking sanctuary (asylum seekers and refugees) in Wales, UK, have unmet health needs and face difficulties accessing services, but little collated evidence. This study addressed this gap to inform policy and practice in reducing health inequities. It aimed to: investigate the health, wellbeing and healthcare experien...

Background Ambulance services across the UK have recognised a clinical and operational problem with persistent high users of the 999 service, but there is a lack of evidence about what works in this setting and how. We aim to evaluate the effectiveness, safety and efficiency of multi-agency case management approaches to the care of people who frequ...

Background Numbers of asylum seekers and refugees living in Wales have increased sharply. Many are liable to have unmet health needs and difficulty accessing services. We investigated the experience of, and access to, unplanned and emergency health services by asylum seekers, refugees and those refused asylum living in Wales. Method We surveyed 21...

Background: In managing hip fracture, effective pain relief before admission to hospital is difficult without risking side effects. Although emergency departments routinely use fascia iliaca compartment block (FICB), there has been little evaluation of its use by paramedics before hospital admission. We aimed to assess whether a multi-centre rando...

Background The numbers of asylum seekers and refugees in Wales have recently increased sharply, but we know little of their health experiences. Aim To investigate asylum seekers’ and refugees’ experiences of health care, especially what helped or hindered. Method Eight volunteer peer researchers were recruited from asylum-seeking and refugee comm...

There has been concern that some of those seeking sanctuary in Wales have unmet health needs and experience difficulty in accessing services, but there is little evidence other than anecdotal. There has also been concern that possible stigma of disclosing mental and physical health problems, and fear of adverse effects on their immigration status, ca...

Objectives To explore paramedics’ experience of delivering fascia iliaca compartment block ( FICB) to patients with suspected hip fracture at the scene of injury. Design Focus groups within a randomised controlled trial. Setting Paramedics based at ambulance stations in the catchment area of one Emergency Department in South Wales, recruited and...

Background Up to 40% of patients with suspected hip fracture report inadequate or no pre-hospital pain management. Morphine may raise risk of complications and may be avoided by paramedics. Fascia Iliaca Compartment Block (FICB) is used in Emergency Department and orthopaedic wards. The RAPID trial tested feasibility of paramedics administering FIC...

Background Routine pre-hospital pain management for hip fracture is inadequate, with risk of potentially fatal complications, particularly from morphine. Fascia Iliaca Compartment Block (FICB) is used in Emergency Department and orthopaedic wards. The RAPID trial tested feasibility of paramedics administering FICB to patients with suspected hip fra...

Background Adequate pain relief in prehospital care is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long term outcomes may be adversely affected by administration of opiate analgesics. Fascia Iliaca Compartment Block (FICB) is routinely undertaken by clinicians...

Background: Physical activity (PA) levels are associated with long term health and levels of physical activity when young are predictive of adult activity levels. Objectives: This study examines factors associated with PA levels in 12-month infants. Method: 141 mother-infant pairs were recruited via a longitudinal birth cohort study (April 2010 to...

Aim Pain relief in prehospital care is a challenge in trauma, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long term outcomes may be adversely affected by administration of opiates. Fascia Iliaca Compartment Block (FICB) is routinely undertaken by hospital clinicians, but has not been fully evaluated...

Background Adequate pain relief at the scene of injury and during transport to hospital is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long-term outcomes may be adversely affected by administration of opiate analgesics. Fascia Iliaca Compartment Block (FICB) i...

Breast cancer risk classifications are useful for prognosis, yet little is known of their effect on patients. This study clarified women's understandings of risk as they "journeyed" through the health care system. Breast cancer patients and women undergoing genetic investigation were recruited ( N = 25) from a large UK Health Board, 2014-2015, comp...

Background Adequate pain relief at the point of injury and during transport to hospital is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long-term outcomes may be adversely affected by administration of opiate analgesics. Fascia iliaca compartment block (FICB) i...

Narratives ascribe meaning to individual experience and life events through a process of storytelling. Storytelling provides a context for understanding illness and health by mirroring life back to the self while at the same time disseminating personal inner thoughts of the storyteller out to the wider world. This chapter will examine the contribut...

INTRODUCTION Adequate pain relief at the scene of injury and during transport to hospital is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilize and long-term outcomes may be adversely affected by administration of opiate analgesics. Fascia Iliaca Compartment Block (FICB) is a...

Abstract Introduction Self-harm is a strong predictor for suicide. Risks for repeat behaviour are heightened in the aftermath of an index episode. There is no consensus on the most effective type of intervention to reduce repetition. Treatment options for patients who do not require secondary mental health services include no support, discharge to...

Narratives ascribe meaning to individual experience and life events through a process of storytelling. Storytelling provides a context for understanding illness and health by mirroring life back to the self while at the same time disseminating personal inner thoughts of the storyteller out to the wider world. This chapter will examine the contribut...

Childhood obesity presents a challenge to public health. This qualitative study explored the main barriers to dietary choices faced by parents with infants, and the types of interventions and policy level recommendations they would like to see put in place, to promote a healthier food environment. 61 semi-structured interviews with prospective pare...

Objective: To estimate the direct healthcare cost of infants born to overweight or obese mothers to the National Health Service in the UK. Design: Retrospective prevalence-based study. Setting: Combined linked anonymised electronic data sets on a cohort of mother-child pairs enrolled on the Growing Up in Wales: Environments for Healthy Living...

Narratives ascribe meaning to individual experience and life events through a process of storytelling. Storytelling provides a context for understanding illness and health by mirroring life back to the self while at the same time disseminating personal inner thoughts of the storyteller out to the wider world. This chapter will examine the contribut...

Nurses need to be adequately prepared to practise competently in increasingly ethnically diverse communities. This study explored nurse educators’ views regarding the extent and nature of preregistration nursing education intended to prepare students for multi-ethnic practice in Wales. A qualitative approach was taken with a purposive sample of pro...

This study examines the effect of low daily physical activity levels and overweight/obesity in pregnancy on delivery and perinatal outcomes. A prospective cohort study combining manually collected postnatal notes with anonymised data linkage. A total of 466 women sampled from the Growing Up in Wales: Environments for Healthy Living study. Women com...

To estimate the direct healthcare cost of being overweight or obese throughout pregnancy to the National Health Service in Wales. Retrospective prevalence-based study. Combined linked anonymised electronic datasets gathered on a cohort of women enrolled on the Growing Up in Wales: Environments for Healthy Living (EHL) study. Women were categorised...

This study examines the effect of diabetes in pregnancy on offspring weight at birth and ages 1 and 5 years. A population-based electronic cohort study using routinely collected linked healthcare data. Electronic medical records provided maternal diabetes status and offspring weight at birth and ages 1 and 5 years (n = 147,773 mother child pairs)....

Childhood injury is the second leading cause of death for infants aged 1--5 years in the United Kingdom (UK) and most unintentional injuries occur in the home. We explored mothers' knowledge and awareness of child injury prevention and sought to discover mothers' views about the best method of designing interventions to deliver appropriate child sa...