Rafael Perera
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View article: Understanding changes in complex care needs over time: key research insights into multimorbidity trajectories
Understanding changes in complex care needs over time: key research insights into multimorbidity trajectories Open
Multimorbidity, the coexistence of multiple chronic diseases or conditions, poses a major challenge for health-care systems worldwide. Traditional research has largely relied on cross-sectional studies, offering limited insight into multim…
View article: Outpatient hospital attendances in people with rheumatoid arthritis during the COVID-19 pandemic and beyond: a cohort study in three nations of the UK
Outpatient hospital attendances in people with rheumatoid arthritis during the COVID-19 pandemic and beyond: a cohort study in three nations of the UK Open
Objectives We aimed to estimate how rheumatology outpatient hospital attendances have changed since the COVID-19 pandemic and determine demographic characteristics associated with observed changes. Methods Using three primary and secondary…
View article: Referral of febrile children in resource-constrained community settings in Asia (Spot Sepsis) – a multi-country, prospective, cohort study
Referral of febrile children in resource-constrained community settings in Asia (Spot Sepsis) – a multi-country, prospective, cohort study Open
In resource-constrained community settings, distinguishing which febrile children require referral is a major unmet need. Current WHO danger signs lack accuracy, resulting in missed severe illness and unnecessary referrals. We developed an…
View article: Prostate specific antigen retesting intervals and trends in England: population based cohort study
Prostate specific antigen retesting intervals and trends in England: population based cohort study Open
Objective To characterise the use of the prostate specific antigen (PSA) test in primary care in England. Design Population based open cohort study. Setting England. Participants 10 235 805 male patients older than 18 years and registered …
View article: Investigating attitudes and framing moral responsibility in healthcare professionals for smoking cessation interventions
Investigating attitudes and framing moral responsibility in healthcare professionals for smoking cessation interventions Open
Objectives Evidence‐based support from healthcare professionals improves smoking cessation outcomes, yet intervention rates among UK general practitioners (GPs) remain suboptimal. This exploratory study explored whether framing messages ar…
View article: Understanding structured medication reviews delivered by clinical pharmacists in primary care in England: a national cross-sectional survey
Understanding structured medication reviews delivered by clinical pharmacists in primary care in England: a national cross-sectional survey Open
Objectives This study explored how Structured Medication Reviews (SMRs) are being undertaken and the challenges to their successful implementation and sustainability. Design A cross-sectional mixed methods online survey. Setting Primary ca…
View article: Exploring the implementation and integration of structured medication reviews in primary care: A qualitative evaluation using normalization process theory
Exploring the implementation and integration of structured medication reviews in primary care: A qualitative evaluation using normalization process theory Open
Background Structured Medication Reviews (SMRs) were introduced into primary care in England for patients living with multiple long-term conditions (MLTCs), polypharmacy, increased frailty, in care homes or at risk of medicines-related har…
View article: Comparison of the analytical and clinical sensitivities of 34 rapid antigen tests with prevalent SARS-CoV-2 variants of concern during the COVID-19 pandemic in the UK
Comparison of the analytical and clinical sensitivities of 34 rapid antigen tests with prevalent SARS-CoV-2 variants of concern during the COVID-19 pandemic in the UK Open
Antigen-detection rapid diagnostic tests (Ag-RDTs) have become a central pillar for the management of coronavirus disease worldwide due to their speed and ease of use and are now being developed for use in other emerging outbreaks. Like ot…
View article: Value-Based Commissioning of Mental Health Services in England: A Feasibility Study Using Multicriteria Decision Analysis
Value-Based Commissioning of Mental Health Services in England: A Feasibility Study Using Multicriteria Decision Analysis Open
MCDA can facilitate value-for-money assessments of mental health services, addressing gaps in comprehensive rationing frameworks. This approach provides a systematic, evidence-driven method for local decision making, with potential for bro…
View article: Impact of structured medication reviews on prescribing in English Primary Care: a nationwide observational cohort study
Impact of structured medication reviews on prescribing in English Primary Care: a nationwide observational cohort study Open
Objectives The present study aimed to evaluate the impact of structured medication reviews (SMRs), by examining the proportion of eligible patients who received a review in the first two years of the programme, and whether SMRs were associ…
View article: Clinical Prediction Models Incorporating Blood Test Trend for Cancer Detection: Systematic Review, Meta-Analysis, and Critical Appraisal
Clinical Prediction Models Incorporating Blood Test Trend for Cancer Detection: Systematic Review, Meta-Analysis, and Critical Appraisal Open
Background Blood tests used to identify patients at increased risk of undiagnosed cancer are commonly used in isolation, primarily by monitoring whether results fall outside the normal range. Some prediction models incorporate changes over…
View article: Identifying profiles, trajectories, burden, social and biological factors in 3.3 million individuals with multimorbidity in England
Identifying profiles, trajectories, burden, social and biological factors in 3.3 million individuals with multimorbidity in England Open
Multimorbidity, the co-occurrence of multiple chronic conditions in an individual, has become a global health challenge affecting populations in high-income and low- to middle-income countries. Despite its increasing prevalence, critical g…
View article: Study of the Absolute meaning and Usage Meaning of the Stage Materials in a Stage Play
Study of the Absolute meaning and Usage Meaning of the Stage Materials in a Stage Play Open
In the stage drama productions we observed, numerous stage materials were capable of conveying various ideas. However, these materials are recognized by the audience as elements of theatrical expression. The stage decorations, props, and b…
View article: Identifying profiles, trajectories, burden, social and biological factors in 3.3 million individuals with multimorbidity in England
Identifying profiles, trajectories, burden, social and biological factors in 3.3 million individuals with multimorbidity in England Open
Multimorbidity, the co-occurrence of multiple chronic conditions in an individual, has become a global health challenge affecting populations in high-income and low- to middle- income countries. Despite its increasing prevalence, critical …
View article: Implementation framework for AI deployment at scale in healthcare systems
Implementation framework for AI deployment at scale in healthcare systems Open
Artificial intelligence (AI) and digital health technologies are increasingly used in the medical field. Despite promises of leading the future of personalized medicine and better clinical outcomes, implementation of AI faces barriers for …
View article: Educational interventions delivered to prescribing advisers to influence primary care prescribing: a very low-cost pragmatic randomised trial using routine data from OpenPrescribing.net
Educational interventions delivered to prescribing advisers to influence primary care prescribing: a very low-cost pragmatic randomised trial using routine data from OpenPrescribing.net Open
Background NHS England issued commissioning guidance on 18 low-priority treatments which should not be routinely prescribed in primary care. We aimed to monitor the impact of an educational intervention delivered to regional prescribing ad…
View article: Risk stratification of childhood infection using host markers of immune and endothelial activation: a multi-country prospective cohort study in Asia (Spot Sepsis)
Risk stratification of childhood infection using host markers of immune and endothelial activation: a multi-country prospective cohort study in Asia (Spot Sepsis) Open
Background Circulating markers of immune and endothelial activation risk stratify infection syndromes agnostic to disease aetiology. However, their utility in children presenting from the community remains unclear. Methods This study recru…
View article: Study protocol: Comparison of different risk prediction modelling approaches for COVID-19 related death using the OpenSAFELY platform
Study protocol: Comparison of different risk prediction modelling approaches for COVID-19 related death using the OpenSAFELY platform Open
On March 11th 2020, the World Health Organization characterised COVID-19 as a pandemic. Responses to containing the spread of the virus have relied heavily on policies involving restricting contact between people. Evolving policies regardi…
View article: Bioactive constituents from Carica papaya fruit: implications for drug discovery and pharmacological applications
Bioactive constituents from Carica papaya fruit: implications for drug discovery and pharmacological applications Open
Carica papaya , commonly known as papaya, is a fruit recognized for its substantial medicinal potential, primarily due to its wide range of bioactive compounds. This review thoroughly examines the pharmacological implications of these cons…
View article: Optimization of SARS-CoV-2 culture from clinical samples for clinical trial applications
Optimization of SARS-CoV-2 culture from clinical samples for clinical trial applications Open
Clinical trials of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) therapeutics often include virological secondary endpoints to compare viral clearance and viral load reduction between treatment and placebo arms. This is typi…
View article: Validity and timeliness of cancer diagnosis data collected during a prospective cohort study and reported by the English and Welsh cancer registries: a retrospective, comparative analysis
Validity and timeliness of cancer diagnosis data collected during a prospective cohort study and reported by the English and Welsh cancer registries: a retrospective, comparative analysis Open
GRAIL Bio UK.
View article: Temporal trends and practice variation of paediatric diagnostic tests in primary care: retrospective analysis of 14 million tests
Temporal trends and practice variation of paediatric diagnostic tests in primary care: retrospective analysis of 14 million tests Open
Objective The primary objective was to investigate temporal trends and between-practice variability of paediatric test use in primary care. Methods and analysis This was a descriptive study of population-based data from Clinical Practice R…
View article: Research inefficiencies in external validation studies of the Framingham Wilson coronary heart disease risk rule: A systematic review
Research inefficiencies in external validation studies of the Framingham Wilson coronary heart disease risk rule: A systematic review Open
Background External validation studies create evidence about a clinical prediction rule’s (CPR’s) generalizability by evaluating and updating the CPR in populations different from those used in the derivation, and also by contributing to e…
View article: Unravelling Elements of Value of Healthcare and Assessing their Importance Using Evidence from Two Discrete-Choice Experiments in England
Unravelling Elements of Value of Healthcare and Assessing their Importance Using Evidence from Two Discrete-Choice Experiments in England Open
The public prioritizes value elements not captured by conventional metrics, such as quality-adjusted life-years. Although cost inclusion did not alter the preference ranking, its inclusion in the value metric warrants careful consideration.