Professor Nicholas Francis
Professor of Primary Care Research
- Email:
- francisna@cardiff.ac.uk
- Telephone:
- +44 (0)29 2068 7133
- Location:
- Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS
I am an academic general practitioner and my research interests are around improving the management of problems commonly seen in general practice.
My research has primarily focused around four main areas:
1) Infections, complications of infections, and antimicrobial use and resistance.
2) Skin conditions, including eczema, acne, skin infections and molluscum contagiosum.
3) Respiratory conditions, including respiratory infections, COPD and asthma.
4) Urinary / renal problems.
2018
- Dekker, A. R.et al. 2018. Effectiveness of GP online training and an information booklet for parents on antibiotic prescribing for children with RTI in primary care: a cluster randomised controlled trial. Journal of Antimicrobial Chemotherapy
- Cope, A.et al. 2018. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database of Systematic Reviews 9, article number: CD010136. (10.1002/14651858.CD010136.pub3)
- Ahmed, H.et al. 2018. Risk of adverse outcomes following urinary tract infection in older people with renal impairment: retrospective cohort study using linked health record data. PLoS Medicine 15(9), article number: e1002652. (10.1371/journal.pmed.1002652)
- Gal, M.et al. 2018. Matching diagnostics development to clinical need: Target product profile development for a point of care test for community-acquired lower respiratory tract infection. PLoS ONE 13(8), article number: e0200531. (10.1371/journal.pone.0200531)
- de Bont, E. G. P. M.et al. 2018. Booklet for childhood fever in out-of-hours primary care: A cluster-randomized controlled trial. Annals of Family Medicine 16(4), pp. 314-321. (10.1370/afm.2265)
- Bongard, E.et al. 2018. Antivirals for influenza-Like Illness? A randomised Controlled trial of Clinical and Cost effectiveness in primary CarE (ALIC4E): the ALIC4E protocol. BMJ Open 8(7), article number: e021032. (10.1136/bmjopen-2017-021032)
- Gillespie, D.et al. 2018. Use of co-primary outcomes for trials of antimicrobial stewardship interventions. Lancet Infectious Diseases 18(6), pp. 595-597. (10.1016/S1473-3099(18)30289-5)
- Butler, C. C.et al. 2018. A trial like ALIC4E: why design a platform, response-adaptive, open, randomised controlled trial of antivirals for influenza-like illness?. ERJ Open Research 4(2), article number: 00046-2018. (10.1183/23120541.00046-2018)
- Ingram, J.et al. 2018. Levels of wound calprotectin and other inflammatory biomarkers aid in deciding which patients with a diabetic foot ulcer need antibiotic therapy (INDUCE study). Diabetic Medicine 35(2), pp. 255-261. (10.1111/dme.13431)
- Santer, M.et al. 2018. Stemming the tide of antimicrobial resistance: implications for management of acne vulgaris. British Journal of General Practice 68(667), pp. 64-65. (10.3399/bjgp18X694457)
- Gobat, N. H.et al. 2018. Talking to the people that really matter about their participation in pandemic clinical research: a qualitative study in four European countries. Health Expectations 21(1), pp. 387-395. (10.1111/hex.12634)
- Butler, C. C.et al. 2018. Point-of-care urine culture for managing urinary tract infection in primary care: a randomised controlled trial of clinical and cost-effectiveness. British Journal of General Practice 68(669), pp. e268-e278. (10.3399/bjgp18X695285)
- Ahmed, H.et al. 2018. Incidence and antibiotic prescribing for clinically diagnosed urinary tract infection in older adults in UK primary care, 2004-2014. PLoS ONE 13(1), article number: e0190521. (10.1371/journal.pone.0190521)
- Gal, M.et al. 2018. Priority needs for conducting pandemic-relevant clinical research with children in Europe: A consensus study with pediatric clinician-researchers. Pediatric Infectious Disease Journal
- Santer, M.et al. 2018. Emollient bath additives for the treatment of childhood eczema (BATHE): multi-centre pragmatic parallel group randomised controlled trial of clinical and cost-effectiveness. BMJ
- Cope, A.et al. 2018. Patients' reasons for consulting a GP when experiencing a dental problem: a qualitative study. British Journal of General Practice
- Ahmed, H.et al. 2018. Antibiotic prophylaxis and clinical outcomes among older adults with recurrent urinary tract infection: cohort study. Age and Ageing
2017
- Francis, N.et al. 2017. Variations in presentation, management, and patient outcomes of urinary tract infection: a prospective four-country primary care observational cohort study. British Journal of General Practice 67(665), pp. e830-e841., article number: 10.3399/bjgp17X693641.
- Aviles-Solis, J. C.et al. 2017. International perception of lung sounds: a comparison of classification across some European borders. BMJ Open Respiratory Research 4(1), article number: e000250. (10.1136/bmjresp-2017-000250)
- Shepherd, V.et al. 2017. Impact of a deferred recruitment model in a randomised controlled trial in primary care (CREAM study). Trials 18(1), article number: 533. (10.1186/s13063-017-2284-x)
- Atwan, A.et al. 2017. Dermatology life quality index (DLQI) as a psoriasis referral triage tool. British Journal of Dermatology 177(4), pp. e136-e137. (10.1111/bjd.15446)
- Bates, J.et al. 2017. General practitioner use of a C-reactive protein point-of-care test to help target antibiotic prescribing in patients with acute exacerbations of chronic obstructive pulmonary disease (the PACE study): study protocol for a randomised controlled trial. Trials 18, article number: 422. (10.1186/s13063-017-2144-8)
- Santer, M.et al. 2017. Views of oral antibiotics and advice seeking about acne: a qualitative study of online discussion forums. British Journal of Dermatology 177(3), pp. 751 -757. (10.1111/bjd.15398)
- Thomas, K.et al. 2017. Identifying priority areas for research into the diagnosis, treatment and prevention of cellulitis (erysipelas) - results of a James Lind Alliance Priority Setting Partnership. British Journal of Dermatology 177(2), pp. 541-543. (10.1111/bjd.15634)
- van Eerd, E. A. M.et al. 2017. Why do physicians lack engagement with smoking cessation treatment in their COPD patients? A multinational qualitative study. NPJ Primary Care Respiratory Medicine 27(1), article number: 41. (10.1038/s41533-017-0038-6)
- Blair, P. S.et al. 2017. Feasibility cluster randomised controlled trial of a within-consultation intervention to reduce antibiotic prescribing for children presenting to primary care with acute respiratory tract infection and cough. BMJ Open 7(5), article number: e014506. (10.1136/bmjopen-2016-014506)
- Ahmed, H.et al. 2017. Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials. BMJ Open 7(5), pp. e015233. (10.1136/bmjopen-2016-015233)
- Gillespie, D.et al. 2017. Determinants of initiation, implementation, and discontinuation of amoxicillin by adults with acute cough in primary care. Patient Preference and Adherence 2017(11), pp. 561-569. (10.2147/PPA.S119256)
- Francis, N. A.et al. 2017. Oral and topical antibiotics for clinically infected eczema in children: a pragmatic randomized controlled trial in ambulatory care. Annals of Family Medicine 15(2), pp. 124-130. (10.1370/afm.2038)
- Francis, N. A.et al. 2017. The management of acne vulgaris in primary care: a cohort study of consulting and prescribing patterns using CPRD. British Journal of Dermatology 176(1), pp. 107-115. (10.1111/bjd.15081)
- Francis, N.et al. 2017. An evaluation of the TARGET Antibiotics Toolkit (Treat Antibiotics Responsibly; Guidance, Education, Tools) to improve antimicrobial stewardship in primary care - is it fit for purpose?. Family Practice
2016
- Laue, J.et al. 2016. How do general practitioners implement decision-making regarding COPD patients with exacerbations? An international focus group study. International Journal of Chronic Obstructive Pulmonary Disease 11(1), pp. 3109-3119. (10.2147/COPD.S118856)
- de Bont, E. G. P. M.et al. 2016. An illness-focused interactive booklet to optimise management and medication for childhood fever and infections in out-of-hours primary care: study protocol for a cluster randomised trial. Trials 17(1), article number: 547. (10.1186/s13063-016-1667-8)
- Gkiousias, V.et al. 2016. Parental perceptions and understanding of information provision, management options and factors influencing the decision-making process in the treatment of children with glue ear. International Journal of Pediatric Otorhinolaryngology 89, pp. 6-12. (10.1016/j.ijporl.2016.07.021)
- Tonkin-Crine, S.et al. 2016. Discrepancies between qualitative and quantitative evaluation of randomised controlled trial results: achieving clarity through mixed methods triangulation. Implementation Science : IS 11, article number: 66. (10.1186/s13012-016-0436-0)
- Cope, A.et al. 2016. Dental consultations in UK general practice and antibiotic prescribing rates: a retrospective cohort study. British Journal of General Practice, pp. e329-e336. (10.3399/bjgp16X684757)
- Francis, N.et al. 2016. Understanding flucloxacillin prescribing trends and treatment non-response in UK primary care: a Clinical Practice Research Datalink (CPRD) study. Journal of Antimicrobial Chemotherapy 71(7), pp. 2037-2046. (10.1093/jac/dkw084)
- Olsen, J. R.et al. 2016. Quality of life impact of childhood skin conditions measured using the Children's Dermatology Life Quality Index (CDLQI): a meta-analysis. British Journal of Dermatology 174(4), pp. 853-861. (10.1111/bjd.14361)
- Cope, A.et al. 2016. Antibiotic prescribing in UK general dental practice: a cross-sectional study. Community Dentistry and Oral Epidemiology 44(2), pp. 145-153. (10.1111/cdoe.12199)
- Waldron, C.et al. 2016. Oral Steroids for the Resolution of Otitis Media with Effusion (OME) in Children (OSTRICH): study protocol for a randomised controlled trial. Trials 17, article number: 115. (10.1186/s13063-016-1236-1)
- Olsen, J. R.et al. 2016. Molluscum contagiosum and associations with atopic eczema in children: a retrospective longitudinal study in primary care. Brtitish Journal of General Practice 66(642), article number: e53. (10.3399/bjgp15X688093)
2015
- Gobat, N. H.et al. 2015. Key stakeholder perceptions about consent to participate in acute illness research: a rapid, systematic review to inform epi/pandemic research preparedness. Trials 16(1), article number: 591. (10.1186/s13063-015-1110-6)
- Santer, M.et al. 2015. Bath additives for the treatment of childhood eczema (BATHE): protocol for multicentre parallel group randomised trial. BMJ Open 5(10), article number: e009575. (10.1136/bmjopen-2015-009575)
- Cope, A.et al. 2015. General practitioners' attitudes towards the management of dental conditions and use of antibiotics in these consultations: a qualitative study. BMJ Open 5(10), article number: e008551. (10.1136/bmjopen-2015-008551)
- Bongard, E.et al. 2015. Analytic laboratory performance of a point of care urine culture kit for diagnosis and antibiotic susceptibility testing. European Journal of Clinical Microbiology & Infectious Diseases 34(10), pp. 2111-2119. (10.1007/s10096-015-2460-4)
- Turnbull, S. L.et al. 2015. The CHICO (Children's Cough) Trial protocol: a feasibility randomised controlled trial investigating the clinical and cost-effectiveness of a complex intervention to improve the management of children presenting to primary care with acute respiratory tract infection. BMJ Open 5(9), pp. 1-7., article number: e008615. (10.1136/bmjopen-2015-008615)
- Gillespie, D.et al. 2015. Antibiotic prescribing and associated diarrhoea: a prospective cohort study of care home residents. Age and Ageing 44(5), pp. 853-860. (10.1093/ageing/afv072)
- de Bont, E. G. P. M.et al. 2015. Childhood fever: a qualitative study on GPs' experiences during out-of-hours care. Family Practice 32(4), pp. 449-455. (10.1093/fampra/cmv029)
- Lugg, F.et al. 2015. Parental views on childhood vaccination against viral gastroenteritis-a qualitative interview study. Family Practice 32(4), pp. 456-461. (10.1093/fampra/cmv035)
- Anthierens, S.et al. 2015. Clinicians' views and experiences of interventions to enhance the quality of antibiotic prescribing for acute respiratory tract infections. Journal of General Internal Medicine 30(4), pp. 408-416. (10.1007/s11606-014-3076-6)
2014
- Godycki-Cwirko, M.et al. 2014. Public beliefs on antibiotics and symptoms of respiratory tract infections among rural and urban population in Poland: a questionnaire study. PLoS ONE 9(10), article number: e109248. (10.1371/journal.pone.0109248)
- Cope, A.et al. 2014. General dental practitioners' perceptions of antimicrobial use and resistance: a qualitative interview study. British Dental Journal 217(5), pp. 653-660., article number: E9. (10.1038/sj.bdj.2014.761)
- Olsen, J.et al. 2014. Development and validation of the Molluscum Contagiosum Diagnostic Tool for Parents: diagnostic accuracy study in primary care. British Journal of General Practice (BJGP) 64(625), pp. e471-e476. (10.3399/bjgp14X680941)
- Davies, F.et al. 2014. Primary and secondary care clinicians? views on self-treatment of COPD exacerbations: A multinational qualitative study. Patient Education and Counseling 96(2), pp. 256-263. (10.1016/j.pec.2014.05.011)
- Tonkin-Crine, S.et al. 2014. Exploring patients' views of primary care consultations with contrasting interventions for acute cough: a six-country European qualitative study. NPJ Primary Care Respiratory Medicine 24, article number: 14026. (10.1038/npjpcrm.2014.26)
- Olsen, J.et al. 2014. Epidemiology of molluscum contagiosum in children: a systematic review. Family Practice 31(2), pp. 130-136. (10.1093/fampra/cmt075)
- Hamoen, M.et al. 2014. Medication use in European primary care patients with lower respiratory tract infection: an observational study. British Journal of General Practice (BJGP) 64(619), pp. e81-e91. (10.3399/bjgp14X677130)
- Brophy, S.et al. 2014. Response to Fujita et al.. The American Journal of Gastroenterology 109, pp. 138-139. (10.1038/ajg.2013.352)
- de Bont, E. G.et al. 2014. Parents' knowledge, attitudes, and practice in childhood fever: an internet-based survey. British Journal of General Practice (BJGP) 64(618), pp. e10-e16. (10.3399/bjgp14X676401)
- Francis, N. 2014. A local public campaign reduces outpatient antibiotic prescribing in Italy. Evidence Based Nursing 18(1), pp. 27. (10.1136/eb-2013-101628)
- Cals, J.et al. 2014. Praten en prikken bij luchtweginfecties: 3,5 jaar follow-up [Talking and injecting in respiratory tract infections: 3.5 years follow-up]. Huisarts en wetenschap 57(1), pp. 6-9. (10.1007/s12445-014-0008-y)
- Hood, K.et al. 2014. Probiotics for Antibiotic-Associated Diarrhoea (PAAD): a prospective observational study of antibiotic-associated diarrhoea (including Clostridium difficile-associated diarrhoea) in care homes. Health Technology Assessment 18(63), pp. 1. (10.3310/hta18630)
- Cope, A.et al. 2014. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults.. Cochrane Database of Systematic Reviews (10.1002/14651858.CD010136)
2013
- Francis, N. A.et al. 2013. Parents' and clinicians' views of an interactive booklet about respiratory tract infections in children: a qualitative process evaluation of the EQUIP randomised controlled trial. BMC Family Practice 14(1), article number: 182. (10.1186/1471-2296-14-182)
- Yardley, L.et al. 2013. Evaluation of a web-based intervention to reduce antibiotic prescribing for LRTI in six European countries: quantitative process analysis of the GRACE/INTRO randomised controlled trial. Implementation Science 8, article number: 134. (10.1186/1748-5908-8-134)
- Coenen, S.et al. 2013. Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough. PLoS ONE 8(10), article number: e76691. (10.1371/journal.pone.0076691)
- Little, P.et al. 2013. Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial. The Lancet 382(9899), pp. 1175-1182. (10.1016/S0140-6736(13)60994-0)
- Spasic, I.et al. 2013. FlexiTerm: a flexible term recognition method. Journal of Biomedical Semantics 4, article number: 27. (10.1186/2041-1480-4-27)
- Greenwood, M.et al. 2013. Automatic extraction of personal experiences from patients' blogs: A case study in chronic obstructive pulmonary disease. Presented at: Third International Conference on Social Computing and its Applications, Karlsruhe, Germany, 30th September - 2nd October 2013.
- Butler, C. C. and Francis, N. A. 2013. Asthma prevalence and humoral immune response in Somali immigrants in the US: implications for the hygiene hypothesis [Editorial]. Primary Care Respiratory Journal 22(3), pp. 262-264. (10.4104/pcrj.2013.00081)
- Brophy, S.et al. 2013. Incidence of campylobacter and salmonella infections following first prescription for PPI: a cohort study using routine data. The American Journal of Gastroenterology 108(7), pp. 1094-1100. (10.1038/ajg.2013.30)
- Cals, J. W. L.et al. 2013. Enhanced communication skills and C-reactive protein point-of-care testing for respiratory tract infection: 3.5-year follow-up of a cluster randomized trial. The Annals of Family Medicine 11(2), pp. 157-164. (10.1370/afm.1477)
- Francis, N. A.et al. 2013. Variation in family physicians' recording of auscultation abnormalities in patients with acute cough is not explained by case mix. A study from 12 European networks. European Journal of General Practice 19(2), pp. 77-84. (10.3109/13814788.2012.733690)
2012
- Francis, N. A.et al. 2012. Delayed antibiotic prescribing and associated antibiotic consumption in adults with acute cough. British Journal of General Practice (BJGP) 62(602), pp. e639-e646. (10.3399/bjgp12X654614)
- Saxena, S., Francis, N. A. and Sharland, M. 2012. Primary care of children: the unique role of GPs. British Journal of General Practice (BJGP) 62(600), pp. 340-341. (10.3399/bjgp12X652166)
- Francis, N. A.et al. 2012. Antibiotics for acute cough: an international observational study of patient adherence in primary care. British Journal of General Practice (BJGP) 62(599), pp. e429-e437. (10.3399/bjgp12X649124)
- Francis, N. A.et al. 2012. Severity assessment for lower respiratory tract infections: potential use and validity of the CRB-65 in primary care. Primary Care Respiratory Journal 21(1), pp. 65-70. (10.4104/pcrj.2011.00083)
2010
- Francis, N. A.et al. 2010. Missed opportunities for earlier treatment? A qualitative interview study with parents of children admitted to hospital with serious respiratory tract infections. Archives of Disease in Childhood 96(2), pp. 154-159. (10.1136/adc.2010.188680)
- McNulty, C. A. M. and Francis, N. A. 2010. Optimizing antibiotic prescribing in primary care settings in the UK: findings of a BSAC multi-disciplinary workshop 2009. Journal of Antimicrobial Chemotherapy 65(11), pp. 2278-2284. (10.1093/jac/dkq361)
- Cals, J. W. L. and Francis, N. A. 2010. Acute cough in adults. British Medical Journal (BMJ) 340(c574), pp. 534-535. (10.1136/bmj.c574)
- Stanton, N., Francis, N. A. and Butler, C. C. 2010. Reducing uncertainty in managing respiratory tract infections in primary care. British Journal of General Practice (BJGP) 60(581), pp. e466-e475. (10.3399/bjgp10X544104)
- Francis, N. A. and Butler, C. C. 2010. Infections of the upper respiratory tract. In: Finch, R. G. et al. eds. Antibiotic and chemotherapy. 9th ed.. Edinburgh: Saunders Elsevier, pp. 567-573.
2009
- Francis, N. A.et al. 2009. Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomised controlled trial. British Medical Journal (BMJ) 339, article number: b2885. (10.1136/bmj.b2885)
- Francis, N. A. 2009. Development and evaluation of an interactive booklet for use in primary care consultations with children with respiratory tract infections. PhD Thesis, Cardiff University.
- Cals, J. W. L.et al. 2009. Predictors of patient-initiated reconsultation for lower respiratory tract infections in general practice. British Journal of General Practice (BJGP) 59(567), pp. 761-764. (10.3399/bjgp09X472656)
2008
- Francis, N. A.et al. 2008. Developing an 'interactive' booklet on respiratory tract infections in children for use in primary care consultations. Patient Education and Counseling 73(2), pp. 286-293. (10.1016/j.pec.2008.07.020)
- Francis, N.et al. 2008. The effect of using an interactive booklet on childhood respiratory tract infections in consultations: Study protocol for a cluster randomised controlled trial in primary care. BMC Family Practice 9(1), pp. 23. (10.1186/1471-2296-9-23)
- Cosby, J. L., Francis, N. A. and Butler, C. C. 2008. Decline of antibiotic use in primary care - Authors' reply. The Lancet Infectious Diseases 8(5), pp. 273. (10.1016/S1473-3099(08)70076-8)
2007
- Cosby, J. L., Francis, N. A. and Butler, C. C. 2007. The role of evidence in the decline of antibiotic use for common respiratory infections in primary care. The Lancet Infectious Diseases 7(11), pp. 749-756. (10.1016/S1473-3099(07)70263-3)
2006
- Butler, C. C., Francis, N. A. and Dinant, G. 2006. Whooping cough in general practice [Editorial]. British Medical Journal (BMJ) 333(7560), pp. 159-160. (10.1136/bmj.333.7560.159)
- Francis, N. A., McCambridge, J. and Rollnick, S. 2006. Understanding Confrontation through experimental study. Addiction -Abingdon- 101(1), pp. 137-138.
- Francis, N. A. 2006. The sore throat consultation [review]. Practitioner 250(1682), pp. 54-58.
- Lindbaek, M.et al. 2006. Clinical course of suspected viral sore throat in young adults: cohort study. Scandinavian Journal of Primary Health Care 24(2), pp. 93-97. (10.1080/02813430600638227)
2005
- Francis, N. A. 2005. Single subject trials in primary care. Postgraduate Medical Journal -London- 81(959), pp. 547-548. (10.1136/pgmj.2005.032581)
- Francis, N.et al. 2005. When smokers are resistant to change: experimental analysis of the effect of patient resistance on practitioner behaviour. Addiction 100(8), pp. 1175-1182. (10.1111/j.1360-0443.2005.01124.x)
I lead a module on common infections that forms part of the Clinical Epidemiology Intercalated BSc for Medical Students.
I also contribute to the undergraduate medical education curriculum by teaching medical epidemiolgy, examining ISCEs, and acting as a mentor.
Current Research Projects
PACE: General Practitioner (GP) use of a C-Reactive Protein (CRP) Point of Care Test (POCT) to help target antibiotic prescribing to patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) who are most likely to benefit.
I am co-Chief Investigator of this NIHR-HTA funded trial of CRP point of care testing to guide the use of antibiotics for acute exacerbation of COPD. http://www.pace-study.co.uk/
OSTRICH: Oral Steroids for the Resolution of Otitis media with effusion in Children
I am co-Chief Investigator of this NIHR-HTA funded trial of oral steroids to improve hearing loss in children with persistent otitis media with effusion. http://www.ostrich-study.co.uk/
CEDAR: Children's Ear Pain Study
I am the Principal Investigator for Wales for this NIHR-HTA funded trial of analgesic ear drops to reduce the use of antibiotics in children with acute otitis media. http://www.bristol.ac.uk/primaryhealthcare/researchthemes/cedar/
PREPARE: Platform for European Preparedness Against (Re-)Emerging Epidemics
This is a large EU-funded project that aims to conduct large-scale clinical research studies on infectious diseases, and is prepared to rapidly respond to any severe infectious disease outbreak. I am involved in work package 1, which seeks to identify and implement solutions to any ethical, administrative, regulatory or legal bottlenecks to conducting research in an infectious disease pandemic. I am also on the trial management group for the ALIC4E trial (https://www.phc.ox.ac.uk/phctrials/trial-portfolio/alic4e) which forms work package 4. https://www.prepare-europe.eu/
