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Parker SG, Kommu SS. Post-intravesical BCG epididymo-orchitis: Case report and a review of the literature. Int J Surg Case Rep 2013; 4:768-70. [PMID: 23856256 DOI: 10.1016/j.ijscr.2013.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/12/2013] [Accepted: 05/26/2013] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Bladder cancer is a significant epidemiological disease. It is managed by primary resection and on-going surveillance for recurrent disease. Intravesical BCG therapy is used in superficial carcinomas to lower the incidence of recurrence and prolong the time to recurrence. BCG therapy is not without its rare but serious side effects. PRESENTATION OF CASE A 75-year-old man presented to the urologist with right testicular pain, after four previous TURBT operations, two courses of intravesical BCG therapy and one STAT dose of intravesical mitomycin. The patient's USS testis showed hypoechoic lesions in the right testis. An orchiectomy was carried out due to the possibility of the USS showing a malignancy. Histology confirmed BCG epididymo-orchitis. DISCUSSION This patient presented with testicular pain fifteen months after the cessation of BCG therapy. Clinicians need to be aware of the potentially long dormancy periods for BCG infections, and their complications, as well as the acute infective BCG presentations. The literature is reviewed and shows the wide range of infective BCG presentations from acute disseminated sepsis to insidious focal infections such as parotiditis and discitis. CONCLUSION This case report demonstrates that due to the delayed and gradual onset of symptoms, BCG infections are difficult to diagnose. The report and the review remind surgeons to keep BCG infection amongst their differentials when treating patients who present after BCG therapy.
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Forster SE, Powers HJ, Foulds GA, Flower DJ, Hopkinson K, Parker SG, Young TA, Saxton J, Pockley AG, Williams EA. Improvement in Nutritional Status Reduces the Clinical Impact of Infections in Older Adults. J Am Geriatr Soc 2012; 60:1645-54. [DOI: 10.1111/j.1532-5415.2012.04118.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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McKee K, Matlabi H, Parker SG. Older People's Quality of Life and Role of Home-Based Technology. Health Promot Perspect 2012; 2:1-8. [PMID: 24688912 DOI: 10.5681/hpp.2012.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 05/27/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Household devices may have a positive impact on daily lives by reducing the burden of several tasks and enriching social interaction. There are varieties of assistive devices such as alarms, sensors, detectors, and life style monitoring devices, which can help in compensating for the activity limitations caused by impairments. This study aimed to review the contribution that residential technology devices can make to older people's lives. METHODS An open-ended literature review following the guidance of the Centre for Review and Dissemination was conducted to establish the current understanding of the topics by using clear and appropriate criteria to select or reject studies. The studies entered into the review were limited by language, topic, and date of publication. RESULTS The research literature indicated that residential facilities which appropriately are designed and supplied can have many benefits for older people such as increasing in-dependence, maximising physical and mental health, and improving their quality of life. CONCLUSION Although most of the literature has explored the positive effects of technology devices on older adults' social networks, independence, psychological well-being, and social status, the possibilities of negative consequences have been neglected. KEYWORDS Quality of life, Older people, Residential technology, Computer-mediated communication.
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Matlabi H, Parker SG, McKee K. Experiences of Extra Care Housing Residents Aged Fifty-Five and Over with Home-Based Technology. SOCIAL BEHAVIOR AND PERSONALITY 2012. [DOI: 10.2224/sbp.2012.40.2.293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Technological interventions could help older people live independently. In this study with 160 people aged 55 and over who were living in extra care housing in England we aimed to explore awareness of, access to, attitudes towards availability, and use of home-based technological (HBT)
devices, and factors that influence the use of devices. A quantitatively designed and structured questionnaire was developed for this study. The majority of new HBT devices were not available in living units or schemes. Moreover, most basic appliances and emergency call systems were used in
the living units. We found that in order to increase the use of technological devices among the elderly, their perceptions, capabilities, attitudes, and needs should be assessed in the designing, planning, and supplying process.
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Tulah AS, Parker SG, Moffatt MF, Wardlaw AJ, Connolly MJ, Sayers I. The role of ALOX5AP, LTA4H and LTB4R polymorphisms in determining baseline lung function and COPD susceptibility in UK smokers. BMC MEDICAL GENETICS 2011; 12:173. [PMID: 22206291 PMCID: PMC3267686 DOI: 10.1186/1471-2350-12-173] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 12/29/2011] [Indexed: 01/24/2023]
Abstract
Background We have previously shown evidence that polymorphisms within genes controlling leukotriene B4 (LTB4) production (ALOX5AP and LTA4H) are associated with asthma susceptibility in children. Evidence also suggests a potential role of LTB4 in COPD disease mechanisms including recruitment of neutrophils to the lung. The aim of the current study was to see if these SNPs and those spanning the receptor genes for LTB4 (LTB4R1 and LTB4R2) influence baseline lung function and COPD susceptibility/severity in smokers. Methods Eight ALOX5AP, six LTA4H and six LTB4R single nucleotide polymorphisms (SNPs) were genotyped in a UK Smoking Cohort (n = 992). Association with baseline lung function (FEV1 and FEV1/FVC ratio) was determined by linear regression. Logistic regression was used to compare smoking controls (n = 176) with spirometry-defined COPD cases (n = 599) and to more severe COPD cases (GOLD stage 3 and 4, n = 389). Results No association with ALOX5AP, LTA4H or LTB4R survived correction for multiple testing. However, we showed modest association with LTA4H rs1978331C (intron 11) with increased FEV1 (p = 0.029) and with increased FEV1/FVC ratio (p = 0.020). Conclusions These data suggest that polymorphisms spanning ALOX5AP, LTA4H and the LTB4R locus are not major determinants of baseline lung function in smokers, but provide tentative evidence for LTA4H rs1978331C (intron 11) in determining baseline FEV1 and FEV1/FVC ratio in Caucasian Smokers in addition to our previously identified role in asthma susceptibility.
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Matlabi H, Parker SG, McKee K. The contribution of home-based technology to older people's quality of life in extra care housing. BMC Geriatr 2011; 11:68. [PMID: 22040111 PMCID: PMC3215176 DOI: 10.1186/1471-2318-11-68] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 10/31/2011] [Indexed: 11/10/2022] Open
Abstract
Background British government policy for older people focuses on a vision of active ageing and independent living. In the face of diminishing personal capacities, the use of appropriate home-based technology (HBT) devices could potentially meet a wide range of needs and consequently improve many aspects of older people's quality of life such as physical health, psychosocial well-being, social relationships, and their physical or living environment. This study aimed to examine the use of HBT devices and the correlation between use of such devices and quality of life among older people living in extra-care housing (ECH). Methods A structured questionnaire was administered for this study. Using purposive sampling 160 older people living in extra-care housing schemes were selected from 23 schemes in England. A face-to-face interview was conducted in each participant's living unit. In order to measure quality of life, the SEIQoL-Adapted and CASP-19 were used. Results Although most basic appliances and emergency call systems were used in the living units, communally provided facilities such as personal computers, washing machines, and assisted bathing equipment in the schemes were not well utilised. Multiple regression analysis adjusted for confounders including age, sex, marital status, living arrangement and mobility use indicated a coefficient of 1.17 with 95% CI (0.05, 2.29) and p = 0.04 [SEIQoL-Adapted] and 2.83 with 95% CI (1.17, 4.50) and p = 0.001 [CASP-19]. Conclusions The findings of the present study will be value to those who are developing new form of specialised housing for older people with functional limitations and, in particular, guiding investments in technological aids. The results of the present study also indicate that the home is an essential site for developing residential technologies.
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Parker SG, Oliver P, Pennington M, Bond J, Jagger C, Enderby P, Curless R, Vanoli A, Fryer K, Julious S, John A, Chater T, Cooper C, Dyer C. Rehabilitation of older patients: day hospital compared with rehabilitation at home. Clinical outcomes. Age Ageing 2011; 40:557-62. [PMID: 21685206 DOI: 10.1093/ageing/afr046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES to test the hypothesis that older people and their informal carers are not disadvantaged by home-based rehabilitation (HBR) relative to day hospital rehabilitation (DHR). DESIGN pragmatic randomised controlled trial. SETTING four geriatric day hospitals and four home rehabilitation teams in England. PARTICIPANTS eighty-nine patients referred for multidisciplinary rehabilitation. The target sample size was 460. INTERVENTION multidisciplinary rehabilitation either in the home or in the day hospital. MEASUREMENTS the primary outcome measure was the Nottingham extended activities of daily living scale (NEADL). Secondary outcome measures included EQ-5D, hospital anxiety and depression scale, therapy outcome measures, hospital admissions and the General Health Questionnaire for carers. RESULTS at the primary end point of 6 months NEADL scores were not significantly in favour of HBR cf. DHR; mean difference -2.139 (95% confidence interval -6.87 to 2.59, P = 0.37). A post hoc analysis suggested non-inferiority for HBR for NEADL but there was considerable statistical uncertainty. CONCLUSION taken together the statistical analyses and lack of power of the trial outcomes do not provide sufficient evidence to conclude that patients in receipt of HBR are disadvantaged compared with those receiving DHR.
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Conroy SP, Stevens T, Parker SG, Gladman JRF. A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: 'interface geriatrics'. Age Ageing 2011; 40:436-43. [PMID: 21616954 DOI: 10.1093/ageing/afr060] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND many frail older people who attend acute hospital settings and who are discharged home within short periods (up to 72 h) have poor outcomes. This review assessed the role of comprehensive geriatric assessment (CGA) for such people. METHODS standard bibliographic databases were searched for high-quality randomised controlled trials (RCTs) of CGA in this setting. When appropriate, intervention effects were presented as rate ratios with 95% confidence intervals. RESULTS five trials of sufficient quality were included. There was no clear evidence of benefit for CGA interventions in this population in terms of mortality [RR 0.92 (95% CI 0.55-1.52)] or readmissions [RR 0.95 (95% CI 0.83-1.08)] or for subsequent institutionalisation, functional ability, quality-of-life or cognition. CONCLUSIONS there is no clear evidence of benefit for CGA interventions in frail older people being discharged from emergency departments or acute medical units. However, few such trials have been carried out and their overall quality was poor. Further well designed trials are justified.
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Cameron ID, Crotty M, Gray L, Kurrle SE, Peel NM, Monaghan N, Parker SG. Whither transition care. Australas J Ageing 2010; 29:147-9. [PMID: 21143358 DOI: 10.1111/j.1741-6612.2010.00493.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Beghé B, Hall IP, Parker SG, Moffatt MF, Wardlaw A, Connolly MJ, Fabbri LM, Ruse C, Sayers I. Polymorphisms in IL13 pathway genes in asthma and chronic obstructive pulmonary disease. Allergy 2010; 65:474-81. [PMID: 19796199 DOI: 10.1111/j.1398-9995.2009.02167.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) are chronic respiratory diseases involving an interaction between genetic and environmental factors. Interleukin-13 (IL13) has been suggested to have a role in both asthma and COPD. We investigated whether single nucleotide polymorphisms (SNPs) in the IL13 pathway may contribute to the susceptibility and severity of asthma and COPD in adults. METHODS Twelve SNPs in IL13 pathway genes -IL4, IL13, IL4RA, IL13RA1, IL13RA2 and STAT6- were genotyped in subjects with asthma (n = 299) and in subjects with COPD or healthy smokers (n = 992). Genetic association was evaluated using genotype and allele models for asthma severity, atopy phenotypes and COPD susceptibility. Linear regression was used to determine the effects of polymorphism on baseline lung function (FEV(1), FEV(1)/FVC). RESULTS In asthmatics, three IL13 SNPs - rs1881457(-1512), rs1800925(-1111) and rs20541(R130Q) - were associated with atopy risk. One SNP in IL4RA1 [rs1805010(I75V)] was associated with asthma severity, and several IL13 SNPs showed borderline significance. IL13 SNPs rs1881457(-1512) and rs1800925(-1111) were associated with better FEV(1) and FEV(1)/FVC in asthmatics. IL13 SNPs rs2066960(intron 1), rs20541(R130Q) and rs1295685(exon 4) were associated with COPD risk and lower baseline lung function in the recessive model. In females, but not in males, rs2250747 of the IL13RA1 gene was associated with COPD and lower FEV(1). CONCLUSION These data suggest that IL13 SNPs (promoter and coding region) and, to a lesser extent, IL4RA SNPs may contribute to atopy and asthma. We also provide tentative evidence that IL13 SNPs in the coding region may be of significance in COPD susceptibility.
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Forster SE, Jones L, Saxton JM, Flower DJ, Foulds G, Powers HJ, Parker SG, Pockley AG, Williams EA. Recruiting older people to a randomised controlled dietary intervention trial--how hard can it be? BMC Med Res Methodol 2010; 10:17. [PMID: 20175903 PMCID: PMC2843618 DOI: 10.1186/1471-2288-10-17] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 02/22/2010] [Indexed: 11/28/2022] Open
Abstract
Background The success of a human intervention trial depends upon the ability to recruit eligible volunteers. Many trials fail because of unrealistic recruitment targets and flawed recruitment strategies. In order to predict recruitment rates accurately, researchers need information on the relative success of various recruitment strategies. Few published trials include such information and the number of participants screened or approached is not always cited. Methods This paper will describe in detail the recruitment strategies employed to identify older adults for recruitment to a 6-month randomised controlled dietary intervention trial which aimed to explore the relationship between diet and immune function (The FIT study). The number of people approached and recruited, and the reasons for exclusion, will be discussed. Results Two hundred and seventeen participants were recruited to the trial. A total of 7,482 letters were sent to potential recruits using names and addresses that had been supplied by local Family (General) Practices. Eight hundred and forty three potential recruits replied to all methods of recruitment (528 from GP letters and 315 from other methods). The eligibility of those who replied was determined using a screening telephone interview, 217 of whom were found to be suitable and agreed to take part in the study. Conclusion The study demonstrates the application of multiple recruitment methods to successfully recruit older people to a randomised controlled trial. The most successful recruitment method was by contacting potential recruits by letter on NHS headed note paper using contacts provided from General Practices. Ninety percent of recruitment was achieved using this method. Adequate recruitment is fundamental to the success of a research project, and appropriate strategies must therefore be adopted in order to identify eligible individuals and achieve recruitment targets. Trial registration number ISRCTN45031464.
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Melis RJF, Meeuwsen EJ, Parker SG, Olde Rikkert MGM. Are memory clinics effective? The odds are in favour of their benefit, but conclusive evidence is not yet available. J R Soc Med 2010; 102:456-7. [PMID: 19875530 DOI: 10.1258/jrsm.2009.090259] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Parker SG, Oliver P, Pennington M, Bond J, Jagger C, Enderby PM, Curless R, Chater T, Vanoli A, Fryer K, Cooper C, Julious S, Donaldson C, Dyer C, Wynn T, John A, Ross D. Rehabilitation of older patients: day hospital compared with rehabilitation at home. A randomised controlled trial. Health Technol Assess 2009; 13:1-143, iii-iv. [PMID: 19712593 DOI: 10.3310/hta13390] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To test the hypotheses that older people and their informal carers are not disadvantaged by home-based rehabilitation (HBR) relative to day hospital rehabilitation (DHR) and that HBR is less costly. DESIGN Two-arm randomised controlled trial. SETTING Four trusts in England providing both HBR and DHR. PARTICIPANTS Clinical staff reviewed consecutive referrals to identify subjects who were potentially suitable for randomisation according to the defined inclusion criteria. INTERVENTIONS Patients were randomised to receive either HBR or DHR. MAIN OUTCOME MEASURES The primary outcome measure was the Nottingham Extended Activities of Daily Living (NEADL) scale. Secondary outcome measures included the EuroQol 5 dimensions (EQ-5D), Hospital Anxiety and Depression Scale (HADS), Therapy Outcome Measures (TOMs), hospital admissions and the General Health Questionnaire (GHQ-30) for carers. RESULTS Overall, 89 subjects were randomised and 42 received rehabilitation in each arm of the trial. At the primary end point of 6 months there were 32 and 33 patients in the HBR and DHR arms respectively. Estimated mean scores on the NEADL scale at 6 months, after adjustment for baseline, were not significantly in favour of either HBR or DHR [DHR 30.78 (SD 15.01), HBR 32.11 (SD 16.89), p = 0.37; mean difference -2.139 (95% CI -6.870 to 2.592)]. Analysis of the non-inferiority of HBR over DHR using a 'non-inferiority' limit (10%) applied to the confidence interval estimates for the different outcome measures at 6 months' follow-up demonstrated non-inferiority for the NEADL scale, EQ-5D and HADS anxiety scale and some advantage for HBR on the HADS depression scale, of borderline statistical significance. Similar results were seen at 3 and 12 months' follow-up, with a statistically significant difference in the mean EQ-5D(index) score in favour of DHR at 3 months (p = 0.047). At the end of rehabilitation, a greater proportion of the DHR group showed a positive direction of change from their initial assessment with respect to therapist-rated clinical outcomes; however, a lower proportion of HBR patients showed a negative direction of change and, overall, median scores on the TOMs scales did not differ between the two groups. Fewer patients in the HBR group were admitted to hospital on any occasion over the 12-month observation period [18 (43%) versus 22 (52%)]; however, this difference was not statistically significant. The psychological well-being of patients' carers, measured at 3, 6 and 12 months, was unaffected by whether rehabilitation took place at day hospital or at home. As the primary outcome measure and EQ-5D(index) scores at 6 months showed no significant differences between the two arms of the trial, a cost-minimisation analysis was undertaken. Neither the public costs nor the total costs at the 6-month follow-up point (an average of 213 days' total follow-up) or the 12-month follow-up point (an average of 395 days' total follow-up) were significantly different between the groups. CONCLUSIONS Compared with DHR, providing rehabilitation in patients' own homes confers no particular disadvantage for patients and carers. The cost of providing HBR does not appear to be significantly different from that of providing DHR. Rehabilitation providers and purchasers need to consider the place of care in the light of local needs, to provide the benefits of both kinds of services. Caution is required when interpreting the results of the RCT because a large proportion of potentially eligible subjects were not recruited to the trial, the required sample size was not achieved and there was a relatively large loss to follow-up. TRIAL REGISTRATION Current Controlled Trials ISRCTN71801032.
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Stewart CE, Hall IP, Parker SG, Moffat MF, Wardlaw AJ, Connolly MJ, Ruse C, Sayers I. PLAUR polymorphisms and lung function in UK smokers. BMC MEDICAL GENETICS 2009; 10:112. [PMID: 19878584 PMCID: PMC2784766 DOI: 10.1186/1471-2350-10-112] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 10/31/2009] [Indexed: 12/15/2022]
Abstract
Background We have previously identified Urokinase Plasminogen Activator Receptor (PLAUR) as an asthma susceptibility gene. In the current study we tested the hypothesis that PLAUR single nucleotide polymorphisms (SNPs) determine baseline lung function and contribute to the development of Chronic Obstructive Pulmonary Disease (COPD) in smokers. Methods 25 PLAUR SNPs were genotyped in COPD subjects and individuals with smoking history (n = 992). Linear regression was used to determine the effects of polymorphism on baseline lung function (FEV1, FEV1/FVC) in all smokers. Genotype frequencies were compared in spirometry defined smoking controls (n = 176) versus COPD cases (n = 599) and COPD severity (GOLD stratification) using logistic regression. Results Five SNPs showed a significant association (p < 0.01) with baseline lung function; rs2302524(Lys220Arg) and rs2283628(intron 3) were associated with lower and higher FEV1 respectively. rs740587(-22346), rs11668247(-20040) and rs344779(-3666) in the 5'region were associated with increased FEV1/FVC ratio. rs740587 was also protective for COPD susceptibility and rs11668247 was protective for COPD severity although no allele dose relationship was apparent. Interestingly, several of these associations were driven by male smokers not females. Conclusion This study provides tentative evidence that the asthma associated gene PLAUR also influences baseline lung function in smokers. However the case-control analyses do not support the conclusion that PLAUR is a major COPD susceptibility gene in smokers. PLAUR is a key serine protease receptor involved in the generation of plasmin and has been implicated in airway remodelling.
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Nancarrow SA, Moran AM, Parker SG. Understanding service context: development of a service pro forma to describe and measure elderly peoples' community and intermediate care services. HEALTH & SOCIAL CARE IN THE COMMUNITY 2009; 17:434-446. [PMID: 19456903 DOI: 10.1111/j.1365-2524.2009.00846.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The purpose of this paper was to develop a pro forma which classifies the components of service delivery and organization which may impact on the outcomes of elderly peoples' community and intermediate care services. The resulting analytic template provides a basis for comparison between services and may help guide service commissioning and development. A qualitative approach was used in which key evaluations and reports were selected on the basis that they described elderly peoples' community and intermediate care services. These were analysed systematically using a qualitative (template) approach to draw out the key themes used to describe services. Themes were then structured hierarchically into an analytic template. Seventeen key documents were analysed. The initial coding framework classified 334 themes describing intermediate care services. These items were then clustered into 78 categories, which were reduced to 17 subcategories, then six overall groupings to describe the services, namely; (1) context; (2) reason for the service; (3) service-users; (4) access to the service; (5) service structure; and (6) the organization of care. The resulting analytic template has been developed into a 'service pro forma' which can be used as a basis to describe and compare a range of services. We propose that all service evaluations should describe, in detail, their context in a comparable way, so that other services can learn from and/or apply the findings from these studies.
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Melis RJF, van Eijken MIJ, Teerenstra S, van Achterberg T, Parker SG, Borm GF, van de Lisdonk EH, Wensing M, Rikkert MGMO. A randomized study of a multidisciplinary program to intervene on geriatric syndromes in vulnerable older people who live at home (Dutch EASYcare Study). J Gerontol A Biol Sci Med Sci 2008; 63:283-90. [PMID: 18375877 DOI: 10.1093/gerona/63.3.283] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The effectiveness of community-based geriatric intervention models for vulnerable older adults is controversial. We evaluated a problem-based multidisciplinary intervention targeting vulnerable older adults at home that promised efficacy through better timing and increased commitment of patients and primary care physicians. This study compared the effects of this new model to usual care. METHODS Primary care physicians referred older people for problems with cognition, nutrition, behavior, mood, or mobility. One hundred fifty-one participants (mean age 82.2 years, 74.8% women) were included in a pseudocluster randomized trial with 6-month follow-up for the primary outcomes. Eighty-five participants received the new intervention, and 66 usual care. In the intervention arm, geriatric nurses visited patients at home for geriatric assessment and management in cooperation with primary care physicians and geriatricians. Modified intention-to-treat analyses focused on differences between treatment arms in functional abilities (Groningen Activity Restriction Scale-3) and mental well-being (subscale mental health Medical Outcomes Study [MOS]-20), using a mixed linear model. RESULTS After 3 months, treatment arms showed significant differences in favor of the new intervention. Functional abilities improved 2.2 points (95% confidence interval [CI], 0.3-4.2) and well-being 5.8 points (95% CI, 0.1-11.4). After 6 months, the favorable effect increased for well-being (9.1; 95% CI, 2.4-15.9), but the effect on functional abilities was no longer significant (1.6; 95% CI, -0.7 to 3.9). CONCLUSIONS This problem-based geriatric intervention improved functional abilities and mental well-being of vulnerable older people. Problem-based interventions can increase the effectiveness of primary care for this population.
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Ruse CE, Hill MC, Tobin M, Neale N, Connolly MJ, Parker SG, Wardlaw AJ. Tumour necrosis factor gene complex polymorphisms in chronic obstructive pulmonary disease. Respir Med 2006; 101:340-4. [PMID: 16867312 DOI: 10.1016/j.rmed.2006.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 05/23/2006] [Accepted: 05/24/2006] [Indexed: 12/20/2022]
Abstract
We aimed to examine the role of tumour necrosis factor gene complex polymorphisms in subjects with chronic obstructive pulmonary disease (COPD). We hypothesized that individuals possessing polymorphic variants associated with higher tumour necrosis factor (TNF) secretion would be more susceptible to and/or have more severe disease. Patients with COPD and population controls underwent detailed clinical phenotyping. Genotyping for the tumour necrosis factor-308 and the lymphotoxin alpha NcoI (LTalpha polymorphisms was carried out by 'blinded' laboratory staff. Three hundred and sixty one individuals (220 cases and 141 controls) were recruited. We showed an association between the LTalphaNcol polymorphism and forced vital capacity (FVC) in a population of older adults with and without COPD. The LTalphaNcol*2 allele was associated with poorer lung function, under a codominant model, with a fall in FVC (expressed as a percentage of its predicted value) of 3.7% for each copy of the LTalphaNcol*2 allele possessed (for FVC, regression coefficient (95% CI)=-3.73(-7.01 to -0.44), P=0.026; for FEV(1) regression coefficient=-3.56(-7.80 to 0.70), P=0.101. However, there was no difference in genotype distribution between the case and control populations. This study adds weight to the suggestion that the TNF gene complex is involved in physiological alterations (FVC) that may affect the development and severity of COPD. The absence of a significant association between the TNF gene-complex polymorphisms in this study does not rule out a modest effect of these polymorphisms on the risk of COPD, as much larger studies are needed to detect modest gene effects on binary disease endpoints.
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Parker SG, Bechinger-English D, Jagger C, Spiers N, Lindesay J. Factors affecting completion of the SF-36 in older people. Age Ageing 2006; 35:376-81. [PMID: 16638761 DOI: 10.1093/ageing/afl003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE to examine the influence of specific clinical impairments and disabilities on the completion of the SF-36 health status measure among older people. DESIGN Prospective observational study. SETTING/PARTICIPANTS An SF-36 was administered to 245 subjects aged 65 years and older. Subjects were chosen by sampling from a variety of inpatient, outpatient and community sources to ensure a range of relevant disabilities. MEASUREMENTS response rates, overall rates of completion, completion of individual questions and time taken to complete. RESULTS severe functional impairment (Barthel index < or = 12) was found in 22.4% (51/228), cognitive impairment in 54.1% (132/244), depressed mood in 77.0% (151/196) and visuospatial dysfunction in 71.3% (134/188). The median number of impairments was three (interquartile range 1-4). Specific physical impairments were visual in 13.2% (31/235), hearing in 30.2% (74/245), impaired manual dexterity in 18.0% (44/245) and dysphasia in 23% (55/239). In multivariate analyses, global functional impairment (P = 0.006), cognitive impairment (P = 0.0001) and impaired manual dexterity (P = 0.005) were significantly associated with more dimensions uncompleted, whilst cognitive impairment (P = 0.001), age (P = 0.006) and visuospatial dysfunction (P = 0.0003) were significantly associated with longer completion times. CONCLUSION the most striking finding of the study was that global rather than specific physical and mental dysfunction was associated with the inability to complete the SF-36 questionnaire. The difficulty appears to lie in the performance of a complex task, rather than with specific aspects of the task which could be overcome by adaptation or aids. Our experience is that this relatively complex questionnaire does not adequately measure functional health status in disabled older people because of non-completion and may therefore overestimate the health of populations.
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Ruse CE, Hill MC, Wheatley AP, Burton PB, Connolly MJ, Parker SG, Wardlaw AJ. Association of beta-2-adrenoceptor polymorphisms and pulmonary function in patients with chronic obstructive pulmonary disease. Geriatr Gerontol Int 2006. [DOI: 10.1111/j.1447-0594.2006.000334.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Increasingly, molecular genetic techniques are being used to improve our understanding of a number of common late onset complex disorders, such as hypertension, Alzheimer's disease and noninsulin dependent diabetes mellitus. Molecular genetic approaches have the potential to yield new information about disease pathogenesis that may be of great importance for the development of future treatments. AIMS This review discusses the evidence for a genetic contribution to the development of chronic obstructive pulmonary disease (COPD) and specifically focuses on the hypothesis that asthma and COPD share some pathogenic mechanisms as originally proposed in 1960 in a theory that has since become known as the Dutch Hypothesis. In particular we will review the evidence from molecular genetics, both in support of and against the theory.
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Wilson AD, Parker SG. Hospital in the home: what next? Med J Aust 2005; 183:228-9. [PMID: 16138792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Accepted: 07/28/2005] [Indexed: 05/04/2023]
Abstract
It is time to focus on issues of roll-out and quality control.
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