http://theses.ncl.ac.uk/jspui/handle/10443/5255 Tue, 15 Sep 2026 10:54:57 GMT 2026-09-15T10:54:57Z http://theses.ncl.ac.uk/jspui/handle/10443/6843 Title: Mild cognitive impairment (MCI) in the population : new criteria and cohort effects Authors: Richardson, Connor Abstract: Much work on identifying individuals at high risk of dementia has focused on the clinical concept of MCI, which is considered to be an intermediate state between normal cognitive ageing and dementia. Many definitions for this state exist, including for example amnestic-MCI and Other Cognitive Impairment no Dementia (OCIND). This study utilises the Cognitive Function and Ageing Studies (CFAS) I & II, to explore the concept of MCI in the UK population. The first study focused on updating the definition of MCI and established a cognitive spectrum to capture participants of CFAS with no cognitive impairment through to dementia. The definitions were then used to estimate the UK population prevalence of MCI. A natural progression was to use the follow-up (wave II) of CFAS II to determine the incidence and progression of MCI and OCIND. The final study focused on risk factors associated with prevalent MCI, OCIND and dementia, as well as incident cognitive impairment. The link between cognitive function and both socio demographic factors (i.e. education, deprivation and loneliness) and medical co morbidities (i.e. Parkinson’s disease, heart attack and diabetes) were investigated. Mild dementia has, along with CFAS defined dementia, declined, (5.7%, 95% CI: 3.8, 8·1) in 1991 to 315,142 (3.0%, 95% CI: 2.4, 3.8) in 2011. There is a clear increase in the prevalence of OCIND with MCI remaining stable. In CFAS II the overall incidence rate for RMCI, is 138.5 per 1000-person years (95% CI: 131.5, 145.5) and 233.5 per 1000-person years (95% CI: 228.4, 238.6) for OCIND. Key risk factors for incident MCI and transition to dementia were smoking status, loneliness and poor self reported health. The analysis highlights the need to move beyond the current narrow dementia criteria which exclude large proportions of older people with cognitive impairment. Findings suggest that the increase in OCIND and stability of MCI could reflect “normal cognitive ageing” among a population which is substantially older. Evidence suggests it is through healthy lifestyle behaviours, better educational attainment, minimizing risks from comorbidities in the wider population which should be further encouraged to reduce risk of cognitive impairment. Description: PhD Thesis Tue, 01 Jan 2019 00:00:00 GMT http://theses.ncl.ac.uk/jspui/handle/10443/6843 2019-01-01T00:00:00Z http://theses.ncl.ac.uk/jspui/handle/10443/6824 Title: How safe are electronic prescribing systems? Evaluating a simulation tool to assess the use of medication-related decision support in electronic prescribing systems in the UK Authors: Heed, Judith Abstract: Electronic prescribing (EP) is widely adopted in healthcare to enhance medication safety and efficiency. Evidence suggests that EP reduces medication errors and adverse drug events, though the extent of benefits can be influenced by several factors, including how the EP system was designed, implemented, customised, and adopted. The researcher considered these different challenges in Chapter 1 and highlighted the importance of optimising EP systems to maximise their benefits. A systematic review of the literature was conducted to explore tools that have been previously used to evaluate the safety of EP systems. Thirteen papers were identified that described tools that were implemented in USA, Canada, Austria, Denmark, France and Korea. (Chapter 2). No equivalent UK tool was found. To address this knowledge gap, the researcher described the development of the e-Prescribing Risk and Safety Evaluation (ePRaSE) tool in the UK and its different component parts (Chapter 3). The researcher then conducted an eDelphi study to obtain expert consensus on the level of risk associated with preventable EP events (Chapter 4). The usability and acceptability of the ePRaSE assessment was then explored using different qualitative methods (Chapter 5). Thirty-two healthcare professionals across 22 different NHS hospitals participated in semi-structured interviews (n=25) and thirteen think-aloud observations (n=20) involving 11 different EP systems. The tool was found to be useful and acceptable, with some areas for further improvement identified (Chapters 6-8). The researcher also presented quantitative results obtained from the national rollout of ePRaSE in 45 hospitals (Chapter 9). Variation in scores was observed, independent of EP system vendor and scope for improvement in EP system configuration was apparent. An overarching discussion and conclusion drawing on both qualitative and quantitative findings was presented in Chapter 10, and key recommendations made to further refine the ePRaSE assessment and help inform future research in this area. Description: PhD Thesis Wed, 01 Jan 2025 00:00:00 GMT http://theses.ncl.ac.uk/jspui/handle/10443/6824 2025-01-01T00:00:00Z http://theses.ncl.ac.uk/jspui/handle/10443/6822 Title: When You Don’t Know, You Don’t Know. Haematopoietic Stem Cell Transplantation Recipients’ Experiences of Long-Term Follow-Up Care in England: A Multi-Method Study Authors: Bell, Blossom Abstract: Understanding and meeting the informational needs of haematopoietic stem cell transplantation (HSCT) recipients is essential for developing person-centred long-term follow-up (LTFU) care. This thesis explores the lived experiences of HSCT recipients in England as they navigate LTFU care, focusing on the psychological, informational, and structural factors that shape engagement and well-being. Using a phenomenological, multi-method approach, it comprises three studies: a systematic review and qualitative evidence synthesis, a qualitative analysis of online written accounts from seventeen HSCT recipients in England, and in-depth interviews with fourteen recipients exploring their informational needs during LTFU. Findings reveal that recipients frequently encounter insufficient information about potential long-term complications and LTFU practices, resulting in persistent uncertainty. Insights from written accounts and interviews show that Future Uncertainty is central to LTFU care for HSCT recipients in England. This uncertainty manifests in two key ways: service navigation uncertainty, relating to how recipients access and move through care systems, and health uncertainty, concerning ongoing risks, late effects, and self-management. While recipients express a strong desire to be prepared for future health events, this is often undermined by the timing, clarity, and objectivity of information provided by transplant clinics. Many become proactive in seeking information, often turning to online resources and peer support, which can be both empowering and anxiety-inducing. Unclear transitions, evolving health risks, and gaps in information contribute to psychological strain, reinforcing the overarching theme of Future Uncertainty in LTFU care. Addressing these challenges requires clear communication, tailored and timely information, written care plans, and strong clinical relationships. Supporting health literacy, clarifying care roles, and guiding recipients to reliable information sources can empower recipients to manage their care with confidence. This thesis highlights the importance of acknowledging the lived experience of uncertainty, encapsulated by one HSCT recipient as: “When you don't know, you don't know.” Description: PhD Thesis Wed, 01 Jan 2025 00:00:00 GMT http://theses.ncl.ac.uk/jspui/handle/10443/6822 2025-01-01T00:00:00Z http://theses.ncl.ac.uk/jspui/handle/10443/6810 Title: Routes to and experiences of a diagnosis of head and neck cancer Authors: Deane, Jennifer Abstract: Head and neck cancer (HNC) is currently the 6th most diagnosed cancer worldwide and is a growing problem. Many HNC are diagnosed at a late stage and patients are generally diagnosed due to the presence of symptoms. However, symptoms can be vague and easily mistaken for benign conditions. There is little understanding of the HNC pathway and there are many different elements that can impact negatively in terms of experiences and outcomes. This thesis will explore the routes to diagnosis for HNC patients to understand what impacts experiences. A multi-method approach was utilised. Study 1 is an analysis of routine data from Public Health England, in which all HNC patients diagnosed between 2006-2014 (68,752 patients) had been assigned a “route to diagnosis”. Studies 2-5 involve qualitative interviews with HNC patients (n=19), General Practitioners (n=8), Dentists (n=12), and HNC surgeons (n=8), which are analysed using thematic analysis. Analysis of the routine data highlights the inequalities within the route to diagnosis, in particular the socio-demographic differences of those presenting through each route. The qualitative interviews highlight a lack of knowledge around symptoms, difficulty in understanding and accessing healthcare services, non-explicit communication around potential cancer diagnoses and fragmented communication within primary care and between primary and secondary care. This thesis provides new insights into the routes to diagnosis of HNC, giving a deeper understanding of the experience of progressing towards diagnosis. Placing the work within the context of the Model of Total Patient Delay, adaptions to the model (e.g., consideration of health literacy) are suggested to enable future studies to better understand patient delays. Suggestions are made on elements of the findings which could be incorporated into clinical practice. Description: Ph. D. Thesis. Wed, 01 Jan 2025 00:00:00 GMT http://theses.ncl.ac.uk/jspui/handle/10443/6810 2025-01-01T00:00:00Z