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Research Development

Staff Publications

 Small purple icon of a book with a magnifying glass on top  Staff Publications

Find out what your colleagues have been writing. This section features articles published by staff working for St Helens and Knowsley Teaching Hospitals and Halton, Knowsley and St Helens community staff.

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All publications by 'Irving G'


Mersey and West Lancashire Teaching Hospitals Staff

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St Helens and Knowsley Hospital Staff - Publications pre April 2024

Left Atrial Appendage Occlusion Versus Direct Oral Anticoagulants in the Prevention of Ischaemic Stroke in Patients with Atrial Fibrillation

Introduction Existing randomised controlled trials assessing the safety and efficacy of left atrial appendage occlusion (LAAO) in atrial fibrillation (AF) were of relatively small sample size, or included patients who could receive oral anticoagulant treatment after device implantation. We compared the outcomes of patients with newly diagnosed AF who received..

Published: 02/02/2024
Authors: Elsheikh S, Irving G, Hill AM, Abdul-Rahim A

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Atrial Fibrillation and Stroke: State-of-the-art and future directions

Introduction Stroke is a major complication of atrial fibrillation (AF). About 25% of ischaemic stroke are cardio-embolic in origin; AF is the most common cause of those.1 Nonvalvular AF carries a 5-fold increased risk of stroke,2 while AF related to mitral stenosis increases the risk of stroke by 20-fold.3 The attributable..

Published: 31/10/2023
Authors: Elsheikh S, Hill AM, Irving G, Abdul-Rahim A

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P303 Explicit glycated haemoglobin goals improve subsequent HbA1c levels with no impact on health-related quality of life

Background National guidelines recognise the importance of individualising HbA1c targets. Many people with diabetes agree to have their targets re-evaluated in consultations in response to specific characteristics. Aims We aimed to evaluate the impact of relaxed or stretch HbA1c goals on subsequent HbA1c levels and health-related quality..

Published: 25/04/2023
Authors: McNulty S, Westall S, Narayanan RP, Irving G, Furlong NJ, Bujawansa S, Cardwell J, Hardy KJ

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P302 Glycated haemoglobin targets: The experiences and views of people with diabetes and diabetes healthcare professionals

Background National guidelines highlight the importance of individualising HbA1c targets. Little is known about the experiences of people with diabetes and diabetes healthcare professionals (HCPs) on the use of HbA1c targets. We explored the experiences of adults with diabetes and diabetes HCPs on the use of glycated haemoglobin..

Published: 25/04/2023
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty SJ, Bujawansa S, Cardwell J, Hardy KJ

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P300 Setting explicit glycated haemoglobin goals improves diabetes-related distress, self-efficacy and wellbeing

Background High levels of diabetes-related distress and low levels of self-efficacy and wellbeing are associated with poorer outcomes in people with diabetes. Aims We evaluated the impact of relaxed or stretch HbA1c targets on diabetes-related distress, self-efficacy and wellbeing in adults with type 1 or type 2 diabetes. Methods We randomised 50..

Published: 25/04/2023
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty S, Bujawansa S, Balafshan T, Cardwell J, Hardy KJ

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Psychometric and biomedical outcomes of glycated haemoglobin target-setting in adults with type 1 and type 2 diabetes

Background The disease burden of diabetes can have wide-ranging implications on patients’ psychological well-being and health-related quality of life. Glycated haemoglobin targets are commonly used to guide patient management in diabetes to reduce the future risk of developing diabetes complications, but little is known of the psychological impact of glycated..

Published: 27/10/2022
Authors: Westall S, Narayanan RP, Irving G, Hardy KJ

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The individualisation of glycaemic targets in response to patient characteristics in type 2 diabetes: a scoping review

Background Evidence and guidelines increasingly support an individualised approach to care for people with type 2 diabetes and individualisation of glycaemic targets in response to patient factors. Methods We undertook a scoping review of the literature for evidence of factors impacting upon glycated haemoglobin target individualisation in adults with type 2 diabetes...

Published: 20/04/2022
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty S, Bujawansa S, Hardy KJ

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St Helens Community Staff

Atrial Fibrillation and Stroke: State-of-the-art and future directions

Introduction Stroke is a major complication of atrial fibrillation (AF). About 25% of ischaemic stroke are cardio-embolic in origin; AF is the most common cause of those.1 Nonvalvular AF carries a 5-fold increased risk of stroke,2 while AF related to mitral stenosis increases the risk of stroke by 20-fold.3 The attributable..

Published: 31/10/2023
Authors: Elsheikh S, Hill AM, Irving G, Abdul-Rahim A

Read More

P303 Explicit glycated haemoglobin goals improve subsequent HbA1c levels with no impact on health-related quality of life

Background National guidelines recognise the importance of individualising HbA1c targets. Many people with diabetes agree to have their targets re-evaluated in consultations in response to specific characteristics. Aims We aimed to evaluate the impact of relaxed or stretch HbA1c goals on subsequent HbA1c levels and health-related quality..

Published: 25/04/2023
Authors: McNulty S, Westall S, Narayanan RP, Irving G, Furlong NJ, Bujawansa S, Cardwell J, Hardy KJ

Read More

P302 Glycated haemoglobin targets: The experiences and views of people with diabetes and diabetes healthcare professionals

Background National guidelines highlight the importance of individualising HbA1c targets. Little is known about the experiences of people with diabetes and diabetes healthcare professionals (HCPs) on the use of HbA1c targets. We explored the experiences of adults with diabetes and diabetes HCPs on the use of glycated haemoglobin..

Published: 25/04/2023
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty SJ, Bujawansa S, Cardwell J, Hardy KJ

Read More

P300 Setting explicit glycated haemoglobin goals improves diabetes-related distress, self-efficacy and wellbeing

Background High levels of diabetes-related distress and low levels of self-efficacy and wellbeing are associated with poorer outcomes in people with diabetes. Aims We evaluated the impact of relaxed or stretch HbA1c targets on diabetes-related distress, self-efficacy and wellbeing in adults with type 1 or type 2 diabetes. Methods We randomised 50..

Published: 25/04/2023
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty S, Bujawansa S, Balafshan T, Cardwell J, Hardy KJ

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Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial

Background The safety, effectiveness, and cost-effectiveness of molnupiravir, an oral antiviral medication for SARS-CoV-2, has not been established in vaccinated patients in the community at increased risk of morbidity and mortality from COVID-19. We aimed to establish whether the addition of molnupiravir to usual care reduced hospital admissions and deaths..

Published: 22/12/2022
Authors: Irving G

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Psychometric and biomedical outcomes of glycated haemoglobin target-setting in adults with type 1 and type 2 diabetes

Background The disease burden of diabetes can have wide-ranging implications on patients’ psychological well-being and health-related quality of life. Glycated haemoglobin targets are commonly used to guide patient management in diabetes to reduce the future risk of developing diabetes complications, but little is known of the psychological impact of glycated..

Published: 27/10/2022
Authors: Westall S, Narayanan RP, Irving G, Hardy KJ

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General practitioners' perceptions of using virtual primary care during the COVID-19 pandemic

Abstract With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs’ perspectives on the main..

Published: 16/05/2022
Authors: Irving G

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The individualisation of glycaemic targets in response to patient characteristics in type 2 diabetes: a scoping review

Background Evidence and guidelines increasingly support an individualised approach to care for people with type 2 diabetes and individualisation of glycaemic targets in response to patient factors. Methods We undertook a scoping review of the literature for evidence of factors impacting upon glycated haemoglobin target individualisation in adults with type 2 diabetes...

Published: 20/04/2022
Authors: Westall S, Narayanan RP, Irving G, Furlong NJ, McNulty S, Bujawansa S, Hardy KJ

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Evaluation of a ‘drop box’ doorstep assessment service to aid remote assessments for COVID-19 in general practice

Abstract: COVID-19 is an established threat whose clinical features and epidemiology continues to evolve. In an effort to contain the disease, the National Health Service has adopted a digital first approach in UK general practice resulting in a significant shift away from face-to-face consultations. Consequently, more consultations are being completed..

Published: 29/03/2021
Authors: Irving G

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The MRCGP Recorded Consultation Assessment: time to drop 10 minutes as standard?

Extract Why do we continue to examine GP trainees at 10 minutes when the RCGP itself has called for longer GP consultations? The recently announced changes to the MRCGP in response to the COVID-19 pandemic has seen the replacement of the Clinical Skills Assessment (CSA) with the Recorded Consultation Assessment (RCA).1..

Published: 28/01/2021
Authors: Irving G

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Which cuff should I use?

Objective To determine the diagnostic accuracy of different methods of blood pressure (BP) measurement compared with reference standards for the diagnosis of hypertension in patients with obesity with a large arm circumference. Data sources MEDLINE, EMBASE, Cochrane, DARE, Medion and Trip databases were searched. Eligibility criteria Cross-sectional, randomised and cohort..

Published: 03/11/2016
Authors: Irving G

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Interventions to increase or decrease the length of primary care physicians' consultation

Background Observational studies have shown differences in process and outcome between the consultations of primary care physicians whose average consultation lengths differ. These differences may be due to self selection. This is the first update of the original review. Objectives To assess the effects of interventions to alter the length..

Published: 25/08/2016
Authors: Irving G

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After Achilles

Extract Contrary to the view that ‘using time as a diagnostic tool’ is ‘sloppy and idle’ and that general practice has ‘floundered’ as a result of such unhelpful phrases, we consider that general practice has struggled to provide a robust evidence base to confirm or refute the value of time..

Published: 01/05/2016
Authors: Irving G

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The AGREE Reporting Checklist is useful for assessing the quality of clinical practice guideline development

Extract At least two systematic reviews of national and international clinical practice guidelines have used the AGREE tools (I and II). Both found that no guideline was perfect and highlighted the same key problems—a lack of applicability and stakeholder involvement. These domains relate to … Irving, G. (2016). The AGREE Reporting..

Published: 12/04/2016
Authors: Irving G

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Do you understand how your health system works?

Extract As family doctors we should be thinking about how our healthcare system works and how we can shape it. We share responsibility for the distribution of limited resources not only as healthcare professionals, but also as patients and taxpaying citizens. But how much do we know about how the..

Published: 05/11/2015
Authors: Irving G

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Adjustment and adaptation in patients with chronic heart failure at the end of life

  Irving, G 2015, 'Adjustment and adaptation in patients with chronic heart failure at the end of life', PhD thesis, University of Liverpool, Liverpool.

Published: 02/09/2015
Authors: Irving G

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The meaning of suffering in patients with advanced progressive cancer

Background There is a lack of research into suffering and what it means to the individual patient with advanced cancer and its importance in end of life care. Aims To explore the concept of suffering and distress by eliciting what individual patients with advanced cancer perceived as suffering and how..

Published: 01/09/2015
Authors: Irving G

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Pharmacological agents for the prevention of vestibular migraine

Background Vestibular migraine is a common cause of episodic vertigo. Many preventive treatments have been proposed for this condition, including calcium antagonists, beta‐blockers, antidepressants, anticonvulsants, selective 5‐HT1 agonists, serotonin antagonists and non‐steroidal anti‐inflammatory drugs (NSAIDs). Objectives To assess the effects of pharmacological agents for the prevention of..

Published: 21/06/2015
Authors: Irving G

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Colchicine for Pericarditis

Background Pericarditis is the inflammation of the pericardium, the membranous sac surrounding the heart. Recurrent pericarditis is the most common complication of acute pericarditis, causing severe and disabling chest pains. Recurrent pericarditis affects one in three patients with acute pericarditis within the first 18 months. Colchicine has been suggested to be..

Published: 28/08/2014
Authors: Irving G

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Cardiovascular disease and cancer compete for the outcome of death

Extract Life is a game of multiple competing risks, and problems arise when we forget that death is a single, non-repetitive event usually attributable to one cause.1 Doctors often consider issues of competing risks when caring for patients with multimorbid chronic disease. For example, it’s not uncommon for a..

Published: 19/08/2014
Authors: Irving G

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From patient uncertainty to WHO policy in two years

Abstract Clinical encounters in daily practice can provide a fertile ground for identifying uncertainties that require further investigation. Addressing such uncertainties by undertaking a Cochrane review can be a rewarding educational process and result in important contributions to health care policy. This paper describes the experiences of a UK GP..

Published: 10/03/2014
Authors: Irving G

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Examining the practice of generalist expertise: a qualitative study identifying constraints and solutions

Objectives Provision of person-centred generalist care is a core component of quality primary care systems. The World Health Organisation believes that a lack of generalist primary care is contributing to inefficiency, ineffectiveness and inequity in healthcare. In UK primary care, General Practitioners (GPs) are the largest group of practising generalists...

Published: 02/12/2013
Authors: Irving G

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Chronic heart failure guidelines: Do they adequately address patient need at the end-of-life?

Introduction A number of international guidelines have been developed to support primary care clinicians improve the quality of care for patients with chronic heart failure at the end of life. The objective of this study was to undertake a systematic evaluation of such guidelines in relation to end-of-life care. Methods..

Published: 03/10/2013
Authors: Irving G, Holden JD

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NAPCRG 2012: reflections from across the pond

Extract The 40th annual meeting of the North American Primary Care Research Group (NAPCRG) was held in New Orleans from 1–5 December 2012. As early-career family doctors from the UK we were keen to explore primary care research from around the world. With delegates from North America and Europe to the antipodes..

Published: 01/08/2013
Authors: Irving G

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Measures of promptness of cancer diagnosis in primary care

Extract Sir, In their discussion Lyratzopoulos et al (2003) make the crucial point that they were not able to examine whether prolonged values of either the primary care interval or the number of pre-referral consultations were either justifiable or preventable. We also wish to question the widely held assumption that optimum..

Published: 01/05/2013
Authors: Irving G, Holden JD

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Global health: time for full integration into GP education

Extract Postgraduate medical training no longer sufficiently prepares UK doctors for the challenges of the 21st century. In 2010, an Independent Commission on the Education of Health Professionals, published in The Lancet, described a ‘mismatch between present professional competencies and the requirements of an increasingly interdependent world’.1 Globalisation, fuelled by a..

Published: 01/05/2013
Authors: Irving G

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The John Henry effect

Extract The “Ballad of John Henry” tells of the legendary black American steel pin driver, John Henry, who swung a huge nine pound hammer driving railroad spikes on the Chesapeake and Ohio railway in the 1870s.1 John Henry was renowned for his strength among his fellow workers and could drive..

Published: 02/04/2013
Authors: Irving G

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The time-efficiency principle: time as the key diagnostic strategy in primary care

Abstract The test and retest opportunity afforded by reviewing a patient over time substantially increases the total gain in certainty when making a diagnosis in low-prevalence settings (the time-efficiency principle). This approach safely and efficiently reduces the number of patients who need to be formally tested in order to make..

Published: 27/03/2013
Authors: Irving G, Holden JD

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VdGM: Vasco da Gama Movement

Extract The Vasco da Gama Movement is delighted to announce that it is participating in the organization of the World Preconference, which will be carried out in Prague on 24–25 June 2013, prior to the Wonca World Conference. The event is organized in partnership with the Rajakumar Movement (Asia-Pacific Region), the Waynakay..

Published: 01/03/2013
Authors: Irving G

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Dismantling Lord Moran’s ladder: the primary care expert generalist

Extract It is over 50 years since Lord Moran suggested that GPs were doctors who have fallen off the specialist ladder.2 Then, two-thirds of early career GPs would have preferred to have been specialists.2 Today Lord Moran’s ladder lives on. General practice is still not a first career choice for..

Published: 01/01/2013
Authors: Irving G

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Long-term protective effects of hepatitis A vaccines. A systematic review

Objective Data on duration and long-term protective effects of hepatitis A vaccines (HepA) have not been reviewed using a systematic approach. Our objective is to provide a comprehensive review of evidence on the duration of protection achieved by HepA, which is needed for revising existing vaccine policies. Limitations in data..

Published: 17/12/2012
Authors: Irving G

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Global health in the UK's GP postgraduate curriculum

Extract Jennifer Hall and colleagues (Aug 25, p 728) highlight an apparent lack of global health content in UK postgraduate curricula. The Curriculum Development Committee of the UK's Royal College of General Practitioners (RCGP) is currently exploring whether more explicit language about global health issues should appear in the GP postgraduate curriculum...

Published: 10/11/2012
Authors: Irving G

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Do GPs really provide 47 minutes a year for the patient?

Extract The recently published RCGP report on medical generalism brings into focus the need for GPs to spend more time with patients to deliver high quality generalist care. Historically, the figure of 47 minutes a year for the patient has been widely cited and discussed as a summary statistic for the..

Published: 01/08/2012
Authors: Irving G

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Hepatitis A immunisation in persons not previously exposed to hepatitis A

Background In many parts of the world, hepatitis A infection represents a significant cause of morbidity and socio‐economic loss. Whilst hepatitis A vaccines have the potential to prevent disease, the degree of protection afforded against clinical outcomes and within different populations remains uncertain. There are two types of hepatitis..

Published: 11/07/2012
Authors: Irving G, Holden JD

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15 minute consultations as standard benefit patients and GPs

Extract Spence claims that increasing appointments to 15 minutes would reduce availability, limit access, and jeopardise safety with an unknown effect on the quality of patient care. We have offered 15 minute appointments as standard in our practice for eight years with huge benefits for our patients and us. Irving, G; Holden,..

Published: 01/06/2012
Authors: Irving G

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Calling time on the 10-minute consultation

Extract In their editorial, Silverman and Kinnersley present a strong case for moving on from the 10-minute consultation. In 2011 an electronic ‘consultation length’ survey of all UK GP trainees (ST1–ST4) was undertaken by the RCGP Associates in Training committee. One of the key questions within the electronic survey was, ‘..

Published: 01/05/2012
Authors: Irving G

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A pause for thought: reflections on the 2011 SAPC Annual Conference

Extract The 41st Annual Scientific Meeting of the Society for Academic Primary Care (SAPC) was held in Bristol. A packed and varied programme,1 together with excellent organisation, brought people together to share ‘breaking news’ in primary care teaching and research. However, conferences are about more than dissemination of new work...

Published: 31/10/2011
Authors: Irving G

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Can generalism help revive the primary healthcare vision?

Extract It is more than 30 years since the World Health Organization (WHO) called for a paradigm-shift to a model of primary healthcare: a vision of creating ‘Health for All’ through ‘putting people at the centre of health care’.1 Since then, we have seen significant advances in health and healthcare. People..

Published: 03/10/2011
Authors: Irving G

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Academic General Practice Training in the UK-what is it All about?

Abstract Academic GPs have made significant contributions to the care of many millions of patients through research in primary care populations. They have also been instrumental in the development of community-based undergraduate medical education. Here, we explore what academic GP training involves and why all associates in training should have..

Published: 01/09/2010
Authors: Irving G

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Depression in advanced cancer

Purpose Depression is one of the most common psychiatric diseases seen in patients with advanced cancer. It is not only an independent predictor of poor survival in advanced cancer but also reduces quality of life, reduces compliance with treatment and prolongs hospitalization. Yet all too often depression is under diagnosed..

Published: 01/08/2010
Authors: Irving G

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The educational benefits of a federation of four training practices

No abstract available. Hargreaves, S; Irving, G; Holden, J. (2010). The educational benefits of a federation of four training practices. Education for Primary Care. 21 (2), 114-115

Published: 31/03/2010
Authors: Irving G, Holden JD

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The Prevalence of Depression in People with Cancer

This chapter contains sections titled: Prevalence of Depression in Cancer Patients Depression by Cancer Type Depression in Advanced Cancer and Palliative Care Demoralization Conclusions References   Massie, MJ; Lloyd-Williams, M; Irving, G; Miller, K. (2010). The Prevalence of Depression in People with Cancer. In: Kissane, DW; Maj, M; Sartorius, N Depression and..

Published: 03/03/2010
Authors: Irving G

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Knowsley Community Staff

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Halton Community Staff

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North West Boroughs Community Health Staff

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