Maria Panagioti

The University of Manchester · Division of Population Health, Health Services Research & Primary Care

Background Primary healthcare has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. This study aims to bridge the gap between the primary healthcare policy and the ongoing healthcare workforce crisis debate by in...

Introduction Around 1 in 20 patients experience avoidable healthcare-associated harm worldwide. Despite longstanding concerns, there is insufficient information available about the safety of healthcare for prisoners. To address this, this study will investigate the scale and nature of avoidable healthcare-associated harm for prisoners in England....

Background We adopt a health system and governance perspective to address the mental health needs of healthcare workers, considering the nature of interventions and the levels and actors involved in governance. The aim is to move the debate forward by identifying governance gaps hampering the implementation of health workforce policies and explorin...

Background The healthcare workforce crisis strongly affects the primary healthcare sector, worsening the work conditions of healthcare workers and hampering service delivery and health system resilience. This study introduces a health system and governance approach to identify transformative capacities in health system contexts. Methods A qualitat...

According to the World Health Organization (WHO), more than 700,000 people take their own life every year globally. WHO also estimates that for every suicide, there are at least 10–20 acts of self-harm and about a hundred people have suicidal thoughts. Every suicide affects a large number of people in the victims immediate and extended circle of fa...

There have been growing concerns about the well-being of staff in inpatient mental health settings, with studies suggesting that they have higher burnout and greater work-related stress levels than staff in other healthcare sectors. When addressing staff well-being, psychological safety can be a useful concept. However, there is no measure of psych...

Aims Suicide is one of the leading causes of death among young people. For adolescents, schools are considered as the best place to identify and respond to youth suicide risk but evidence on culturally sensitive, school-based suicide prevention programs is limited in low-resource settings such as Pakistan. This study aims to explore the perspective...

Background: Given the accumulating research, evolving psychosocial treatment, and equivocal findings, updating WHO’s Mental Health Gap Action Programme-2015 was necessary to ensure guidelines reflect effective strategies for alcohol use disorder (AUD). Objective: To estimate the effects of psychosocial interventions on drinking and related outcome...

Background. Primary healthcare has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. This study aims to bridge the gap between the primary healthcare policy and the ongoing healthcare workforce crisis debate by i...

Aims Telemedicine has been promoted as an effective way of managing type‐2 diabetes (T2DM) in primary care. However, the effectiveness of telemedicine is unclear. We investigated the clinical and cost‐effectiveness of different telemedicine interventions for people with T2DM, compared to usual care. Methods We searched Medline, Embase, Cochrane, C...

There is some evidence for attentional biases in individuals with chronic pain (CP). Cultural and linguistic differences might affect the manifestation of these processes across populations. However, such attentional biases have not been explored in the Arabic-speaking population. The current study investigated these attentional biases and possible...

Background: The healthcare workforce globally is facing high stress levels and deteriorating mental health due to workplace, labour market and policy deficiencies that further exacerbate the existing crisis. However, comprehensive and effective action is missing. Aims: We adopt a health system and governance perspective to address the mental health...

Background: Suicidal thoughts and behaviors (STBs) in young people is a major public health problem, which is on the rise globally. Aims: We applied the first network meta-analyses to examine the effectiveness of existing intervention types and contents to reduce STBs and improve suicide prevention competencies in educational settings. Method: We s...

Importance Discharge from the hospital to the community has been associated with serious patient risks and excess service costs. Objective To evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the ho...

Background Suicidal ideation and attempts are growing public health concerns globally. Evidence from high-income countries suggests that individuals with psychosis and bipolar disorder are at increased risk of suicidal ideation and attempts, but there is a scarcity of evidence from South Asia. AimsTo estimate the prevalence of suicidal ideation and...

Introduction The lived experiences of chronic pain (CP) among Arabic-speaking populations remain underexplored. A better understanding of these experiences and their associations with attention difficulties, coping mechanisms, and treatment options could lead to improved support for this group. Methods This qualitative study utilised a descriptive...

Background: It is unclear whether the future risk of cardiovascular events in breast cancer survivors is greater than in the general population. Objectives: This meta-analysis reports the incidence of cardiovascular events in patients with breast cancer, before quantifying the risk of cardiovascular disease development in breast cancer patients, co...

Background Informal carers are central in supporting patients at the end of life, but this has substantial negative impacts on carers’ own mental health. When carers are unable to cope, this may affect their ability to support the patient and increase the likelihood of patient hospital admissions. Further, demographic changes mean demands for care...

Background Self-harm is an important predictor of a suicide death. Culturally appropriate strategies for the prevention of self-harm and suicide are needed but the evidence is very limited from low- and middle-income countries (LMICs). This study aims to investigate the effectiveness of a culturally adapted manual-assisted problem-solving intervent...

Aims It is unclear whether the future risk of cardiovascular events in breast cancer (Bc) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in Bc patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular even...

Introduction Suicide is a leading cause of death among young people and most deaths by suicide occur in low and middle-income countries. School is the best place where we can identify and respond to youth suicide risk. School-based interventions for suicide prevention in young people have been successful across US, Europe and Australia, but require...

Introduction Carers of people with mental illness may face distinct challenges, including navigating fragmented health and social services during discharge from mental health hospitals. Currently, limited examples of interventions that support carers of people with mental illness in improving patient safety during transitions of care exist. We aime...

Mindfulness interventions (MIs) emphasize living in the present moment without being judgmental of one’s feelings and sensations. We aimed to evaluate the effectiveness of MIs, including both mindfulness-based and mindfulness-informed interventions, in reducing overall obsessive–compulsive and related disorders (OCRDs) severity and comorbid depress...

Objectives: Self-harm rates and clinical presentations differ by ethnicity. South Asian women are at risk of self-harm. Previous research suggested investigating individuals' experiences with self-harm with qualitative studies in developing self-harm prevention strategies. This research aims to explore self-harm experiences among South Asians in t...

Background Treatment burden represents the work patients undertake because of their healthcare, and the impact of that effort on the patient. Most research has focused on older adults (65+) with multiple long-term conditions (MLTC-M) but there are more younger adults (18-65) living with MLTC-M and they may experience treatment burden differently. U...

Objectives: Prisoners use healthcare services three times more frequently than the general population with poorer health outcomes. Their distinct healthcare needs often pose challenges to safe healthcare provision. This study aimed to characterise patient safety incidents reported in prisons to guide practice improvement and identify health policy...

Background: Previous findings have indicated that self-harm and suicide are associated with different rates, and different risk and protective factors in South Asian people compared with White people in the UK. Substantial qualitative research has explored experiences of self-harm and suicide in South Asian people. Aims: The study aims to review...

Introduction Patients being discharged from inpatient mental wards often describe safety risks in terms of inadequate information sharing and involvement in discharge decisions. Through stakeholder engagement, we co-designed, developed and adapted two versions of a care bundle intervention, the SAFER Mental Health care bundle for adult and youth in...

Objective: The proportions of older adults' transitions through acknowledging their hearing loss to getting access to treatment are unknown. This was examined using data from a nationally representative cohort in England. Design: Patient and healthcare factors associated with referrals were examined cross-sectionally, through primary to secondar...

Background COVID-19 has exacerbated the significant and longstanding mental health inequalities for ethnic minorities, who were less likely to access mental health support in primary care but more likely to end up in crisis care compared to the majority ethnic group. Services were poorly offered and accessed to respond to the increased mental healt...

Understanding how adverse professional life experiences affect the mental well-being of cardiologists is important. An unmet and equally important need is to design and implement strategies to prevent emotional harassment and discrimination at health-care workplaces and to effectively support cardiologists who have been exposed to adverse professio...

Objective This study aimed to develop a measure of contributory factors to safety incidents in care homes to be completed by residents and/or their unpaid carers. Introduction Care home residents are particularly vulnerable to patient safety incidents, due to higher likelihood of frailty, multimorbidity and cognitive decline. However, despite resi...

Background Family carers play a central role in supporting people at the end of life, but often suffer detrimental impacts on their own mental health as a result. This project conducted evidence synthesis of research into factors that may affect carers’ mental health to help identify ways of maintaining their mental health. It worked closely with a...

Information-processing biases such as attentional, interpretation, and memory biases are believed to play a role in exacerbating and maintaining chronic pain (CP). Evidence suggests that individuals with CP show attentional bias toward pain-related information. However, the selective attentional processes that underpin this bias are not always well...

Background Prescribing of strong opioids and antibiotics impacts patient safety, yet little is known about the effects GP wellness has on overprescribing of both medications in primary care. Aim To examine associations between strong opioid and antibiotic prescribing and practice- weighted GP burnout and wellness. Design and setting A retrospecti...

Background General practices are experiencing increasing pressures due to rising demand, declining staff numbers, and knock-on impacts on patient care. The COVID-19 pandemic has added further challenges and reinforced the importance of teamwork and organisational settings. We undertook a mixed-method systematic review to explore which interventions...

Objective To examine the association of physician burnout with the career engagement and the quality of patient care globally. Design Systematic review and meta-analysis. Data sources Medline, PsycINFO, Embase, and CINAHL were searched from database inception until May 2021. Eligibility criteria for selecting studies Observational studies assessing...

Background General Practitioners (GPs) report high levels of burnout, job dissatisfaction, and turnover intention. The complexity of presenting problems to general practice makes diagnostic uncertainty a common occurrence that has been linked to burnout. The interrelationship between diagnostic uncertainty with other factors such as burnout, job sa...

Objective To examine the association of physician burnout with the career engagement and the quality of patient care globally. Design Systematic review and meta-analysis. Data sources Medline, PsycINFO, Embase, and CINAHL were searched from database inception until May 2021. Eligibility criteria for selecting studies Observational studies assess...

Background Individuals with vitamin B12 deficiency (including pernicious anaemia) often report being ‘let down’ or stigmatised by general practice systems and policy, and choose instead to self-medicate via injection; the association between this and perceptions of safe primary care in this group of people is unknown. Aim To examine the associatio...

Background Family carers are central in supporting patients nearing the end of life, but this often has an impact on their own mental health. Understanding what factors may affect carers’ mental health is important in developing strategies to maintain mental health, through identifying carers at risk who may need added monitoring and support or dev...

Objective The authors examined associations between stressors and burnout in trainee doctors during the COVID-19 pandemic. Methods An anonymous online questionnaire including 42 questions on general and pandemic-specific stressors, and the Maslach Burnout Inventory-Health Services Survey (MBI-HSS), was sent to 1000 randomly selected trainee doctor...

Introduction: Suicide is a global health concern. Sociocultural factors have an impact on self-harm and suicide rates. In Pakistan, both self-harm and suicide are considered as criminal offence's and are condemned on both religious and social grounds. The proposed intervention 'Youth Culturally Adapted Manual Assisted Problem Solving Training (YCM...

Importance: Residents of long-term care facilities (LTCFs) experience high hospitalization rates, yet little is known about the effects of transitional care interventions for these residents. Objective: To assess the association of transitional care interventions with readmission rates and other outcomes for residents of LTCFs who are 65 years a...

Background: Current evidence supports the use of wearable trackers in by people with cardiometabolic conditions. However, as the health benefits are small and conflicted confounded by heterogeneity, there remains uncertainty of as to which patient groups are most helped by wearable trackers are most helpful. Objective: This study examined the eff...

Background Cognitive–behavioural therapy (CBT) is frequently used as an umbrella term to include a variety of psychological interventions. It remains unclear whether more complex CBT contributes to greater depression reduction. Aims To (a) compare the effectiveness of core, complex and ultra-complex CBT against other psychological intervention, me...

Objective: To compare the efficacy of different statin therapies by intensity for prevention of cardiovascular disease (CVD) in people with diabetes according to non-high-density lipoprotein cholesterol (non-HDL-C). Design: Systematic review and network meta-analysis. Data Sources: Searches in MEDLINE, Cochrane Central Register of Controlled Tri...

Purpose The adverse impact of hearing loss (HL) extends beyond auditory impairment and may affect the individuals' psychosocial wellbeing. We aimed to examine whether there exists a causal psychosocial pathway between HL and depression in later life, via socioeconomic factors and quality of life, and whether hearing aids usage alleviates depressive...

Objective: We aimed to update the prevalence estimates of hearing loss in older adults in England using a nationally representative sample of adults aged 50 years old and older. Design: A comparative cross-sectional study design was implemented. Hearing loss was defined as ≥35 dB HL at 3.0 kHz, as measured via Hearcheck in the better-hearing ear...

Background Patients recovering from an episode in an intensive care unit (ICU) frequently experience medication errors on transition to the hospital ward. Structured handover recommendations often underestimate the challenges and complexity of ICU patient transitions. For adult ICU patients transitioning to a hospital ward, it is currently unclear...

Objectives This study aims to develop a comprehensive list of stressors relevant to junior doctors and will also report findings exploring the associations between burnout and stressors, which include work and non-work–related stressors as well as pandemic-related stressors. Methods An anonymous online questionnaire was sent to 1000 randomly selec...

Background: Discharge from acute mental health inpatient units is often a vulnerable period for patients. Multiple professionals and agencies are involved and processes and procedures are not standardized, often resulting in communication delays and co-ordination failures. Early and appropriate discharge planning and standardization of procedures c...

Objective To describe the distribution of consultations at the practice level and examine whether increases are uniform or driven by people who consult more frequently. Design Retrospective cohort study. Setting UK general practice data from the Clinical Practice Research Datalink (CPRD) GOLD database. Participants 1 699 709 314 consultation eve...

Objectives Chronic obstructive pulmonary disease contributes to substantial health and economic burden worldwide. Co-morbid depression and anxiety are highly prevalent in patients with chronic obstructive pulmonary disease. Depressive symptoms in chronic obstructive pulmonary disease are associated with poorer survival, longer hospitalisation and i...

The original version of this article contained a mistake in the Table 3. In Table 3: Two rows were accidentally cut out which reported the B coefficients and standard errors for two variables in the multiple regression model, the hyperoursal symptom cluster, avoidance/numbing symptom cluster. The corrected table is presented below.

Introduction Junior doctors have previously reported high levels of burnout; and additional stressors have likely emerged from the COVID-19 pandemic may further accelerate burnout. There is a need to identify which particular stressors are most likely to lead to burnout in junior doctors in order to develop appropriate interventions. Objectives 1)...

Background The number of individuals with a visual impairment in the UK was estimated a few years ago to be around 1.8 million. People can be visually impaired from birth, childhood, early adulthood or later in life. Those with visual impairment are subject to health inequities and increased risk for patient safety incidents in comparison to the ge...

Background The COVID-19 pandemic forced the rapid implementation of changes to practice in mental health services, in particular transitions of care. Care transitions pose a particular threat to patient safety. Aims This study aimed to understand the perspectives of different stakeholders about the impact of temporary changes in practice and polic...

Background Schizophrenia and bipolar disorder are severe mental illnesses which are highly prevalent worldwide. Risperidone and Paliperidone are treatments for either illnesses, but their efficacy compared to other antipsychotics and growing reports of hormonal imbalances continue to raise concerns . As existing evidence on both antipsychotics are...

Objective This study aimed to develop interpretive insights concerning Infection Prevention and Control (IPC) in care homes for older people. Design This study had a meta-ethnography design. Data Sources Six bibliographic databases were searched from inception to May 2020 to identify the relevant literature. Review Methods A meta-ethnography was...

Importance Wearable physical activity (PA) trackers, such as accelerometers, fitness trackers, and pedometers, are accessible technologies that may encourage increased PA levels in line with current recommendations. However, whether their use is associated with improvements in PA levels in participants who experience 1 or more cardiometabolic condi...

Objective To assess whether CC is more effective at reducing suicidal ideation in people with depression compared with usual care, and whether study and patient factors moderate treatment effects. Method We searched Medline, Embase, PubMed, PsycINFO, CINAHL, CENTRAL from inception to March 2020 for Randomised Controlled Trials (RCTs) that compared...

Hearing loss is a major health challenge that can have severe physical, social, cognitive, economic, and emotional consequences on people’s quality of life. Currently, the modifiable factors linked to socioeconomic inequalities in hearing health are poorly understood. Therefore, an online database search (PubMed, Scopus, and Psych) was conducted to...