Managing Complex Needs

Through this theme, we will implement a step change in the delivery of care for people with complex needs arising from long term conditions (LTCs). This will result in services that are more person-centred, cost effective and that will improve quality of life for patients and their ability to undertake gainful employment.

Initially, the theme will focus upon musculoskeletal and neurological conditions as exemplar LTCs that may run throughout life, and which are associated with the development of complex physical, psychological and social needs arising from diseases themselves or as a consequence of therapy. Both conditions have a serious negative impact on health and quality of life, need long-term therapy with a variety of medicines (each with many potential major side effects) and require care to be delivered between hospitals and the community.

Lessons learnt about the organisation and delivery of services for these conditions will directly inform changes needed in service delivery for other complex neurological and rheumatological LTCs that will be addressed.

If you would like to find out more about our work in the area, please contact the Theme Leader, Professor Tony Marson via a.g.marson@liv.ac.uk

Read more about the CAPS project or a summary via our CLAHRC NWC "Bite"

Read more about Transitional Care for Young Adults with Long Term Conditions

Publications

Allen S, Lowe D, Harris RV, Brown S, Rogers SN. Is social inequality related to different patient concerns in routine oral cancer follow-up clinics?. European Archives of Oto-Rhino-Laryngology. 2017 Jan 1;274(1):451-9.
DOI: 10.1007/s00405-016-4208-x

Allen S, Harris R, Brown SL, Humphris G, Zhou Y, Rogers SN. High levels of socioeconomic deprivation do not inhibit patients’ communication of concerns in head and neck cancer review clinics. British Journal of Oral and Maxillofacial Surgery. 2018 Jul 1;56(6):536-9.
DOI: 10.1016/j.bjoms.2018.05.015

Allen S, Ridgers SN, Harris RV. Socio-economic differences in patient participation behaviours in doctor-patient interactions - Asystematic mapping review of the literature. Health Expectations. 2019 Aug 9

doi: 10.1111/hex.12956

Atim-Oluk M, Jackson CF, Marson AG. Oxcarbazepine add-on for drug-resistant partial epilepsy (Protocol). Cochrane Database of Systematic Reviews. 2016 Nov 15;11(CD012433). 

DOI: 10.1002/14651858.CD012433

Bonnett LJ, Powell GA, Smith CT, Marson AG. Risk of a seizure recurrence after a breakthrough seizure and the implications for driving: further analysis of the standard versus new antiepileptic drugs (SANAD) randomised controlled trial. BMJ open. 2017 Jul 1;7(7):e015868.
DOI: 10.1136/bmjopen-2017-015868

Bonnett LJ, Powell GA, Smith CT, Marson AG. Breakthrough seizures—Further analysis of the Standard versus New Antiepileptic Drugs (SANAD) study. PloS one. 2017 Dec 21;12(12):e0190035. 
DOI: 10.1371/journal.pone.0190035

Bromley RL, Weston J, Marson AG. Maternal use of antiepileptic agents during pregnancy and major congenital malformations in children. Jama. 2017 Nov 7;318(17):1700-1.
DOI: 10.1001/jama.2017.14485

Burke L, Kirkham J, Arnott J, Gray V, Peak M, Beresford MW. The transition of adolescents with juvenile idiopathic arthritis or epilepsy from paediatric health-care services to adult health-care services: a scoping review of the literature and a synthesis of the evidence. Journal of Child Health Care. 2018 Sep;22(3):332-58. 
DOI: 10.1177/1367493517753330

Doherty AJ, Jones SP, Chauhan U, Gibson JM. Eating well, living well and weight management: A co-produced semi-qualitative study of barriers and facilitators experienced by adults with intellectual disabilities. Journal of Intellectual Disabilities. 2018 Jan 1:1744629518773938.
DOI: 10.1177%2F1744629518773938

Doherty AJ, Jones SP, Chauhan U, Gibson JM. An integrative review of multicomponent weight management interventions for adults with intellectual disabilities. Journal of applied research in intellectual disabilities. 2018 Jan;31:39-51.
DOI: 10.1111/jar.12367

Doherty AJ, Jones SP, Chauhan U, Gibson JM. Healthcare practitioners' views and experiences of barriers and facilitators to weight management interventions for adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities. 2019 Apr 15; 001– 11
DOI: 10.1111/jar.12596

Grainger R, Pearson M, Dixon P, Devonport E, Timoney M, Bodger K, Kirkham J, Marson A. Referral patterns after a seizure admission in an English region: an opportunity for effective intervention? An observational study of routine hospital data. BMJ open. 2016 Jan 1;6(1):e010100. 
DOI: 10.1136/bmjopen-2015-010100

Greenhalgh  J, Weston  J, Dundar  Y, Nevitt  SJ, Marson  AG. Antiepileptic drugs as prophylaxis for postcraniotomy seizures. Cochrane Database of Systematic Reviews. 2018 May 23; 5(CD007286). 
DOI: 10.1002/14651858.CD007286.pub4. 

Hanna KL, Hepworth LR, Rowe F. Screening methods for post-stroke visual impairment: a systematic review. Disability and rehabilitation. 2017 Dec 4;39(25):2531-43.
DOI: 10.1080/09638288.2016.1231846

Hanna KL, Rowe FJ. Clinical versus evidence-based rehabilitation options for post-stroke visual impairment. Neuro-Ophthalmology. 2017 Nov 2;41(6):297-305.
DOI: 10.1080/01658107.2017.1337159

Holmes EA, Plumpton C, Baker GA, Jacoby A, Ring A, Williamson P, Marson A, Hughes DA. Patient‐Focused Drug Development Methods for Benefit–Risk Assessments: A Case Study Using a Discrete Choice Experiment for Antiepileptic Drugs. Clinical Pharmacology & Therapeutics. 2019 Mar;105(3):672-83.
DOI: 10.1002/cpt.1231

Hughes DM, Bonnett LJ, Czanner G, Komárek A, Marson AG, García-Fiñana M. Identification of patients who will not achieve seizure remission within 5 years on AEDs. Neurology. 2018 Nov 27;91(22):e2035-44.
DOI: 10.1212/WNL.0000000000006564

Hughes DM, Bonnett LJ, Marson AG, García‐Fiñana M. Identifying patients who will not reachieve remission after breakthrough seizures. Epilepsia. 2019 Mar 22.
DOI: 10.1111/epi.14697

Leone MA, Giussani G, Nevitt SJ, Marson AG, Beghi E. Immediate antiepileptic drug treatment, versus placebo, deferred, or no treatment for first unprovoked seizure. Cochrane Database of Systematic Reviews. 2016 May 6; 5 (CD007144). 
DOI: 10.1002/14651858.CD007144.pub2

Lunt C, Dowrick C, Lloyd-Williams M. The role of day care in supporting older people living with long-term conditions. Current opinion in supportive and palliative care. 2018 Dec;12(4):510.
DOI: 10.1097%2FSPC.0000000000000391

Maguire MJ, Jackson CF, Marson AG, Nevitt SJ. Treatments for the prevention of Sudden Unexpected Death in Epilepsy (SUDEP). Cochrane Database of Systematic Reviews. 2016 Jul 19; 7(CD011792). 
DOI: 10.1002/14651858.CD011792.pub2

Male LR, Noble A, Atkinson J, Marson T. Measuring patient experience: a systematic review to evaluate psychometric properties of patient reported experience measures (PREMs) for emergency care service provision. International Journal for Quality in Health Care. 2017 Mar 2;29(3):314-26. 
DOI: 10.1093/intqhc/mzx02

Male LR, Noble A, Snape DA, Dixon P, Marson T. Perceptions of emergency care using a seizure care pathway for patients presenting to emergency departments in the North West of England following a seizure: a qualitative study. BMJ open. 2018 Sep 1;8(9):e021246.
DOI: 10.1136/bmjopen-2017-021246

Nevitt SJ, Marson AG, Weston J, Tudur Smith C. Phenytoin versus valproate monotherapy for partial onset seizures and generalised onset tonic-clonic seizures: an individual participant data review. Cochrane Database of Systematic Reviews. 2016 Apr 28; 4(CD001769). 
DOI: 10.1002/14651858.CD001769.pub3

Nevitt  SJ, Marson  AG, Tudur Smith  C. Carbamazepine versus phenobarbitone monotherapy for epilepsy: an individual participant data review. Cochrane Database of Systematic Reviews. 2018 Oct 24; 10(CD001904).
DOI: 10.1002/14651858.CD001904.pub4.

Nevitt  SJ, Marson  AG, Weston  J, Tudur Smith  C. Sodium valproate versus phenytoin monotherapy for epilepsy: an individual participant data review. Cochrane Database of Systematic Reviews. 2018 Aug 9; 8(CD001769). 
DOI: 10.1002/14651858.CD001769.pub4.

Nevitt SJ, Sudell M, Tudur Smith C, Marson AG. Topiramate versus carbamazepine monotherapy for epilepsy: an individual participant data review. Cochrane Database of Systematic Reviews. 2016 Jan 28; 12(CD012065). 
DOI: 10.1002/14651858.CD012065.pub2

Nevitt SJ, Sudell M, Weston J, Tudur Smith C, Marson AG. Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data. Cochrane Database of Systematic Reviews. 2017 Jun 29; 6(CD011412). 
DOI: 10.1002/14651858.CD011412.pub3 .

Nevitt  SJ, Tudur Smith  C, Marson  AG. Oxcarbazepine versus phenytoin monotherapy for epilepsy: an individual participant data review. Cochrane Database of Systematic Reviews. 2018 Oct 23; 10(CD003615). 
DOI: 10.1002/14651858.CD003615.pub4.

Nevitt SJ, Tudur Smith C, Weston J, Marson AG. Lamotrigine versus carbamazepine monotherapy for epilepsy: an individual participant data review. Cochrane Database of Systematic Reviews. 2018 Jun 28; 11(CD001031). 
DOI: 10.1002/14651858.CD001031.pub3

Panebianco  M, Prabhakar  H, Marson  AG. Rufinamide add‐on therapy for refractory epilepsy. Cochrane Database of Systematic Reviews. 2018 Apr 25; 4 (CD011772). 
DOI: 10.1002/14651858.CD011772.pub2.

Powell G, Saunders M, Rigby A, Marson AG. Immediate-release versus controlled-release carbamazepine in the treatment of epilepsy. Cochrane Database of Systematic Reviews. 2016 Dec 9; 12(CD007124). 
DOI: 10.1002/14651858.CD007124.pub5

Ramaratnam S, Panebianco M, Marson AG. Lamotrigine add-on for drug-resistant partial epilepsy. Cochrane Database of Systematic Reviews. 2016 Jun 22; 6(CD001909). 
DOI: 10.1002/14651858.CD001909.pub2

Tucker A, Mithoo J, Cleary P, Woodhead M, MacPherson P, Wingfield T, Davies S, Wake C, McMaster P, Squire SB. Quantifying the need for enhanced case management for TB patients as part of TB cohort audit in the North West of England: a descriptive study. BMC public health. 2017 Dec;17(1):881. 
DOI 10.1186/s12889-017-4892-5

Weston J, Bromley R, Jackson CF, Adab N, Clayton-Smith J, Greenhalgh J, Hounsome J, McKay AJ, Tudur Smith C, Marson AG. Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child. Cochrane Database of Systematic Reviews. 2016 Nov 7; 11(CD010224). 
DOI: 10.1002/14651858.CD010224.pub2

Wingfield T, MacPherson P, Sodha P, Tucker A, Mithoo J, Squire SB, Cleary P. Contacts of underserved tuberculosis patients have higher odds of TB disease in North West England: a cohort study. The International Journal of Tuberculosis and Lung Disease. 2019 Mar 1;23(3):337-43.
DOI: 10.5588/ijtld.18.0467

Ziso B, Dixon PA, Marson AG. Epilepsy management in older people: Lessons from National Audit of Seizure management in Hospitals (NASH). Seizure. 2017 Aug 1;50:33-7.
DOI: 10.1016/j.seizure.2017.05.002