Initial presentations of multiple sclerosis: understanding pathways to diagnosis Filled

该博士学位旨在更好地了解随后被诊断为多发性硬化症(MS)的人是如何经历他们的初始症状并提供初级保健的。学生将首先从患者的角度进行检查，然后使用大型医疗数据集来检查和理解患者经历和有记录的诊断之间的异同。多发性硬化症患者在被诊断之前会经历各种症状，来自英国和海外的大型研究表明，在正式诊断之前，他们需要与全科医生和其他医疗保健提供者进行更多的5年预约。然而，目前尚不清楚后来被诊断为多发性硬化症的人是如何在疾病旅程的最早阶段做出如何以及何时寻求医疗护理的决定。学生将试图了解多发性硬化症患者何时感知到他们的症状已经开始，以及他们此时如何与医疗保健专业人员互动。他们将通过对伦敦东部新诊断为多发性硬化症的人进行集中采访，研究不同多发性硬化症患者在从初级保健转诊方面面临的潜在障碍。这将使学生了解包括种族、民族、性别和社会经济贫困在内的社会健康决定因素对多发性硬化症诊断路径的影响，这些因素是在一个独特的多元化和贫困人口中实现的。然后，学生将利用伦敦东部可用的相关医疗保健数据集来检查这些报告的症状是如何记录在初级保健记录中的。他们将对参与研究第一部分的人的医疗记录进行详细研究，以帮助理解随后接受多发性硬化症诊断的不同人群的症状可能被记录下来的方式。然后，他们将使用伦敦东部100万人的大型、多样化的初级保健数据集(&gt；1000人患有多发性硬化症)来了解症状记录方式的模式，以及这些模式与后来被诊断为多发性硬化症的人的经历有何不同。与多发性硬化症协会的合作嵌入到整个博士学位中，包括公众参与培训。在他们的最后一年，学生将完成在微软协会研究和对外事务委员会的实习，以确保他们的发现产生政策影响。他们将与多发性硬化症学会研究传播团队合作，通过多个渠道向多发性硬化症患者传播研究结果，以提高公众的知识和认识。

This PhD aims to better understand how people subsequently diagnosed with multiple sclerosis (MS)experience their initial symptoms and present to primary care. The student will firstly examine this from the patient perspective, before using large healthcare datasets to examine and understand the similarities and differences between patient experiences and documented diagnoses.People with MS experience a variety of symptoms before they are diagnosed, and large studies from the UK and overseas have shown that they have more appointments with GPs and other healthcare providers for 5 years before they are formally diagnosed. However, it remains unknown how people subsequently diagnosed with MS make decisions about how and when to seek medical care at the earliest stage of their disease journey.The student will seek to understand when people with MS perceive their symptoms to have started, and how they interact with healthcare professionals at this time. They will examine the potential barriers that different people with MS face in terms of onward referral from primary care using focused interviews with people newly diagnosed with MS in East London. This will allow the student to understand the impact of social determinants of health including race, ethnicity, gender and socioeconomic deprivation on pathways to MS diagnosis within a uniquely diverse and deprived population.The student will then take advantage of linked healthcare datasets available in East London to examine how these reported symptoms are recorded in primary care records. They will perform a detailed study of the healthcare records of people who have taken part in the first part of the study, facilitating an understanding of how symptoms might be recorded across different groups of people who subsequently receive an MS diagnosis. They will then use a large, diverse primary care dataset of >1,000,000 people in East London (>1000 with MS) to understand patterns in the way that symptoms are recorded, and how these reflectand differ from the experience of people subsequently diagnosed with MS.Collaboration with the MS Society is embedded across the PhD, including public involvement training. During their final year, the student will complete an internship within the Research & External Affairs directorate at the MS Society in order to ensure policy impact from their findings. They will collaborate with the MS Society Research Communications team to disseminate findings to people affected by MS via a number of channels, to improve public knowledge and awareness.