Ioan Humphreys

Swansea University | SWAN · Swansea Centre for Health Economics "SCHE"

Background Lymphoedema is a progressive condition causing significant alterations to life, exerting pressures on unscheduled care from complications including cellulitis and wounds. An on the ground education programme (OGEP) was implemented to raise knowledge, competence and confidence in lymphoedema management in community clinical services. The...

Background Hand hygiene and its significance for reducing the spread of infection is well evidenced and has been brought into sharp focus following the COVID-19 pandemic. Although a crucial clinical skill in ensuring safe healthcare, little is known regarding nursing students’ effectiveness of hand hygiene practice. Aim The aim of this study was t...

Background Ambulance services staff are under more pressure than ever. Inadequate numbers face unmanageable workloads. For the first time in more than three decades, these employees in England and Wales have taken industrial action over wages and working conditions. Aims This study aimed to understand the wellbeing and working environment of ambul...

Background: Lymphoedema is a chronic condition affecting daily activities of life, causing significant alterations and adjustments. Since 2015, lymphaticovenous anastomosis (LVA) has been available on the National Health Service for people with lymphoedema in Wales, United Kingdom. This study aimed to explore the impact and outcomes after LVA over...

This study aimed to estimate costs associated with managing patients with cellulitis from the UK National Health Service (NHS) perspective. The analysis was undertaken through the Secure Anonymised Information Linkage Databank, which brings together population-scale, individual-level anonymised linked data from a wide range of sources, including 80...

This unique evaluation aimed to estimate, the financial impact of non-attendance on a nation-wide hospital lymphoedema service. Along with gaining some understanding of patient characteristics of those who Did Not Attend (DNA) and were subsequently discharged. The evaluation design interrogated existing performance data from 2012 to 2022. This info...

Objective To estimate the cost-consequence of treating spasticity early with botulinum toxin in the acute stroke unit. Design Secondary cost-consequence analysis, using data from a double-blind randomised-controlled trial. Setting Single-centre specialised stroke unit. Subjects and Interventions Patients with Action Research Arm Test grasp-score...

Objective: Maggot therapy (MT) or larval debridement therapy is a recognised, effective but underutilised treatment for the management of hard-to-heal wounds and infected ulcers. It is available on NHS prescription in the UK, where wound management is predominantly nurse-led. Anecdotal reports and published literature suggest that nurses may be re...

Objective The aim of the study was to explore public opinion and perceptions of maggot therapy (larval therapy), a treatment option for hard-to-heal wounds. Method The study used a mixed-method approach to obtain quantitative and qualitative data. A focus group was convened to explore opinions and views of maggot therapy with a small group of memb...

Compression garments are the mainstay of lymphoedema treatment, yet the process of obtaining by prescription is lengthy, governed by funding, involves numerous professionals with little patient value and often involes copious inaccuracies, delays and errors. This service evaluation estimates the potential impact of changing the way compression garm...

Objectives To explore associations between exposures to medicines prescribed for asthma and their discontinuation in pregnancy and preterm birth [<37 or <32 weeks], SGA [<10th and <3rd centiles], and breastfeeding at 6–8 weeks. Methods Design. A population-based cohort study. Setting. The Secure Anonymised Information Linkage [SAIL] databank in Wa...

The aim of this study was to estimate costs associated with the management of patients with venous leg ulcers (VLUs) from the perspective of the UK National Health Service (NHS). The analysis was undertaken through the Secure Anonymised Information Linkage Databank which brings together and anonymously links a wide range of person‐based data from a...

We conducted a small pilot study examining the opinions of school teachers across five Welsh primary schools on the possibility of introducing grand challenges (such as antibacterial resistance), and concepts to help solve such challenges (such as the use of living maggots to help treat infected wounds) to pupils at a young age. Our questionnaire-b...

Background Patients with lymphoedema referred to a lymphoedema service from care homes in one health board area in Wales were often complex cases, with repeated cellulitis, a history of falls and other complications. A pilot project was initiated to develop education and raise awareness of lymphoedema among care home staff. Aims To enable care sta...

Objectives To explore associations between exposure to antidepressants, their discontinuation, depression [medicated or unmediated] and preterm birth [<37 and <32 weeks], small for gestational age (SGA) [<10th and <3rd centiles], breastfeeding [any] at 6–8 weeks. Methods Design: A population-based cohort study. Setting: The Secure Anonymised Infor...

Background Eating disorders have the highest morbidity of all mental disorders in the UK and can require admission to hospital. We aimed to provide whole system quantification of inpatient admission and general practitioner (GP) contact costs to the National Health Service (NHS) for patients with eating disorders in Wales. Methods The Secure Anony...

Ioan Humphreys, Research Assistant, College of Human and Health Sciences, Swansea University ( i.humphreys@swansea.ac.uk ), describes his involvement in evaluating some exciting initiatives to improve care.

The National School of Healthcare Sciences-accredited BSc Health Sciences forms a suite of undergraduate degrees within the College of Human and Health Sciences (CHHS) that prepares students for careers in Healthcare Sciences, including respiratory & sleep physiology and cardiac physiology. The program consists of university-based teaching and asse...

Aims: The aim of this economic analysis was to estimate the economic impact of the On the Ground Education Programme (OGEP) within one local University Health Board (UHB) in Wales. Background: The burden of managing chronic oedema can be considerable to the NHS. Developing innovative solutions to the care and management of patients with chronic oe...

Lymphoedema Network Wales has focused on maximising the impact of its service through the effective use of available resources to ensure high-quality and consistent care for people with lymphoedema across Wales. The aim of this evaluation was to estimate the economic impact of a national lymphoedema service on the NHS Wales budget. Work was underta...

Patients with chronic oedema and 'wet legs' are frequently seen in the community setting, with research indicating that more than half of community nurses' caseloads are patients with chronic oedema. However, a lack of nurse education and standardised care pathways for this condition has been identified. In June 2016, the Welsh Government supported...

Neighborhood-level interventions provide an opportunity to better understand the impact of neighborhoods on health. In 2001, the Welsh Government, United Kingdom, funded Communities First, a program of neighborhood regeneration delivered to the 100 most deprived of the 881 electoral wards in Wales. In this study, the authors examined the associatio...

Background Fissure sealant (FS) and fluoride varnish (FV) have been shown to be effective in preventing dental caries when tested against a no-treatment control. However, the relative clinical effectiveness and cost-effectiveness of these interventions is unknown. Objective To compare the clinical effectiveness and cost-effectiveness of FS and FV...

Study objective: We aim to determine clinical and cost-effectiveness of a paramedic protocol for the care of older people who fall. Methods: We undertook a cluster randomized trial in 3 UK ambulance services between March 2011 and June 2012. We included patients aged 65 years or older after an emergency call for a fall, attended by paramedics ba...

Fissure sealant (FS) and fluoride varnish (FV) are effective in preventing dental caries when compared with a no-treatment control. However, the relative clinical effectiveness of these interventions is uncertain. The objective of the study was to compare the clinical effectiveness of FS and FV in preventing dental caries in first permanent molars...

Background Emergency calls are frequently made to ambulance services for older people who have fallen, but ambulance crews often leave patients at the scene without any ongoing care. We evaluated a new clinical protocol which allowed paramedics to assess older people who had fallen and, if appropriate, refer them to community-based falls services....

Aim: The aim of this rapid-evidence assessment of the literature is to assess the existing evidence relating to the management of cancer and non-cancer related chronic oedema/Lymphoedema in the community setting. Methods: Using the PICO (Patient/ Population/Problem Intervention Comparison Outcomes) method online journal databases MEDLINE, CINAHL an...

Background Policy makers often target deprived neighbourhoods for regeneration with the expectation that population health will improve, since housing and neighbourhoods of low quality, as well as the social and economic determinants of poor health, are concentrated in the most deprived areas. Our aim was to examine the effects of Communities First...

People with dementia are susceptible to adverse drug reactions (ADRs). However, they are not always closely monitored for potential problems relating to their medicines: structured nurse-led ADR Profiles have the potential to address this care gap. We aimed to assess the number and nature of clinical problems identified and addressed and changes in...

Chronic wounds are known to represent a significant burden to patients and National Health Service (NHS) alike. However, previous attempts to estimate the costs associated with the management of chronic wounds have been based on literature studies or broad estimates derived from incidence rates and extrapolations from relatively small-scale studies...

Introduction Recent systematic reviews have highlighted the dearth of evidence on the effectiveness of regeneration on health and health inequalities. ‘Communities First’ is an area-wide regeneration scheme to improve the lives of people living in the most deprived areas in Wales (UK). This study will evaluate the impact of Communities First on res...

Background: A current pragmatic randomised controlled trial of the Strengthening Families Programme (SFP) is evaluating impacts on family functioning, alcohol use and other outcomes. This presentation describes a mixed-method process evaluation which explored how SFP was delivered by local and statutory bodies in seven areas of Wales. Methods:...

Objective: To evaluate effectiveness, safety and cost-effectiveness of Computerised Clinical Decision Support (CCDS) for paramedics attending older people who fall. Design: Cluster trial randomised by paramedic; modelling. Setting: 13 ambulance stations in two UK emergency ambulance services. Participants: 42 of 409 eligible paramedics, who...

Objective: To evaluate the cost effectiveness of a behavioural therapy intervention shown to be clinically effective in comparison with usual care for stroke patients with aphasia. Design: Randomised controlled trial with comparison of costs and calculation of incremental cost effectiveness ratio. Setting: Community. Participants: Participan...

Prevention of alcohol, drug and tobacco misuse by young people is a key public health priority. There is a need to develop the evidence base through rigorous evaluations of innovative approaches to substance misuse prevention. The Strengthening Families Programme 10-14 is a universal family-based alcohol, drugs and tobacco prevention programme, whi...

Background: This study aimed to determine the mortality burden associated with seasonal influenza in the United Kingdom (UK) using linked: individual patient, hospital and family doctor records, including mortality stratified by: age, risk factors and complications. Materials and Methods: A crosssectional observational study was carried out using d...

Background: The present study aimed to determine the burden of seasonal influenza in the United Kingdom, by vaccination status, and to assess whether the characteristics of vaccinated patients differed from unvaccinated patients. Materials and Methods: A cross-sectional observational study was performed using data derived from the linked General Pr...

Objective: To evaluate the cost effectiveness of a psychological adjustment group shown to be clinically effective in comparison with usual care for people with multiple sclerosis. Design: Randomized controlled trial with comparison of costs and calculation of incremental cost effectiveness ratio. Setting: Community. Participants: People wit...

The purpose of this study was to review the literature relating to the psychosocial costs associated with traumatic brain injury (TBI). Nine online journal databases, including MEDLINE, CINAHL, PsychINFO, and PUBMED, were queried for studies between July 2010 and May 2012 pertaining to the economic burden of head injuries. Additional studies were i...

Background: Tumour gene expression analysis is useful in predicting adjuvant chemotherapy benefit in early breast cancer patients. This study aims to examine the implications of routine Oncotype DX testing in the UK. Methods: Women with oestrogen receptor positive (ER+), pNO or pN1mi breast cancer were assessed for adjuvant chemotherapy and subseq...

To assess the cost-effectiveness of installing thermostatic mixer valves (TMVs) in reducing risks of bath water scalds and estimate the costs of avoiding bath water scalds. The evaluation was undertaken from the perspective of the UK public sector, and conducted in conjunction with a randomised control trial of TMVs installed in social housing in G...

Background Older people who fall make up a substantial proportion of the 999 workload. They are a particularly vulnerable group who may benefit from referral to specialised community based falls services. This requires early identification, ideally from dispatch codes assigned in the ambulance call centre.Objective To assess the feasibility of usin...

Many emergency ambulance calls are for older people who have fallen. As half of them are left at home, a community-based response may often be more appropriate than hospital attendance. The SAFER 1 trial will assess the costs and benefits of a new healthcare technology--hand-held computers with computerised clinical decision support (CCDS) software...

Ceri J Phillips, Ioan HumphreysInstitute for Health Research, School of Health Science, Swansea University, Swansea, Wales, UKAbstract: Multiple sclerosis (MS) is one of the most common causes of neurological disability in young and middle-aged adults, with current prevalence rates estimated to be 30 per 100,000 populations. Women are approximately...