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Richards DA, Bollen J, Jones B, Melendez-Torres GJ, Hulme C, Cockcroft E, Cook H, Cooper J, Creanor S, Cruickshank S, Dawe P, Doris F, Iles-Smith H, Kent M, Logan P, O'Connell A, Onysk J, Owens R, Quinn L, Rafferty AM, Romanczuk L, Russell AM, Shepherd M, Singh SJ, Sugg HVR, Coon JT, Tooze S, Warren FC, Whale B, Wootton S. Evaluation of a COVID-19 fundamental nursing care guideline versus usual care: The COVID-NURSE cluster randomized controlled trial. J Adv Nurs 2024; 80:2137-2152. [PMID: 37986547 DOI: 10.1111/jan.15959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
AIM To evaluate the impact of usual care plus a fundamental nursing care guideline compared to usual care only for patients in hospital with COVID-19 on patient experience, care quality, functional ability, treatment outcomes, nurses' moral distress, patient health-related quality of life and cost-effectiveness. DESIGN Parallel two-arm, cluster-level randomized controlled trial. METHODS Between 18th January and 20th December 2021, we recruited (i) adults aged 18 years and over with COVID-19, excluding those invasively ventilated, admitted for at least three days or nights in UK Hospital Trusts; (ii) nurses caring for them. We randomly assigned hospitals to use a fundamental nursing care guideline and usual care or usual care only. Our patient-reported co-primary outcomes were the Relational Aspects of Care Questionnaire and four scales from the Quality from the Patient Perspective Questionnaire. We undertook intention-to-treat analyses. RESULTS We randomized 15 clusters and recruited 581 patient and 418 nurse participants. Primary outcome data were available for 570-572 (98.1%-98.5%) patient participants in 14 clusters. We found no evidence of between-group differences on any patient, nurse or economic outcomes. We found between-group differences over time, in favour of the intervention, for three of our five co-primary outcomes, and a significant interaction on one primary patient outcome for ethnicity (white British vs. other) and allocated group in favour of the intervention for the 'other' ethnicity subgroup. CONCLUSION We did not detect an overall difference in patient experience for a fundamental nursing care guideline compared to usual care. We have indications the guideline may have aided sustaining good practice over time and had a more positive impact on non-white British patients' experience of care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE We cannot recommend the wholescale implementation of our guideline into routine nursing practice. Further intervention development, feasibility, pilot and evaluation studies are required. IMPACT Fundamental nursing care drives patient experience but is severely impacted in pandemics. Our guideline was not superior to usual care, albeit it may sustain good practice and have a positive impact on non-white British patients' experience of care. REPORTING METHOD CONSORT and CONSERVE. PATIENT OR PUBLIC CONTRIBUTION Patients with experience of hospitalization with COVID-19 were involved in guideline development and writing, trial management and interpretation of findings.
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Affiliation(s)
- David A Richards
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jess Bollen
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Ben Jones
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Claire Hulme
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Emma Cockcroft
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Heather Cook
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Joanne Cooper
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Siobhan Creanor
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Phoebe Dawe
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Faye Doris
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Merryn Kent
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Pip Logan
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Abby O'Connell
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Jakub Onysk
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Rosie Owens
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Lynne Quinn
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Anne Marie Rafferty
- Florence Nightingale School of Nursing and Midwifery, Kings College University London, London, UK
| | | | | | - Maggie Shepherd
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK
| | - Holly V R Sugg
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | - Susannah Tooze
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Fiona C Warren
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Bethany Whale
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Stephen Wootton
- Institute of Human Nutrition, University of Southampton, Southampton, UK
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Hernar I, Cooper JG, Nilsen RM, Skinner TC, Strandberg RB, Iversen MM, Graue M, Ernes T, Løvaas KF, Madsen TV, Lie SS, Richards DA, Ueland GÅ, Haugstvedt A. Diabetes Distress and Associations With Demographic and Clinical Variables: A Nationwide Population-Based Registry Study of 10,186 Adults With Type 1 Diabetes in Norway. Diabetes Care 2024; 47:126-131. [PMID: 37922320 PMCID: PMC10733651 DOI: 10.2337/dc23-1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/16/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVE To estimate diabetes distress prevalence and associations with demographic and clinical variables among adults with type 1 diabetes in Norway. RESEARCH DESIGN AND METHODS In this nationwide population-based registry study, the 20-item Problem Areas in Diabetes (PAID-20) questionnaire was sent to 16,255 adults with type 1 diabetes. Linear regression models examined associations of demographic and clinical variables with distress. RESULTS In total, 10,186 individuals (62.7%) completed the PAID-20, with a mean score of 25.4 (SD 18.4) and 21.7% reporting high distress. Respondents endorsed worrying about the future and complications as the most problematic item (23.0%). Female sex, younger age, non-European origin, primary education only, unemployment, smoking, continuous glucose monitoring use, more symptomatic hypoglycemia, reduced foot sensitivity, treated retinopathy, and higher HbA1c were associated with higher distress. CONCLUSIONS Diabetes distress is common among adults with type 1 diabetes and associated with clinically relevant factors, underlining that regular care should include efforts to identify and address distress.
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Affiliation(s)
- Ingvild Hernar
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - John G. Cooper
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Roy M. Nilsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Timothy C. Skinner
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
| | - Ragnhild B. Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marjolein M. Iversen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Centre on Patient-Reported Outcomes Data, Haukeland University Hospital, Bergen, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tony Ernes
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Karianne F. Løvaas
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tone V. Madsen
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Silje S. Lie
- Department of Health, VID Specialized University, Stavanger, Norway
| | - David A. Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Grethe Å. Ueland
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Graue M, Igland J, Haugstvedt A, Hernar I, Birkeland KI, Zoffmann V, Richards DA, Kolltveit BCH. Evaluation of an interprofessional follow-up intervention among people with type 2 diabetes in primary care-A randomized controlled trial with embedded qualitative interviews. PLoS One 2023; 18:e0291255. [PMID: 37967084 PMCID: PMC10650997 DOI: 10.1371/journal.pone.0291255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/21/2023] [Indexed: 11/17/2023] Open
Abstract
With an ageing population and improved treatments people live longer with their chronic diseases, and primary care clinics face more costly and difficult-to-treat multimorbid patients. To meet these challenges, current guidelines for the management of type 2 diabetes suggest that an interprofessional team should collaborate to enhance the delivery of worthwhile self-management support interventions. In this study, we aimed to evaluate the effects of an empowerment-based interprofessional follow-up intervention in people with type 2 diabetes in primary care on patient-reported outcomes, biomarkers and weight, and to explore the experiences of patients attending the intervention. We invited patients during regular visits to their general practitioners. The 12-month intervention included 1) empowerment-based counselling; 2) a standardized medical report. The control group received consultations with physicians only. The primary outcome was the Patient Activation Measure, a patient-reported measure assessing individual knowledge, skills, and confidence integral to managing one's health and healthcare. After the trial we conducted qualitative interviews. We observed no difference in the primary outcome scores. On secondary outcomes we found a significant between-group intervention effect in favor of the intervention group, with mean differences in glycemic control after 12 months (B [95% CI] = -8.6 [-17.1, -0.1] mmol/l; p = 0.045), and significant within-group changes of weight (B [95% CI] = -1.8 kg [-3.3, -0.3]; p = 0.02) and waist circumference (B [95% CI] = -3.9 cm [-7.3, -0.6]; p = 0.02). The qualitative data showed that the intervention opened patients' eyes for reflections and greater awareness, but they needed time to take on actions. The patients emphasized that the intervention gave rise to other insights and a greater understanding of their health challenges. We suggest testing the intervention among patients with larger disease burden and a more expressed motivation for change.
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Affiliation(s)
- Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jannicke Igland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ingvild Hernar
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Vibeke Zoffmann
- Interdisciplinary Research Unit of Women’s, Children’s and Families’ Health, Julie Marie Centre, Rigshospitalet, Copenhagen, Denmark
- Institute of Public Health Copenhagen University, Copenhagen, Denmark
| | - David A. Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Beate-Christin Hope Kolltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Vossevangen Medical Center, Voss, Norway
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Chiwanga FS, Woodford J, Masika GM, Richards DA, Savi V, von Essen L. An mHealth Intervention to Improve Guardians' Adherence to Children's Follow-Up Care for Acute Lymphoblastic Leukemia in Tanzania (GuardiansCan Project): Protocol for a Development and Feasibility Study. JMIR Res Protoc 2023; 12:e48799. [PMID: 37403706 PMCID: PMC10433028 DOI: 10.2196/48799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/13/2023] [Accepted: 07/05/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Cancer is a leading cause of death during childhood and in low- and middle-income countries survival rates can be as low as 20%. A leading reason for low childhood cancer survival rates in low- and middle-income countries such as Tanzania is treatment abandonment. Contributing factors include poor communication between health care providers and children's guardians, insufficient cancer knowledge, and psychological distress. OBJECTIVE Our aim is to respond to Tanzanian guardians' poor adherence to children's follow-up care after treatment for acute lymphoblastic leukemia with the help of mobile health (mHealth) technology. Our goal is to increase guardians' adherence to children's medications and follow-up visits and to decrease their psychological distress. METHODS Following the Medical Research Council framework for developing and evaluating complex interventions, we will undertake the GuardiansCan project in an iterative phased approach to develop an mHealth intervention for subsequent testing. Public contribution activities will be implemented throughout via the establishment of a Guardians Advisory Board consisting of guardians of children with acute lymphoblastic leukemia. We will examine the acceptability, feasibility, and perceived impact of Guardians Advisory Board activities via an impact log and semistructured interviews (study I). In phase 1 (intervention development) we will explore guardians' needs and preferences for the provision of follow-up care reminders, information, and emotional support using focus group discussions and photovoice (study II). We will then co-design the mHealth intervention with guardians, health care professionals, and technology experts using participatory action research (study III). In phase 2 (feasibility), we will examine clinical, methodological, and procedural uncertainties associated with the intervention and study procedures to prepare for the design and conduct of a future definitive randomized controlled trial using a single-arm pre-post mixed methods feasibility study (study IV). RESULTS Data collection for the GuardiansCan project is anticipated to take 3 years. We plan to commence study I by recruiting Guardians Advisory Board members in the autumn of 2023. CONCLUSIONS By systematically following the intervention development and feasibility phases of the Medical Research Council Framework, and working alongside an advisory board of guardians, we intend to develop an acceptable, culturally appropriate, feasible, and relevant mHealth intervention with the potential to increase guardians' adherence to children's follow-up care after treatment of acute lymphoblastic leukemia, leading to a positive impact on children's health and chances to survive, and reducing distress for guardians. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/48799.
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Affiliation(s)
- Faraja S Chiwanga
- Department of Women's and Children's health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
- Directorate of Medical Services, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Joanne Woodford
- Department of Women's and Children's health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
| | - Golden M Masika
- Department of Women's and Children's health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
- Department of Clinical Nursing, University of Dodoma, Dodoma, United Republic of Tanzania
| | - David A Richards
- Department of Women's and Children's health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Victor Savi
- Department of Women's and Children's health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Department of Women's and Children's health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
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Hernar I, Graue M, Igland J, Richards DA, Riise HKR, Haugstvedt A, Kolltveit BCH. Patient activation in adults attending appointments in general practice: a cross-sectional study. BMC Prim Care 2023; 24:144. [PMID: 37430197 DOI: 10.1186/s12875-023-02102-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 07/03/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Patient activation refers to patients' knowledge, confidence, skills, ability, beliefs, and willingness to manage their health and healthcare. Patient activation is an essential component of self-management and identifying patient activation levels will identify people at risk for health decline at an earlier stage. We aimed to explore patient activation in among adults attending general practice by (1) investigating differences in patient activation according to characteristics and markers of health-related behaviour; (2) examining the associations of quality of life and satisfaction with health with patient activation; and (3) comparing patient activation between persons with or without type 2 diabetes (T2D) and with or without elevated T2D risk. METHODS We performed a cross-sectional study and recruited 1,173 adult patients from four Norwegian general practices between May to December 2019. The participants completed a questionnaire containing sociodemographic and clinical variables, the Patient Activation Measure (PAM-13), the quality of life and satisfaction with health items from the WHO Quality of Life-BREF, three questions about exercise (regularity, intensity and exercise time), the Finnish Diabetes Risk Score (FINDRISC) and Body Mass Index. We tested differences between groups and associations using Chi-squared tests, Fisher's exact tests, t-tests, one-way ANOVAs and Spearman's rho tests. RESULTS The sample's mean PAM-13 score was 69.8 (0-100) (SD 14.8). In the total population, we found that participants reporting higher patient activation scores also reported more favourable health-related behaviours (exercise and healthy eating). We found positive correlations between the PAM-13 scores and, respectively, the quality of life score and the satisfaction with health score. We found no differences in patient activation between people with or without T2D and those with or without elevated T2D risk. CONCLUSIONS We found that higher patient activation was associated with favourable health-related behaviours, a better quality of life and better satisfaction with health among adults attending four general practices in Norway. Assessing patient activation has the potential to help general practitioners identify patients who might benefit from closer follow-up in advance of negative health outcomes.
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Affiliation(s)
- Ingvild Hernar
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway.
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
| | - Jannicke Igland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - David A Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
- Institute for Health Research, College of Medicine and Health,, University of Exeter, Exeter, UK
| | - Hilde Kristin Refvik Riise
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
| | - Beate-Christin Hope Kolltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
- Vossevangen Medical Centre, Voss, Norway
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Schäfer-Keller P, Graf D, Denhaerynck K, Santos GC, Girard J, Verga ME, Tschann K, Menoud G, Kaufmann AL, Leventhal M, Richards DA, Strömberg A. A multicomponent complex intervention for supportive follow-up of persons with chronic heart failure: a randomized controlled pilot study (the UTILE project). Pilot Feasibility Stud 2023; 9:106. [PMID: 37370176 DOI: 10.1186/s40814-023-01338-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Heart failure (HF) is a progressive disease associated with a high burden of symptoms, high morbidity and mortality, and low quality of life (QoL). This study aimed to evaluate the feasibility and potential outcomes of a novel multicomponent complex intervention, to inform a future full-scale randomized controlled trial (RCT) in Switzerland. METHODS We conducted a pilot RCT at a secondary care hospital for people with HF hospitalized due to decompensated HF or with a history of HF decompensation over the past 6 months. We randomized 1:1; usual care for the control (CG) and intervention group (IG) who received the intervention as well as usual care. Feasibility measures included patient recruitment rate, study nurse time, study attrition, the number and duration of consultations, intervention acceptability and intervention fidelity. Patient-reported outcomes included HF-specific self-care and HF-related health status (KCCQ-12) at 3 months follow-up. Clinical outcomes were all-cause mortality, hospitalization and days spent in hospital. RESULTS We recruited 60 persons with HF (age mean = 75.7 years, ± 8.9) over a 62-week period, requiring 1011 h of study nurse time. Recruitment rate was 46.15%; study attrition rate was 31.7%. Follow-up included 2.14 (mean, ± 0.97) visits per patient lasting a total of 166.96 min (mean, ± 72.55), and 3.1 (mean, ± 1.7) additional telephone contacts. Intervention acceptability was high. Mean intervention fidelity was 0.71. We found a 20-point difference in mean self-care management change from baseline to 3 months in favour of the IG (Cohens' d = 0.59). Small effect sizes for KCCQ-12 variables; less IG participants worsened in health status compared to CG participants. Five deaths occurred (IG = 3, CG = 2). There were 13 (IG) and 18 (CG) all-cause hospital admissions; participants spent 8.90 (median, IQR = 9.70, IG) and 15.38 (median, IQR = 18.41, CG) days in hospital. A subsequent full-scale effectiveness trial would require 304 (for a mono-centric trial) and 751 participants (for a ten-centre trial) for HF-related QoL (effect size = 0.3; power = 0.80, alpha = 0.05). CONCLUSION We found the intervention, research methods and outcomes were feasible and acceptable. We propose increasing intervention fidelity strategies for a full-scale trial. TRIAL REGISTRATION ISRCTN10151805 , retrospectively registered 04/10/2019.
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Affiliation(s)
- Petra Schäfer-Keller
- Institute of Applied Research in Health, School of Health Sciences Fribourg, HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland.
- Cardiology, HFR Fribourg - Hôpital Cantonal, Fribourg, Switzerland.
| | - Denis Graf
- Cardiology, HFR Fribourg - Hôpital Cantonal, Fribourg, Switzerland
| | - Kris Denhaerynck
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Gabrielle Cécile Santos
- Institute of Applied Research in Health, School of Health Sciences Fribourg, HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | - Josepha Girard
- Institute of Applied Research in Health, School of Health Sciences Fribourg, HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | - Marie-Elise Verga
- Institute of Applied Research in Health, School of Health Sciences Fribourg, HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | - Kelly Tschann
- Institute of Applied Research in Health, School of Health Sciences Fribourg, HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | - Grégoire Menoud
- Institute of Applied Research in Health, School of Health Sciences Fribourg, HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | - Anne-Laure Kaufmann
- Data Acquisition Unit, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Sion, Switzerland
| | | | - David A Richards
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden
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Dichter MN, Müller M, Möhler R, Balzer K, Richards DA. Misinterpreting the MRC Framework on complex interventions. Int J Nurs Stud 2023; 141:104478. [PMID: 36935309 DOI: 10.1016/j.ijnurstu.2023.104478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023]
Affiliation(s)
- Martin Nikolaus Dichter
- Institute of Nursing Science, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany.
| | - Martin Müller
- Nursing Science and Interprofessional Care, Department for Primary Care and Health Services Research, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Katrin Balzer
- Institute for Social Medicine and Epidemiology, Nursing Research Group, University of Lübeck, Germany
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Sugg HVR, Richards DA, Russell AM, Burnett S, Cockcroft EJ, Thompson Coon J, Cruickshank S, Doris FE, Hunt HA, Iles-Smith H, Kent M, Logan PA, Morgan LM, Morley N, Rafferty AM, Shepherd MH, Singh SJ, Tooze SJ, Whear R. Nurses' strategies for overcoming barriers to fundamental nursing care in patients with COVID-19 caused by infection with the SARS-COV-2 virus: Results from the 'COVID-NURSE' survey. J Adv Nurs 2023; 79:1003-1017. [PMID: 35467757 PMCID: PMC9111453 DOI: 10.1111/jan.15261] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/03/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
AIMS To identify strategies used by registered nurses and non-registered nursing care staff in overcoming barriers when providing fundamental nursing care for non-invasively ventilated inpatients with COVID-19. DESIGN Online survey with open-ended questions to collect qualitative data. METHODS In August 2020, we asked UK-based nursing staff to describe any strategies they employed to overcome barriers to delivering care in 15 fundamental nursing care categories when providing care to non-invasively ventilated patients with COVID-19. We analysed data using Framework Analysis. RESULTS A total of 1062 nurses consented to participate in our survey. We derived four themes. 1) Communication behaviours included adapting verbal and non-verbal communication with patients, using information technology to enable patients' significant others to communicate with staff and patients, and establishing clear information-sharing methods with other staff. 2) Organizing care required clustering interventions, carefully managing supplies, encouraging patient self-care and using 'runners' and interdisciplinary input. 3) Addressing patients' well-being and values required spending time with patients, acting in loco familiae, providing access to psychological and spiritual support, obtaining information about patients' wishes early on and providing privacy and comforting/meaningful items. 4) Management and leadership behaviours included training, timely provision of pandemic information, psychological support, team huddles and facilitating regular breaks. CONCLUSIONS Our respondents identified multiple strategies in four main areas of clinical practice. Management and leadership are crucial to both fundamental care delivery and the well-being of nurses during pandemics. Grouping strategies into these areas of action may assist nurses and leaders to prepare for pandemic nursing. IMPACT As these strategies are unlikely to be exclusive to the COVID-19 pandemic, their global dissemination may improve patient experience and help nurses deliver fundamental care when planning pandemic nursing. However, their effectiveness is unknown. Therefore, we are currently evaluating these strategies in a cluster randomized controlled trial.
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Affiliation(s)
- Holly V R Sugg
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - David A Richards
- College of Medicine and Health, University of Exeter, Exeter, UK.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Sarah Burnett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Emma J Cockcroft
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- College of Medicine and Health, University of Exeter, Exeter, UK.,The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | | | - Faye E Doris
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Harriet A Hunt
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Heather Iles-Smith
- School of Health and Society, University of Salford, Salford, UK.,Northern Care Alliance NHS Group, Salford, UK
| | - Merryn Kent
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Philippa A Logan
- School of Medicine, University of Nottingham, Queens Medical centre, Nottingham, UK
| | - Leila M Morgan
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Naomi Morley
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne Marie Rafferty
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Maggie H Shepherd
- College of Medicine and Health, University of Exeter, Exeter, UK.,NIHR Exeter Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, Leicester, UK.,University Hospitals of Leicester NHS Trust, Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK
| | - Susannah J Tooze
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rebecca Whear
- College of Medicine and Health, University of Exeter, Exeter, UK
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9
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Driessen E, Cohen ZD, Lorenzo-Luaces L, Hollon SD, Richards DA, Dobson KS, Dimidjian S, Delgadillo J, Vázquez FL, McNamara K, Horan JJ, Gardner P, Oei TP, Mehta AHP, Twisk JWR, Cristea IA, Cuijpers P. Efficacy and moderators of cognitive therapy versus behavioural activation for adults with depression: study protocol of a systematic review and meta-analysis of individual participant data. BJPsych Open 2022; 8:e154. [PMID: 35946068 PMCID: PMC9379999 DOI: 10.1192/bjo.2022.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cognitive therapy and behavioural activation are both widely applied and effective psychotherapies for depression, but it is unclear which works best for whom. Individual participant data (IPD) meta-analysis allows for examining moderators at the participant level and can provide more precise effect estimates than conventional meta-analysis, which is based on study-level data. AIMS This article describes the protocol for a systematic review and IPD meta-analysis that aims to compare the efficacy of cognitive therapy and behavioural activation for adults with depression, and to explore moderators of treatment effect. (PROSPERO: CRD42022341602). METHOD Systematic literature searches will be conducted in PubMed, PsycINFO, EMBASE and the Cochrane Library, to identify randomised clinical trials comparing cognitive therapy and behavioural activation for adult acute-phase depression. Investigators of these trials will be invited to share their participant-level data. One-stage IPD meta-analyses will be conducted with mixed-effects models to assess treatment effects and to examine various available demographic, clinical and psychological participant characteristics as potential moderators. The primary outcome measure will be depressive symptom level at treatment completion. Secondary outcomes will include post-treatment anxiety, interpersonal functioning and quality of life, as well as follow-up outcomes. CONCLUSIONS To the best of our knowledge, this will be the first IPD meta-analysis concerning cognitive therapy versus behavioural activation for adult depression. This study has the potential to enhance our knowledge of depression treatment by using state-of-the-art statistical techniques to compare the efficacy of two widely used psychotherapies, and by shedding more light on which of these treatments might work best for whom.
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Affiliation(s)
- Ellen Driessen
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, The Netherlands; and Depression Expertise Center, Pro Persona Mental Health Care, The Netherlands
| | - Zachary D Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | | | | | - David A Richards
- Department of Health and Community Science, Faculty of Health and Life Sciences, University of Exeter, UK; and Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Norway
| | | | - Sona Dimidjian
- Crown Institute and Department of Psychology and Neuroscience, University of Colorado Boulder, USA
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, University of Sheffield, UK
| | - Fernando L Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Spain
| | | | - John J Horan
- Counseling Psychology Program, Arizona State University, USA
| | - Pauline Gardner
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Australia
| | - Tian P Oei
- School of Psychology, The University of Queensland, Australia
| | - Anuj H P Mehta
- Department of Psychology, University of Toronto Scarborough, Canada
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, The Netherlands
| | - Ioana A Cristea
- Department of Brain and Behavioral Sciences, University of Pavia; and IRCCS Mondino Foundation, Italy
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
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10
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Abstract
Purpose
Past research on the motivational processes underpinning knowledge sharing has assumed that the sharing processes are similar for all individuals. Yet, sharing is a fundamental affiliative behavior, and the sharing processes can differ between people. This study aims to propose and test a model of the moderating influence that employee attachment patterns have on the theory of reasoned action (TRA)-defined knowledge sharing processes.
Design/methodology/approach
The authors administered a questionnaire to 1,103 employees from a range of industries who participated in an online Qualtrics survey. Advanced forms for structural equation modeling and latent profile analysis were used to assess the proposed model.
Findings
The results revealed that participants in the study exhibited the latent profiles corresponding to secure, dismissive, preoccupied and fearful patterns. The preoccupied cohort had the lowest knowledge sharing behavior, yet the strongest links within the sharing process. Secure, dismissive and fearful had similar sharing levels, but the strength of the TRA-defined processes differed. These findings underscore equifinality: although sharing may be approximately equal across different attachment patterns, the fundamental processes underpinning sharing differ.
Research limitations/implications
The authors used self-report data, given that sharing attitudes, norms and intentions may not be overly amenable to ratings even from well-acquainted others. Further, the use of advanced analytical methods helps to minimize common method concerns. Additionally, causal mechanisms underscoring the TRA have been demonstrated (Ajzen and Fishbein, 2005), allowing us to explore the moderating role of attachment patterns.
Practical implications
This study speaks to the importance of considering employees’ attachment patterns, and developing comprehensive intra-organizational norms, policies and systems that support and encourage knowledge sharing from employees with a variety of attachment patterns.
Originality/value
This study uniquely contributes to knowledge sharing literatures by incorporating attachment patterns as moderators within the TRA-defined sharing processes. The authors provide important insights on the role of individuals’ attachment patterns have for knowledge sharing behaviors, but also highlight how structure of knowledge sharing differed across subgroups of employees, determined based on their dispositional attachment pattern.
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11
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Whear R, Abbott RA, Bethel A, Richards DA, Garside R, Cockcroft E, Iles‐Smith H, Logan PA, Rafferty AM, Shepherd M, Sugg HVR, Russell AM, Cruickshank S, Tooze S, Melendez‐Torres GJ, Thompson Coon J. Impact of COVID-19 and other infectious conditions requiring isolation on the provision of and adaptations to fundamental nursing care in hospital in terms of overall patient experience, care quality, functional ability, and treatment outcomes: systematic review. J Adv Nurs 2022; 78:78-108. [PMID: 34554585 PMCID: PMC8657334 DOI: 10.1111/jan.15047] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/02/2021] [Accepted: 09/05/2021] [Indexed: 01/28/2023]
Abstract
AIM This systematic review identifies, appraises and synthesizes the evidence on the provision of fundamental nursing care to hospitalized patients with a highly infectious virus and the effectiveness of adaptations to overcome barriers to care. DESIGN Systematic review. DATA SOURCES In July 2020, we searched Medline, PsycINFO (OvidSP), CINAHL (EBSCOhost), BNI (ProQuest), WHO COVID-19 Database (https://search.bvsalud.org/) MedRxiv (https://www.medrxiv.org/), bioRxiv (https://www.biorxiv.org/) and also Google Scholar, TRIP database and NICE Evidence, forwards citation searching and reference checking of included papers, from 2016 onwards. REVIEW METHODS We included quantitative and qualitative research reporting (i) the views, perceptions and experiences of patients who have received fundamental nursing care whilst in hospital with COVID-19, MERS, SARS, H1N1 or EVD or (ii) the views, perceptions and experiences of professional nurses and non-professionally registered care workers who have provided that care. We included review articles, commentaries, protocols and guidance documents. One reviewer performed data extraction and quality appraisal and was checked by another person. RESULTS Of 3086 references, we included 64 articles; 19 empirical research and 45 review articles, commentaries, protocols and guidance documents spanning five pandemics. Four main themes (and 11 sub-themes) were identified. Barriers to delivering fundamental care were wearing personal protective equipment, adequate staffing, infection control procedures and emotional challenges of care. These barriers were addressed by multiple adaptations to communication, organization of care, staff support and leadership. CONCLUSION To prepare for continuation of the COVID-19 pandemic and future pandemics, evaluative studies of adaptations to fundamental healthcare delivery must be prioritized to enable evidence-based care to be provided in future. IMPACT Our review identifies the barriers nurses experience in providing fundamental care during a pandemic, highlights potential adaptations that address barriers and ensure positive healthcare experiences and draws attention to the need for evaluative research on fundamental care practices during pandemics.
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Affiliation(s)
- Rebecca Whear
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
| | - Rebecca A. Abbott
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
| | - Alison Bethel
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
| | - David A. Richards
- College of Medicine and HealthUniversity of ExeterExeterUK
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Ruth Garside
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Emma Cockcroft
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Heather Iles‐Smith
- School of Health and SocietyUniversity of SalfordSalfordUK
- Northern Care Alliance NHS GroupSalfordUK
| | - Pip A. Logan
- School of MedicineUniversity of NottinghamQueens Medical CentreNottinghamUK
| | - Ann Marie Rafferty
- Faculty of Nursing, Midwifery and Palliative CareKing’s College LondonLondonUK
| | - Maggie Shepherd
- NIHR Exeter Clinical Research FacilityRoyal Devon and Exeter NHS Foundation TrustExeterUK
- Institute of Biomedical and Clinical ScienceCollege of Medicine and HealthUniversity of ExeterExeterUK
| | | | | | | | - Susannah Tooze
- College of Medicine and HealthUniversity of ExeterExeterUK
| | | | - Jo Thompson Coon
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
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12
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Sugg HVR, Russell AM, Morgan LM, Iles-Smith H, Richards DA, Morley N, Burnett S, Cockcroft EJ, Thompson Coon J, Cruickshank S, Doris FE, Hunt HA, Kent M, Logan PA, Rafferty AM, Shepherd MH, Singh SJ, Tooze SJ, Whear R. Fundamental nursing care in patients with the SARS-CoV-2 virus: results from the 'COVID-NURSE' mixed methods survey into nurses' experiences of missed care and barriers to care. BMC Nurs 2021; 20:215. [PMID: 34724949 PMCID: PMC8558545 DOI: 10.1186/s12912-021-00746-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 10/08/2021] [Indexed: 11/12/2022] Open
Abstract
Background Patient experience of nursing care is associated with safety, care quality, treatment outcomes, costs and service use. Effective nursing care includes meeting patients’ fundamental physical, relational and psychosocial needs, which may be compromised by the challenges of SARS-CoV-2. No evidence-based nursing guidelines exist for patients with SARS-CoV-2. We report work to develop such a guideline. Our aim was to identify views and experiences of nursing staff on necessary nursing care for inpatients with SARS-CoV-2 (not invasively ventilated) that is omitted or delayed (missed care) and any barriers to this care. Methods We conducted an online mixed methods survey structured according to the Fundamentals of Care Framework. We recruited a convenience sample of UK-based nursing staff who had nursed inpatients with SARS-CoV-2 not invasively ventilated. We asked respondents to rate how well they were able to meet the needs of SARS-CoV-2 patients, compared to non-SARS-CoV-2 patients, in 15 care categories; select from a list of barriers to care; and describe examples of missed care and barriers to care. We analysed quantitative data descriptively and qualitative data using Framework Analysis, integrating data in side-by-side comparison tables. Results Of 1062 respondents, the majority rated mobility, talking and listening, non-verbal communication, communicating with significant others, and emotional wellbeing as worse for patients with SARS-CoV-2. Eight barriers were ranked within the top five in at least one of the three care areas. These were (in rank order): wearing Personal Protective Equipment, the severity of patients’ conditions, inability to take items in and out of isolation rooms without donning and doffing Personal Protective Equipment, lack of time to spend with patients, lack of presence from specialised services e.g. physiotherapists, lack of knowledge about SARS-CoV-2, insufficient stock, and reluctance to spend time with patients for fear of catching SARS-CoV-2. Conclusions Our respondents identified nursing care areas likely to be missed for patients with SARS-CoV-2, and barriers to delivering care. We are currently evaluating a guideline of nursing strategies to address these barriers, which are unlikely to be exclusive to this pandemic or the environments represented by our respondents. Our results should, therefore, be incorporated into global pandemic planning. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00746-5.
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Affiliation(s)
- Holly V R Sugg
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Anne-Marie Russell
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Leila M Morgan
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Heather Iles-Smith
- School of Health and Society, University of Salford, Allerton Building, Frederick Rd, Salford, M6 6PU, UK.,Northern Care Alliance NHS Group, Stott Lane, Salford, M6 8HD, UK
| | - David A Richards
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063, Bergen, Norway
| | - Naomi Morley
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Sarah Burnett
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Emma J Cockcroft
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Jo Thompson Coon
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | | | - Faye E Doris
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Harriet A Hunt
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Merryn Kent
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Philippa A Logan
- School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2UH, UK
| | - Anne Marie Rafferty
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, SE1 8WA, UK
| | - Maggie H Shepherd
- NIHR Exeter Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.,Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, University Road, Leicester, LE1 7RH, UK.,University Hospitals of Leicester NHS Trust, Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Susannah J Tooze
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Rebecca Whear
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
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13
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Moriarty AS, Paton LW, Snell KIE, Riley RD, Buckman JEJ, Gilbody S, Chew-Graham CA, Ali S, Pilling S, Meader N, Phillips B, Coventry PA, Delgadillo J, Richards DA, Salisbury C, McMillan D. The development and validation of a prognostic model to PREDICT Relapse of depression in adult patients in primary care: protocol for the PREDICTR study. Diagn Progn Res 2021; 5:12. [PMID: 34215317 PMCID: PMC8254312 DOI: 10.1186/s41512-021-00101-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Most patients who present with depression are treated in primary care by general practitioners (GPs). Relapse of depression is common (at least 50% of patients treated for depression will relapse after a single episode) and leads to considerable morbidity and decreased quality of life for patients. The majority of patients will relapse within 6 months, and those with a history of relapse are more likely to relapse in the future than those with no such history. GPs see a largely undifferentiated case-mix of patients, and once patients with depression reach remission, there is limited guidance to help GPs stratify patients according to risk of relapse. We aim to develop a prognostic model to predict an individual's risk of relapse within 6-8 months of entering remission. The long-term objective is to inform the clinical management of depression after the acute phase. METHODS We will develop a prognostic model using secondary analysis of individual participant data drawn from seven RCTs and one longitudinal cohort study in primary or community care settings. We will use logistic regression to predict the outcome of relapse of depression within 6-8 months. We plan to include the following established relapse predictors in the model: residual depressive symptoms, number of previous depressive episodes, co-morbid anxiety and severity of index episode. We will use a "full model" development approach, including all available predictors. Performance statistics (optimism-adjusted C-statistic, calibration-in-the-large, calibration slope) and calibration plots (with smoothed calibration curves) will be calculated. Generalisability of predictive performance will be assessed through internal-external cross-validation. Clinical utility will be explored through net benefit analysis. DISCUSSION We will derive a statistical model to predict relapse of depression in remitted depressed patients in primary care. Assuming the model has sufficient predictive performance, we outline the next steps including independent external validation and further assessment of clinical utility and impact. STUDY REGISTRATION ClinicalTrials.gov ID: NCT04666662.
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Affiliation(s)
- Andrew S Moriarty
- Department of Health Sciences, University of York, York, England.
- Hull York Medical School, University of York, York, England.
| | - Lewis W Paton
- Department of Health Sciences, University of York, York, England
| | - Kym I E Snell
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, England
| | - Richard D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, England
| | - Joshua E J Buckman
- Centre for Outcomes and Research Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, England
- iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, England
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, England
- Hull York Medical School, University of York, York, England
| | | | - Shehzad Ali
- Department of Health Sciences, University of York, York, England
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Stephen Pilling
- Centre for Outcomes and Research Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, England
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, England
| | - Nick Meader
- Centre for Reviews and Dissemination, University of York, York, England
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, England
| | - Peter A Coventry
- Department of Health Sciences, University of York, York, England
| | - Jaime Delgadillo
- Department of Psychology, University of Sheffield, Sheffield, England
| | - David A Richards
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, England
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway, USA
| | - Chris Salisbury
- Centre for Academic Primary Care, University of Bristol, Bristol, England
| | - Dean McMillan
- Department of Health Sciences, University of York, York, England
- Hull York Medical School, University of York, York, England
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14
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Grigoroglou C, van der Feltz-Cornelis C, Hodkinson A, Coventry PA, Zghebi SS, Kontopantelis E, Bower P, Lovell K, Gilbody S, Waheed W, Dickens C, Archer J, Blakemore A, Adler DA, Aragones E, Björkelund C, Bruce ML, Buszewicz M, Carney RM, Cole MG, Davidson KW, Gensichen J, Grote NK, Russo J, Huijbregts K, Huffman JC, Menchetti M, Patel V, Richards DA, Rollman B, Smit A, Zijlstra-Vlasveld MC, Wells KB, Zimmermann T, Unutzer J, Panagioti M. Effectiveness of collaborative care in reducing suicidal ideation: An individual participant data meta-analysis. Gen Hosp Psychiatry 2021; 71:27-35. [PMID: 33915444 DOI: 10.1016/j.genhosppsych.2021.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED To assess whether CC is more effective at reducing suicidal ideation in people with depression compared with usual care, and whether study and patient factors moderate treatment effects. METHOD We searched Medline, Embase, PubMed, PsycINFO, CINAHL, CENTRAL from inception to March 2020 for Randomised Controlled Trials (RCTs) that compared the effectiveness of CC with usual care in depressed adults, and reported changes in suicidal ideation at 4 to 6 months post-randomisation. Mixed-effects models accounted for clustering of participants within trials and heterogeneity across trials. This study is registered with PROSPERO, CRD42020201747. RESULTS We extracted data from 28 RCTs (11,165 patients) of 83 eligible studies. We observed a small significant clinical improvement of CC on suicidal ideation, compared with usual care (SMD, -0.11 [95%CI, -0.15 to -0.08]; I2, 0·47% [95%CI 0.04% to 4.90%]). CC interventions with a recognised psychological treatment were associated with small reductions in suicidal ideation (SMD, -0.15 [95%CI -0.19 to -0.11]). CC was more effective for reducing suicidal ideation among patients aged over 65 years (SMD, - 0.18 [95%CI -0.25 to -0.11]). CONCLUSION Primary care based CC with an embedded psychological intervention is the most effective CC framework for reducing suicidal ideation and older patients may benefit the most.
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Affiliation(s)
- Christos Grigoroglou
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England.
| | | | - Alexander Hodkinson
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Peter A Coventry
- Department of Health Sciences, University of York, York, England
| | - Salwa S Zghebi
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Evangelos Kontopantelis
- Faculty of Biology, Medicine and Health, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, England
| | - Peter Bower
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England; Greater Manchester Mental Health NHS Foundation Trust, Manchester, England
| | - Simon Gilbody
- Department of Health Sciences, Hull York Medical School, HYMS, University of York, York, England
| | - Waquas Waheed
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | | | - Janine Archer
- School of Health and Society, School of Health and Society, University of Salford, England
| | - Amy Blakemore
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England
| | - David A Adler
- Departments of Psychiatry and Medicine, Tufts Medical Center and Tufts University School of Medicine, England
| | - Enric Aragones
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Cecilia Björkelund
- Primary Health Care School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Marta Buszewicz
- Institute of Epidemiology and Health, Faculty of Population and Health Sciences, University College London, London, England
| | - Robert M Carney
- Department of Psychiatry, Washington University in St. Louis (WUSTL), St. Louis, Missouri, USA
| | - Martin G Cole
- Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada
| | - Karina W Davidson
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, LMU Klinikum, Ludwig-Maximilians, University Munich Pettenkoferstr. 10, 80336 Munich, Germany
| | - Nancy K Grote
- School of Social Work, University of Washington, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Klaas Huijbregts
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jeff C Huffman
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Vikram Patel
- The Pershing Square Professor of Global Health, Harvard Medical School, Boston, MA, USA
| | - David A Richards
- Institute of Health Research, University of Exeter College of Medicine and Health, Exeter, England; Western University of Norway, Bergen, Norway
| | - Bruce Rollman
- Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Annet Smit
- HAN University of Applied Sciences, Nijmegen, Netherlands
| | | | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA; Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| | - Thomas Zimmermann
- Department of General Practice / Primary Care, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jurgen Unutzer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Maria Panagioti
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
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Hernar I, Graue M, Strandberg RB, Lie SS, Sigurdardottir AK, Richards DA, Kolltveit BCH, Haugstvedt A. Young adults with type 1 diabetes and their experiences with diabetes follow-up and participation in the DiaPROM pilot trial: A qualitative study. Diabet Med 2021; 38:e14535. [PMID: 33547702 DOI: 10.1111/dme.14535] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/11/2021] [Accepted: 02/02/2021] [Indexed: 12/16/2022]
Abstract
AIM To explore young adults' experiences of outpatient follow-up appointments, completing electronic Patient-Reported Outcome Measures (PROMs), and using the Problem Areas In Diabetes (PAID) scale during the Diabetes Patient-Reported Outcome Measures (DiaPROM) pilot trial. METHODS We performed a qualitative study among 19 young adults (aged 22-39 years) with type 1 diabetes who participated in the pilot trial. Between February and June 2019, we conducted individual, semi-structured telephone interviews with participants from the intervention and control arms. We analysed the data using thematic analysis. RESULTS Our analyses generated three themes, each with two subthemes: (1) Follow-up with limitations; (i) Marginal dialogue about everyday challenges, (ii) Value of supportive relationships and continuity, indicate that previous follow-up had been experienced as challenging and insufficient. (2) New insights and raised awareness; (i) More life-oriented insights, (ii) Moving out of the comfort zone, suggest mostly positive experiences with completing questionnaires and discussing the PAID scores. (3) Addressing problem areas with an open mind; (i) Need for elaboration, (ii) Preparedness for dialogue, indicate that both openness and explanations were vital in the follow-up. CONCLUSIONS Participants characterised the previous follow-up as challenging and insufficient. They described completing and using the PAID as somewhat uncomfortable yet worthwhile. Our findings also suggest that by utilising diabetes distress data alongside health and biomedical outcomes, consultations became more attuned to the young adults' wishes and needs, mainly because the dialogue was more focused and direct. Hence, the PAID has the potential to facilitate person-centredness and improve patient-provider relationships.
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Affiliation(s)
- Ingvild Hernar
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ragnhild B Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Silje S Lie
- Faculty of Health, VID Specialised University, Sandnes, Norway
| | - Arun K Sigurdardottir
- School of Health Sciences, University of Akureyri, Akureyri, Iceland
- Akureyri Hospital, Akureyri, Iceland
| | - David A Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Richards DA, Sugg HV, Cockcroft E, Cooper J, Cruickshank S, Doris F, Hulme C, Logan P, Iles-Smith H, Melendez-Torres GJ, Rafferty AM, Reed N, Russell AM, Shepherd M, Singh SJ, Thompson Coon J, Tooze S, Wootton S, Abbott R, Bethel A, Creanor S, Quinn L, Tripp H, Warren FC, Whear R, Bollen J, Hunt HA, Kent M, Morgan L, Morley N, Romanczuk L. COVID-NURSE: evaluation of a fundamental nursing care protocol compared with care as usual on experience of care for noninvasively ventilated patients in hospital with the SARS-CoV-2 virus-protocol for a cluster randomised controlled trial. BMJ Open 2021; 11:e046436. [PMID: 34039574 PMCID: PMC8159671 DOI: 10.1136/bmjopen-2020-046436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/21/2021] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Patient experience of nursing care is correlated with safety, clinical effectiveness, care quality, treatment outcomes and service use. Effective nursing care includes actions to develop nurse-patient relationships and deliver physical and psychosocial care to patients. The high risk of transmission of the SARS-CoV-2 virus compromises nursing care. No evidence-based nursing guidelines exist for patients infected with SARS-CoV-2, leading to potential variations in patient experience, outcomes, quality and costs. METHODS AND ANALYSIS: we aim to recruit 840 in-patient participants treated for infection with the SARS-CoV-2 virus from 14 UK hospitals, to a cluster randomised controlled trial, with embedded process and economic evaluations, of care as usual and a fundamental nursing care protocol addressing specific areas of physical, relational and psychosocial nursing care where potential variation may occur, compared with care as usual. Our coprimary outcomes are patient-reported experience (Quality from the Patients' Perspective; Relational Aspects of Care Questionnaire); secondary outcomes include care quality (pressure injuries, falls, medication errors); functional ability (Barthell Index); treatment outcomes (WHO Clinical Progression Scale); depression Patient Health Questionnaire-2 (PHQ-2), anxiety General Anxiety Disorder-2 (GAD-2), health utility (EQ5D) and nurse-reported outcomes (Measure of Moral Distress for Health Care Professionals). For our primary analysis, we will use a standard generalised linear mixed-effect model adjusting for ethnicity of the patient sample and research intensity at cluster level. We will also undertake a planned subgroup analysis to compare the impact of patient-level ethnicity on our primary and secondary outcomes and will undertake process and economic evaluations. ETHICS AND DISSEMINATION Research governance and ethical approvals are from the UK National Health Service Health Research Authority Research Ethics Service. Dissemination will be open access through peer-reviewed scientific journals, study website, press and online media, including free online training materials on the Open University's FutureLearn web platform. TRIAL REGISTRATION NUMBER ISRCTN13177364; Pre-results.
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Affiliation(s)
- David A Richards
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Holly Vr Sugg
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Emma Cockcroft
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Joanne Cooper
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Faye Doris
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Claire Hulme
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Phillipa Logan
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | | | - G J Melendez-Torres
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne Marie Rafferty
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
| | - Nigel Reed
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne-Marie Russell
- Academy of Nursing, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Maggie Shepherd
- NIHR Clinical Research Facility, University of Exeter, Exeter, UK
| | - Sally J Singh
- Cardiac/Pulmonary Rehabilitation, Leicester Royal Infirmary, Leicester, UK
| | - Jo Thompson Coon
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Susannah Tooze
- Academy of Nursing, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Stephen Wootton
- Insitute of Human Nutrition, University of Southampton, Southampton, UK
| | - Rebecca Abbott
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Alison Bethel
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Lynne Quinn
- Clinical Trials Unit, University of Exeter, Exeter, UK
| | - Harry Tripp
- Clinical Trials Unit, University of Exeter, Exeter, UK
| | - Fiona C Warren
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rebecca Whear
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Harriet A Hunt
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Merryn Kent
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Leila Morgan
- Academy of Nursing, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Naomi Morley
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Lidia Romanczuk
- NIHR Clinical Research Facility, University of Exeter, Exeter, UK
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Hernar I, Graue M, Richards DA, Strandberg RB, Nilsen RM, Rekdal M, Løvaas KF, Madsen TV, Tell GS, Haugstvedt A. Use of patient-reported outcome measures (PROMs) in clinical diabetes consultations: the DiaPROM randomised controlled pilot trial. BMJ Open 2021; 11:e042353. [PMID: 33853796 PMCID: PMC8054082 DOI: 10.1136/bmjopen-2020-042353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/17/2020] [Accepted: 03/31/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To pilot test the proposed DiaPROM trial components and address uncertainties associated with conducting a full-scale randomised controlled trial (RCT) to evaluate whether such a trial is feasible. DESIGN Two-arm pilot RCT. PARTICIPANTS Adults aged ≥18-39 years, with minimum 1 year type 1 diabetes duration, attending outpatient follow-up. Exclusion criteria were pregnancy, severe cognitive, somatic or psychiatric conditions and impaired vision. RANDOMISATION AND INTERVENTION All participants completed electronic Patient-Reported Outcome Measures (PROMs) prior to the annual diabetes consultation. Using computer-generated block-randomisation without blinding, we assigned participants in a 1:1 ratio stratified by sex to receive standard care or an intervention. Physicians reviewed diabetes distress scores (Problem Areas In Diabetes scale) and referred individuals with scores ≥30 or single item(s) ≥3 to minimum two diabetes nurse consultations where reported problems were reviewed and discussed. OUTCOMES Recruitment and retention rates; participants perceptions about intervention components. Variance and estimated between-group differences in follow-up scores (Diabetes Distress Scale (DDS), WHO 5-Well-being Index, Perceived Competence for Diabetes Scale and glycaemic control) and DDS correlation with baseline scores, to assist sample size calculations. RESULTS We randomised 80 participants to the control or intervention arm (one participant was later excluded). 23/39 intervention arm participants qualified for additional consultations and 17 attended. 67/79 attended the 12-month follow-up (15.2% attrition); 5/17 referred to additional consultations were lost to follow-up (29.4% attrition). Participants reported PROMs as relevant (84.6%) and acceptable (97.4%) but rated the usefulness of consultations as moderate to low. Baseline mean±SD DDS score was 2.1±0.69; DDS SD was 0.71 (95% CI: 0.60 to 0.86) at follow-up; correlation between baseline and follow-up DDS scores was 0.8 (95% CI: 0.7 to 0.9). CONCLUSIONS The pilot trial revealed need for intervention modifications ahead of a full-scale trial to evaluate use of PROMs in diabetes consultations. Specifically, participant acceptability and intervention implementation need further investigation.
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Affiliation(s)
- Ingvild Hernar
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - David A Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Ragnhild B Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Roy Miodini Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | | | - Karianne Fjeld Løvaas
- Norwegian Diabetes Register for Adults, Norwegian Organisation for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tone V Madsen
- Norwegian Diabetes Register for Adults, Norwegian Organisation for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Schäfer-Keller P, Santos GC, Denhaerynck K, Graf D, Vasserot K, Richards DA, Strömberg A. Self-care, symptom experience, needs, and past health-care utilization in individuals with heart failure: results of a cross-sectional study. Eur J Cardiovasc Nurs 2021; 20:464-474. [PMID: 33693590 DOI: 10.1093/eurjcn/zvaa026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/13/2020] [Indexed: 11/12/2022]
Abstract
AIMS Self-care in heart failure (HF) is generally sub-optimal and impacts morbidity and mortality. To describe self-care prevalence and explore its relationships with symptom experience, patient needs, and health-care utilization in a Swiss hospital providing regional secondary care. METHODS AND RESULTS Cross-sectional study, convenience sample of individuals with HF from four campuses of one regional Swiss hospital. Self-care was assessed via the Self-Care of Heart Failure Index (SCHFI) and the European Heart Failure Self-care Behaviour Scale (EHFScBS), symptom experience via the M.D. Anderson Symptom Inventory-HF (MDASI-HF) and needs via the Heart Failure Needs Assessment Questionnaire (HFNAQ). Healthcare utilization reflected the preceding year's hospitalization incidence. A cut-off level of ≥70% indicated adequate self-care. We analysed SCHFI, EHFScBS, MDASI-HF and HFNAQ scores' relationships with hospitalizations using Spearman's rho correlation; no prior hypotheses were stated. Sample of 310 individuals with HF (37.4% female; mean age 76.8; 55% NYHA III). Adequate self-care maintenance, management, and confidence were reported by 24%, 10%, and 61%. respectively. The sample's mean number of experienced symptoms was 12.8 (SD 4.0) and 14.0 (SD 5.8) for needs. Over the previous year, 269 hospitalizations had occurred (median: 0, IQR 1). Hospitalizations positively correlated with self-care; symptom experience with needs. Neither symptom experience nor needs correlated with hospitalizations. CONCLUSION The findings indicated low self-care levels and suggest a need for increased support to maintain physiological stability, manage symptoms and prevent hospitalizations. This study is the first of its kind in Switzerland and among few studies worldwide to report on self-care, symptom experience, needs, and health-care utilization. Interventional studies are warranted considering baseline self-care capabilities, symptoms, and needs of individuals with HF.
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Affiliation(s)
- Petra Schäfer-Keller
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland Fribourg, Haute Ecole de Santé Fribourg, Route des Arsenaux 16a, Fribourg, CH-1700, Switzerland
| | - Gabrielle Cécile Santos
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland Fribourg, Haute Ecole de Santé Fribourg, Route des Arsenaux 16a, Fribourg, CH-1700, Switzerland.,Institute of Higher Education and Research in Healthcare IUFRS, Faculty of Biology and Medicine, University of Lausanne and Lausanne University Hospital, Route de la Corniche 10, Lausanne, CH-1010, Switzerland
| | - Kris Denhaerynck
- Institute of Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, Basel, CH-4056, Switzerland
| | - Denis Graf
- Cardiology, HFR Fribourg, HFR Fribourg - Hôpital cantonal, Route de Bertigny 8, Fribourg, CH-1708, Switzerland
| | - Krystel Vasserot
- Nursing Direction, HFR Fribourg, HFR Fribourg - Hôpital cantonal, Case postale, Chemin des Pensionnats 2-6, Villars-sur-Glâne, CH-1752, Switzerland
| | - David A Richards
- College of Medicine and Health, South Cloisters, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Building 511-001, Campus US, Linköping, SE-581 83, Sweden
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19
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Affiliation(s)
- David A Richards
- College of Medicine and Health, University of Exeter, St Luke's Campus, Exeter EX1 2LU, UK
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20
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Sugg HVR, Richards DA, Frost J. What is Morita Therapy? The Nature, Origins, and Cross-Cultural Application of a Unique Japanese Psychotherapy. J Contemp Psychother 2020. [DOI: 10.1007/s10879-020-09464-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Abstract
Morita Therapy is a Japanese psychotherapy which contrasts with established Western approaches in teaching, through behavioural experience, that symptoms are part of the natural ecology of human experience. Morita Therapy has received increasing international interest over the decades, and the first randomized controlled trial of Morita Therapy to be published outside of China has recently demonstrated the promise of the approach in treating Western patients. To respond to the resulting interest in Morita Therapy from patients and practitioners, and facilitate further Morita Therapy research, it is necessary to provide the detailed explanation of Morita Therapy which is currently rare in the West. In this article, we fill this gap with a thorough description of Morita Therapy in terms of the key principles, objectives and processes of the approach; its basis in Eastern philosophy and naturalism; its sociohistorical context and development over a wide range of formats, patient conditions, and countries. To enable Western practitioners to appreciate and capitalize on the potential value of Morita Therapy as a distinct alternative for patients, we illustrate the approach’s unique method and objective compared to Western psychotherapies, and provide recommendations for practitioners applying Morita Therapy across cultures.
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Moriarty AS, Coventry PA, Hudson JL, Cook N, Fenton OJ, Bower P, Lovell K, Archer J, Clarke R, Richards DA, Dickens C, Gask L, Waheed W, Huijbregts KM, van der Feltz-Cornelis C, Ali S, Gilbody S, McMillan D. The role of relapse prevention for depression in collaborative care: A systematic review. J Affect Disord 2020; 265:618-644. [PMID: 31791677 DOI: 10.1016/j.jad.2019.11.105] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/01/2019] [Accepted: 11/21/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Relapse (the re-emergence of depression symptoms before full recovery) is common in depression and relapse prevention strategies are not well researched in primary care settings. Collaborative care is effective for treating acute phase depression but little is known about the use of relapse prevention strategies in collaborative care. We undertook a systematic review to identify and characterise relapse prevention strategies in the context of collaborative care. METHODS We searched for Randomised Controlled Trials (RCTs) of collaborative care for depression. In addition to published material, we obtained provider and patient manuals from authors to provide more detail on intervention content. We reported the extent to which collaborative care interventions addressed four relapse prevention components. RESULTS 93 RCTs were identified. 31 included a formal relapse prevention plan; 42 had proactive monitoring and follow-up after the acute phase; 39 reported strategies for optimising sustained medication adherence; and 20 of the trials reported psychological or psycho-educational treatments persisting beyond the acute phase or focussing on long-term health/relapse prevention. 30 (32.3%) did not report relapse prevention approaches. LIMITATIONS We did not receive trial materials for approximately half of the trials, which limited our ability to identify relevant features of intervention content. CONCLUSION Relapse is a significant risk amongst people treated for depression and interventions are needed that specifically address and minimise this risk. Given the advantages of collaborative care as a delivery system for depression care, there is scope for more consistency and increased effort to implement and evaluate relapse prevention strategies.
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Affiliation(s)
- Andrew S Moriarty
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Peter A Coventry
- Department of Health Sciences and Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, UK.
| | - Joanna L Hudson
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Natalie Cook
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Oliver J Fenton
- Tees, Esk and Wear Valleys NHS Foundation Trust, South and West Community Mental Health Team, Acomb Garth, 2 Oak Rise, York, YO24 4LJ, UK.
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Janine Archer
- School of Health and Society, University of Salford, Mary Seacole Building, Broad St, Frederick Road Campus, Salford, M6 6PU, UK.
| | - Rose Clarke
- Sheffield IAPT, St George's Community Health Centre, Winter Street, Sheffield, South Yorkshire, S3 7ND, UK.
| | - David A Richards
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Chris Dickens
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Linda Gask
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Waquas Waheed
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Klaas M Huijbregts
- GGNet, Mental Health, RGC SKB Winterswijk, Beatrixpark 1, 7101 BN Winterswijk, The Netherlands.
| | | | - Shehzad Ali
- Epidemiology and Biostatistics Department, Schulich School of Medicine & Dentistry, Western University, Kresge Building, Room K201, London, Ontario, N6A 5C1, Canada; Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - Simon Gilbody
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Dean McMillan
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
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Martin PG, Jones CP, Cipiccia S, Batey DJ, Hallam KR, Satou Y, Griffiths I, Rau C, Richards DA, Sueki K, Ishii T, Scott TB. Compositional and structural analysis of Fukushima-derived particulates using high-resolution x-ray imaging and synchrotron characterisation techniques. Sci Rep 2020; 10:1636. [PMID: 32005927 PMCID: PMC6994464 DOI: 10.1038/s41598-020-58545-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/16/2020] [Indexed: 11/24/2022] Open
Abstract
Both the three-dimensional internal structure and elemental distribution of near-field radioactive fallout particulate material released during the March 2011 accident at the Fukushima Daiichi Nuclear Power Plant is analysed using combined high-resolution laboratory and synchrotron radiation x-ray techniques. Results from this study allow for the proposition of the likely formation mechanism of the particles, as well as the potential risks associated with their existence in the environment, and the likely implications for future planned reactor decommissioning. A suite of particles is analyzed from a locality 2 km from the north-western perimeter of the site – north of the primary contaminant plume in an area formerly attributed to being contaminated by fallout from reactor Unit 1. The particles are shown to exhibit significant structural similarities; being amorphous with a textured exterior, and containing inclusions of contrasting compositions, as well as an extensive internal void volume – bimodal in its size distribution. A heterogeneous distribution of the various elemental constituents is observed inside a representative particle, which also exhibited a Fukushima-derived radiocesium (134Cs, 135Cs and 137Cs) signature with negligible natural Cs. We consider the structure and composition of the particle to suggest it formed from materials associated with the reactor Unit 1 building explosion, with debris fragments embedded into the particles surface. Such a high void ratio, comparable to geological pumice, suggests such material formed during a rapid depressurisation and is potentially susceptible to fragmentation through attrition.
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Affiliation(s)
- Peter G Martin
- Interface Analysis Centre, School of Physics, University of Bristol, Bristol, BS8 1TL, UK.
| | - Christopher P Jones
- Interface Analysis Centre, School of Physics, University of Bristol, Bristol, BS8 1TL, UK
| | - Silvia Cipiccia
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot, Oxfordshire, OX11 0DE, UK
| | - Darren J Batey
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot, Oxfordshire, OX11 0DE, UK
| | - Keith R Hallam
- Interface Analysis Centre, School of Physics, University of Bristol, Bristol, BS8 1TL, UK
| | - Yukihiko Satou
- Collaborative Laboratories for Advanced Decommissioning Science (CLADS), Japan Atomic Energy Agency (JAEA), Tomioka-Machi, Futaba-gun, Fukushima, 979-1151, Japan
| | - Ian Griffiths
- Department of Materials, University of Oxford, Oxford, OX1 3PH, UK
| | - Christoph Rau
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot, Oxfordshire, OX11 0DE, UK
| | - David A Richards
- School of Geographical Sciences, University of Bristol, Bristol, BS8 1SS, UK
| | - Keisuke Sueki
- Faculty of Pure and Applied Sciences, University of Tsukuba, Tsukuba, Ibaraki, 305-8571, Japan
| | - Tatsuya Ishii
- Faculty of Pure and Applied Sciences, University of Tsukuba, Tsukuba, Ibaraki, 305-8571, Japan
| | - Thomas B Scott
- Interface Analysis Centre, School of Physics, University of Bristol, Bristol, BS8 1TL, UK
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Sugg HVR, Frost J, Richards DA. Personalising psychotherapies for depression using a novel mixed methods approach: an example from Morita therapy. Trials 2020; 21:41. [PMID: 31915064 PMCID: PMC6950935 DOI: 10.1186/s13063-019-3788-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 10/05/2019] [Indexed: 11/11/2022] Open
Abstract
Background Current quantitative methods for personalising psychotherapies for depression are unlikely to be able to inform clinical decision-making for hundreds of years. Novel alternative methods to generate hypotheses for prospective testing are therefore required, and we showcase mixed methods as one such approach. By exploring patients’ perspectives in depth, and integrating qualitative and quantitative data at the level of the individual, we may identify new potential psychosocial predictors of psychotherapy outcomes, potentially informing the personalisation of depression treatment in a shorter timeframe. Using Morita therapy (a Japanese psychotherapy) as an exemplar, we thus explored how Morita therapy recipients’ views on treatment acceptability explain their adherence and response to treatment. Methods The Morita trial incorporated a pilot randomised controlled trial of Morita therapy versus treatment as usual for depression, and post-treatment qualitative interviews. We recruited trial participants from general practice record searches in Devon, UK, and purposively sampled data from 16 participants for our mixed methods analysis. We developed typologies of participants’ views from our qualitative themes, and integrated these with quantitative data on number of sessions attended and whether participants responded to treatment in a joint typologies and statistics display. We enriched our analysis using participant vignettes to demonstrate each typology. Results We demonstrated that (1) participants who could identify with the principles of Morita therapy typically responded to treatment, regardless of how many sessions they attended, whilst those whose orientation towards treatment was incompatible with Morita therapy did not respond to treatment, again regardless of treatment adherence and (2) participants whose personal circumstances impeded their opportunity to engage in Morita therapy attended the fewest sessions, though still benefitted from treatment if the principles resonated with them. Conclusions We identified new potential relationships between “orientation” and outcomes, and “opportunity” and adherence, which could not have been identified using existing non-integrative methods. This mixed methods approach warrants replication in future trials and with other psychotherapies to generate hypotheses, based on typologies (or profiles) of patients for whom a treatment is more or less likely to be suitable, to be tested in prospective trials. Trial registration Current Controlled Trials, ISRCTN17544090. Registered on 23 July 2015.
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Affiliation(s)
- Holly Victoria Rose Sugg
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK.
| | - Julia Frost
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - David A Richards
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
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Kitson A, Carr D, Conroy T, Feo R, Grønkjær M, Huisman-de Waal G, Jackson D, Jeffs L, Merkley J, Muntlin Athlin Å, Parr J, Richards DA, Sørensen EE, Wengström Y. Speaking Up for Fundamental Care: the ILC Aalborg Statement. BMJ Open 2019; 9:e033077. [PMID: 31822543 PMCID: PMC6924742 DOI: 10.1136/bmjopen-2019-033077] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The International Learning Collaborative (ILC) is an organisation dedicated to understanding why fundamental care, the care required by all patients regardless of clinical condition, fails to be provided in healthcare systems globally. At its 11th annual meeting in 2019, nursing leaders from 11 countries, together with patient representatives, confirmed that patients' fundamental care needs are still being ignored and nurses are still afraid to 'speak up' when these care failures occur. While the ILC's efforts over the past decade have led to increased recognition of the importance of fundamental care, it is not enough. To generate practical, sustainable solutions, we need to substantially rethink fundamental care and its contribution to patient outcomes and experiences, staff well-being, safety and quality, and the economic viability of healthcare systems. KEY ARGUMENTS We present five propositions for radically transforming fundamental care delivery:Value: fundamental care must be foundational to all caring activities, systems and institutionsTalk: fundamental care must be explicitly articulated in all caring activities, systems and institutions.Do: fundamental care must be explicitly actioned and evaluated in all caring activities, systems and institutions.Own: fundamental care must be owned by each individual who delivers care, works in a system that is responsible for care or works in an institution whose mission is to deliver care. RESEARCH fundamental care must undergo systematic and high-quality investigations to generate the evidence needed to inform care practices and shape health systems and education curricula. CONCLUSION For radical transformation within health systems globally, we must move beyond nursing and ensure all members of the healthcare team-educators, students, consumers, clinicians, leaders, researchers, policy-makers and politicians-value, talk, do, own and research fundamental care. It is only through coordinated, collaborative effort that we will, and must, achieve real change.
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Affiliation(s)
- Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Devin Carr
- University Hospital and Frankel Cardiovascular Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Mette Grønkjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Getty Huisman-de Waal
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Lianne Jeffs
- Lunenfeld-Tananbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Jane Merkley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tananbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Åsa Muntlin Athlin
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Jennifer Parr
- Patient Experience and Nursing, Counties Manukau District Health Board, Auckland, New Zealand
| | - David A Richards
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Erik Elgaard Sørensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Yvonne Wengström
- Division of Neurobiology Care Science and Society, Nursing, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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Richards DA, Bazeley P, Borglin G, Craig P, Emsley R, Frost J, Hill J, Horwood J, Hutchings HA, Jinks C, Montgomery A, Moore G, Plano Clark VL, Tonkin-Crine S, Wade J, Warren FC, Wyke S, Young B, O'Cathain A. Integrating quantitative and qualitative data and findings when undertaking randomised controlled trials. BMJ Open 2019; 9:e032081. [PMID: 31772096 PMCID: PMC6886933 DOI: 10.1136/bmjopen-2019-032081] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
It is common to undertake qualitative research alongside randomised controlled trials (RCTs) when evaluating complex interventions. Researchers tend to analyse these datasets one by one and then consider their findings separately within the discussion section of the final report, rarely integrating quantitative and qualitative data or findings, and missing opportunities to combine data in order to add rigour, enabling thorough and more complete analysis, provide credibility to results, and generate further important insights about the intervention under evaluation. This paper reports on a 2 day expert meeting funded by the United Kingdom Medical Research Council Hubs for Trials Methodology Research with the aims to identify current strengths and weaknesses in the integration of quantitative and qualitative methods in clinical trials, establish the next steps required to provide the trials community with guidance on the integration of mixed methods in RCTs and set-up a network of individuals, groups and organisations willing to collaborate on related methodological activity. We summarise integration techniques and go beyond previous publications by highlighting the potential value of integration using three examples that are specific to RCTs. We suggest that applying mixed methods integration techniques to data or findings from studies involving both RCTs and qualitative research can yield insights that might be useful for understanding variation in outcomes, the mechanism by which interventions have an impact, and identifying ways of tailoring therapy to patient preference and type. Given a general lack of examples and knowledge of these techniques, researchers and funders will need future guidance on how to undertake and appraise them.
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Affiliation(s)
- David A Richards
- Institute of Health Sciences, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Patricia Bazeley
- Transitional Research and Social Innovation Group, Western Sydney University, Penrith South, New South Wales, Australia
| | - Gunilla Borglin
- Department of Care Science, Malmo University, Malmo, Skåne, Sweden
- Department of Nursing Education, Lovisenberg Diaconal University College, Oslo, Akershus, Norway
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, UK
| | - Julia Frost
- Institute of Health Sciences, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Jacqueline Hill
- Institute of Health Sciences, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Jeremy Horwood
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | | | - Clare Jinks
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Alan Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Graham Moore
- School of Social Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Vicki L Plano Clark
- School of Education, University of Cincinnati College of Education Criminal Justice and Human Services, Cincinnati, Ohio, USA
| | - Sarah Tonkin-Crine
- Department of Primary Care Health Sciences, and NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, Oxfordshire, UK
| | - Julia Wade
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Fiona C Warren
- Institute of Health Sciences, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Glasgow, UK
| | - Bridget Young
- Institute of Population Health Sciences, University of Liverpool, Liverpool, Merseyside, UK
| | - Alicia O'Cathain
- Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
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27
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Pentecost C, Frost J, Sugg HVR, Hilli A, Goodwin VA, Richards DA. Patients' and nurses' experiences of fundamental nursing care: A systematic review and qualitative synthesis. J Clin Nurs 2019; 29:1858-1882. [PMID: 31661591 PMCID: PMC7319357 DOI: 10.1111/jocn.15082] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 08/07/2019] [Accepted: 08/24/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To systematically identify, appraise and synthesise patients', residents' and nurses' experiences of fundamental nursing care for nutrition, elimination, mobility and hygiene. BACKGROUND The evidence base for effective nursing behaviours to assist people with their fundamental care needs is sparse, hampering the development of effective interventions. Synthesising data on patients' and nurses' experiences of fundamentals of nursing care could contribute to the development of such an intervention. METHODS Systematic review and synthesis of qualitative data from qualitative studies on patients' and nurses' experiences of fundamental nursing care behaviours addressing peoples' nutrition, elimination, mobility and hygiene needs. We appraised study quality and relevance and used a narrative approach to data synthesis, fulfilling PRISMA criteria (Appendix S2). RESULTS We identified 22,374 papers, and 47 met our inclusion criteria. Most papers were of low quality. Sixteen papers met our quality and relevance criteria and were included for synthesis. Papers were about nutrition (2) elimination (2), mobility (5), hygiene (5) and multiple care areas (2). We found nurses and patients report that fundamental nursing care practices involve strong leadership, collaborative partnerships with patients and cohesive organisational practices aligned to nursing care objectives and actions. CONCLUSIONS To improve fundamental care and interventions suitable for testing may require attention to leadership, patient-nurse relationships and organisational coherence plus the fundamentals of care nursing interventions themselves. RELEVANCE TO CLINICAL PRACTICE More rigorous mixed methods research about fundamental nursing care is needed to inform nursing practice and improve patient's experience. Nursing interventions should include effective nurse leadership and nurse-patient collaboration and a focus on fundamental care by the host organisation.
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Affiliation(s)
- Claire Pentecost
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Julia Frost
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Holly V R Sugg
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Angelique Hilli
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Victoria A Goodwin
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - David A Richards
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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Weiss JM, Csoszi T, Maglakelidze M, Hoyer RJ, Beck JT, Domine Gomez M, Lowczak A, Aljumaily R, Rocha Lima CM, Boccia RV, Hanna W, Nikolinakos P, Chiu VK, Owonikoko TK, Schuster SR, Hussein MA, Richards DA, Sawrycki P, Bulat I, Hamm JT, Hart LL, Adler S, Antal JM, Lai AY, Sorrentino JA, Yang Z, Malik RK, Morris SR, Roberts PJ, Dragnev KH. Myelopreservation with the CDK4/6 inhibitor trilaciclib in patients with small-cell lung cancer receiving first-line chemotherapy: a phase Ib/randomized phase II trial. Ann Oncol 2019; 30:1613-1621. [PMID: 31504118 PMCID: PMC6857609 DOI: 10.1093/annonc/mdz278] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Chemotherapy-induced damage of hematopoietic stem and progenitor cells (HSPC) causes multi-lineage myelosuppression. Trilaciclib is an intravenous CDK4/6 inhibitor in development to proactively preserve HSPC and immune system function during chemotherapy (myelopreservation). Preclinically, trilaciclib transiently maintains HSPC in G1 arrest and protects them from chemotherapy damage, leading to faster hematopoietic recovery and enhanced antitumor immunity. PATIENTS AND METHODS This was a phase Ib (open-label, dose-finding) and phase II (randomized, double-blind placebo-controlled) study of the safety, efficacy and PK of trilaciclib in combination with etoposide/carboplatin (E/P) therapy for treatment-naive extensive-stage small-cell lung cancer patients. Patients received trilaciclib or placebo before E/P on days 1-3 of each cycle. Select end points were prespecified to assess the effect of trilaciclib on myelosuppression and antitumor efficacy. RESULTS A total of 122 patients were enrolled, with 19 patients in part 1 and 75 patients in part 2 receiving study drug. Improvements were seen with trilaciclib in neutrophil, RBC (red blood cell) and lymphocyte measures. Safety on trilaciclib+E/P was improved with fewer ≥G3 adverse events (AEs) in trilaciclib (50%) versus placebo (83.8%), primarily due to less hematological toxicity. No trilaciclib-related ≥G3 AEs occurred. Antitumor efficacy assessment for trilaciclib versus placebo, respectively, showed: ORR (66.7% versus 56.8%, P = 0.3831); median PFS [6.2 versus 5.0 m; hazard ratio (HR) 0.71; P = 0.1695]; and OS (10.9 versus 10.6 m; HR 0.87; P = 0.6107). CONCLUSION Trilaciclib demonstrated an improvement in the patient's tolerability of chemotherapy as shown by myelopreservation across multiple hematopoietic lineages resulting in fewer supportive care interventions and dose reductions, improved safety profile, and no detriment to antitumor efficacy. These data demonstrate strong proof-of-concept for trilaciclib's myelopreservation benefits. CLINICAL TRAIL NUMBER NCT02499770.
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Affiliation(s)
- J M Weiss
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, USA
| | - T Csoszi
- Oncology, Hetenyi Geza Korhaz, Onkologiai Kozpont, Szolnok, Hungary
| | - M Maglakelidze
- Department of Oncology, Research Institute of Clinical Medicine, Tbilisi, Georgia, USA
| | - R J Hoyer
- Department of Oncology, Memorial Hospital, University of Colorado Health, Colorado Springs, USA
| | - J T Beck
- Department of Medical Oncology and Hematology, Highlands Oncology Group, Fayetteville, USA
| | - M Domine Gomez
- Department of Oncology, University Hospital Fundacion Jimenez Diaz, IIS-FJD, Madrid, Spain
| | - A Lowczak
- Department of Pulmonology, Faculty of Health and Science, University of Warmia and Mazury in Olsztyn, Poland
| | - R Aljumaily
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, USA
| | - C M Rocha Lima
- Gibbs Cancer Center and Research Institute, Spartanburg, USA
| | - R V Boccia
- Center for Cancer and Blood Disorders, Bethesda, USA
| | - W Hanna
- Hematology/Oncology, University of Tennessee Medical Center, Knoxville, USA
| | - P Nikolinakos
- University Cancer & Blood Center, LLC, Athens, Greece
| | - V K Chiu
- Department of Hematology/Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, USA
| | - T K Owonikoko
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, USA
| | | | - M A Hussein
- Department of Oncology, Florida Cancer Specialists, Leesburg, USA
| | - D A Richards
- Department of Oncology, US Oncology Research, Tyler, USA
| | - P Sawrycki
- Department of Cancer Chemotherapy, Provincial Hospital, Toruń, Poland
| | - I Bulat
- ARENSIA Oncology Unit, Institute of Oncology, Chisinau, Moldova
| | - J T Hamm
- Department of Medical Oncology, Norton Health Care, Louisville, USA
| | - L L Hart
- Drug Development Program, Floridia Cancer Specialists, Fort Myers, USA
| | - S Adler
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - J M Antal
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - A Y Lai
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - J A Sorrentino
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - Z Yang
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - R K Malik
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - S R Morris
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - P J Roberts
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - K H Dragnev
- Department of Hematology/Oncology, Norris Cotton Cancer Center Dartmouth-Hitchcock Medical Center, Lebanon, USA.
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Goodwin VA, Hill JJ, Fullam JA, Finning K, Pentecost C, Richards DA. Intervention development and treatment success in UK health technology assessment funded trials of physical rehabilitation: a mixed methods analysis. BMJ Open 2019; 9:e026289. [PMID: 31467046 PMCID: PMC6720467 DOI: 10.1136/bmjopen-2018-026289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Physical rehabilitation is a complex process, and trials of rehabilitation interventions are increasing in number but often report null results. This study aimed to establish treatment success rates in physical rehabilitation trials funded by the National Institute of Health Research Health Technology Assessment (NIHR HTA) programme and examine any relationship between treatment success and the quality of intervention development work undertaken. DESIGN This is a mixed methods study. SETTING This study was conducted in the UK. METHODS The NIHR HTA portfolio was searched for all completed definitive randomised controlled trials of physical rehabilitation interventions from inception to July 2016. Treatment success was categorised according to criteria developed by Djulbegovic and colleagues. Detailed textual data regarding any intervention development work were extracted from trial reports and supporting publications and informed the development of quality ratings. Mixed methods integrative analysis was undertaken to explore the relationship between quantitative and qualitative data using joint displays. RESULTS Fifteen trials were included in the review. Five reported a definitive finding, four of which were in favour of the 'new' intervention. Eight trials reported a true negative (no difference) outcome. Integrative analysis indicated those with lower quality intervention development work were less likely to report treatment success. CONCLUSIONS Despite much effort and funding, most physical rehabilitation trials report equivocal findings. Greater focus on high quality intervention development may reduce the likelihood of a null result in the definitive trial, alongside high quality trial methods and conduct.
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Affiliation(s)
- Victoria A Goodwin
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Jacqueline J Hill
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - James A Fullam
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Katie Finning
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Claire Pentecost
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - David A Richards
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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30
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Martin PG, Louvel M, Cipiccia S, Jones CP, Batey DJ, Hallam KR, Yang IAX, Satou Y, Rau C, Mosselmans JFW, Richards DA, Scott TB. Provenance of uranium particulate contained within Fukushima Daiichi Nuclear Power Plant Unit 1 ejecta material. Nat Commun 2019; 10:2801. [PMID: 31243294 PMCID: PMC6594968 DOI: 10.1038/s41467-019-10937-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 06/11/2019] [Indexed: 11/09/2022] Open
Abstract
Here we report the results of multiple analytical techniques on sub-mm particulate material derived from Unit 1 of the Fukushima Daiichi Nuclear Power Plant to provide a better understanding of the events that occurred and the environmental legacy. Through combined x-ray fluorescence and absorption contrast micro-focused x-ray tomography, entrapped U particulate are observed to exist around the exterior circumference of the highly porous Si-based particle. Further synchrotron radiation analysis of a number of these entrapped particles shows them to exist as UO2-identical to reactor fuel, with confirmation of their nuclear origin shown via mass spectrometry analysis. While unlikely to represent an environmental or health hazard, such assertions would likely change should break-up of the Si-containing bulk particle occur. However, more important to the long-term decommissioning of the reactors at the FDNPP (and environmental clean-upon), is the knowledge that core integrity of reactor Unit 1 was compromised with nuclear material existing outside of the reactors primary containment.
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Affiliation(s)
- Peter G Martin
- Interface Analysis Centre, School of Physics, HH Wills Physics Laboratory, University of Bristol, Bristol, BS8 1TL, UK.
| | - Marion Louvel
- Department of Earth Sciences, University of Cambridge, Bullard Laboratories, Madingley Road, Cambridge, CB3 0EZ, UK
| | - Silvia Cipiccia
- Diamond Light Source, Harwell Science and Innovation Park, Didcot, OX, OX11 0DE, UK
| | - Christopher P Jones
- Interface Analysis Centre, School of Physics, HH Wills Physics Laboratory, University of Bristol, Bristol, BS8 1TL, UK
| | - Darren J Batey
- Diamond Light Source, Harwell Science and Innovation Park, Didcot, OX, OX11 0DE, UK
| | - Keith R Hallam
- Interface Analysis Centre, School of Physics, HH Wills Physics Laboratory, University of Bristol, Bristol, BS8 1TL, UK
| | - Ian A X Yang
- Interface Analysis Centre, School of Physics, HH Wills Physics Laboratory, University of Bristol, Bristol, BS8 1TL, UK
| | - Yukihiko Satou
- Collaborative Laboratories for Advanced Decommissioning Science, Japan Atomic Energy Agency, Tomioka-Machi, Futaba-gun, Fukushima, 979-1151, Japan
| | - Christoph Rau
- Diamond Light Source, Harwell Science and Innovation Park, Didcot, OX, OX11 0DE, UK
| | - J Fred W Mosselmans
- Diamond Light Source, Harwell Science and Innovation Park, Didcot, OX, OX11 0DE, UK
| | - David A Richards
- School of Geographical Sciences, University of Bristol, Bristol, BS8 1SS, UK
| | - Thomas B Scott
- Interface Analysis Centre, School of Physics, HH Wills Physics Laboratory, University of Bristol, Bristol, BS8 1TL, UK
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31
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Sugg HVR, Frost J, Richards DA. Morita Therapy for depression (Morita Trial): an embedded qualitative study of acceptability. BMJ Open 2019; 9:e023873. [PMID: 31147359 PMCID: PMC6549637 DOI: 10.1136/bmjopen-2018-023873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/23/2018] [Accepted: 03/21/2019] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To explore the views of UK-based recipients of Morita Therapy (MT) on the acceptability of MT. DESIGN Qualitative study nested within a pilot randomised controlled trial of MT (a Japanese psychological therapy largely unknown in the UK) versus treatment as usual, using post-treatment semistructured interviews analysed with a framework approach. SETTING AND PARTICIPANTS Participants who received MT as part of the Morita Trial, recruited for the trial from General Practice record searches in Devon, UK. Data from 16 participants were purposively sampled for analysis. RESULTS We identified five themes which, together, form a model of how different participants viewed and experienced MT. Overall, MT was perceived as acceptable by many participants who emphasised the value of the approach, often in comparison to other treatments they had tried. These participants highlighted how accepting and allowing difficulties as natural phenomena and shifting attention from symptoms to external factors had facilitated symptom reduction and a sense of empowerment. We found that how participants understood and related to the principles of MT, in light of their expectations of treatment, was significantly tied to the extent to which MT was perceived as acceptable. Our findings also highlighted the distinction between MT in principle and practice, with participants noting challenges of engaging with the process of therapy such as fear and discomfort around rest, needing sufficient support from the therapist and others, and the commitment of treatment. CONCLUSIONS People in the UK can accept the premise of MT, and consider the approach beneficial and novel. Therefore, proceeding to a large-scale trial of MT is appropriate with minor modifications to our clinical protocol. Participants' expectations and understandings of treatment play a key role in acceptability, and future research may investigate these potential moderators of acceptability in MT. TRIAL REGISTRATION NUMBERC ISRCTN17544090; Pre-results.
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Affiliation(s)
| | - Julia Frost
- Medical School, University of Exeter, Exeter, UK
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Richards SH, Campbell JL, Dickens C, Anderson R, Gandhi M, Gibson A, Kessler D, Knight L, Kuyken W, Richards DA, Taylor RS, Turner K, Ukoumunne OC, Davey A, Warren FC, Winder RE, Wright CA. Enhanced psychological care in cardiac rehabilitation services for patients with new-onset depression: the CADENCE feasibility study and pilot RCT. Health Technol Assess 2019; 22:1-220. [PMID: 29856312 DOI: 10.3310/hta22300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Around 19% of people screened by UK cardiac rehabilitation programmes report having moderate or severe symptoms of depression. These individuals are at an increased risk of cardiac mortality and morbidity, reduced quality of life and increased use of health resources compared with their non-depressed counterparts. Maximising psychological health is a goal of cardiac rehabilitation, but psychological care is patchy. OBJECTIVE(S) To examine the feasibility and acceptability of embedding enhanced psychological care (EPC) within cardiac rehabilitation, we tested the feasibility of developing/implementing EPC and documented the key uncertainties associated with undertaking a definitive evaluation. DESIGN A two-stage multimethods study; a feasibility study and a qualitative evaluation, followed by an external pilot cluster randomised controlled trial (RCT) with a nested qualitative study. SETTING UK comprehensive cardiac rehabilitation teams. PARTICIPANTS Adults eligible for cardiac rehabilitation following an acute coronary syndrome with new-onset depressive symptoms on initial nurse assessment. Patients who had received treatment for depression in the preceding 6 months were excluded. INTERVENTIONS The EPC intervention comprised nurse-led mental health-care co-ordination and behavioural activation within cardiac rehabilitation. The comparator was usual cardiac rehabilitation care. MAIN OUTCOME MEASURES Measures at baseline, and at the 5- (feasibility and pilot) and 8-month follow-ups (pilot only). Process measures related to cardiac team and patient recruitment, and participant retention. Outcomes included depressive symptoms, cardiac mortality and morbidity, anxiety, health-related quality of life and service resource use. Interviews explored participant and nurses' views and experiences. RESULTS Between September 2014 and May 2015, five nurses from four teams recruited participants into the feasibility study. Of the 203 patients screened, 30 were eligible and nine took part (the target was 20 participants). At interview, participants and nurses gave valuable insights into the EPC intervention design and delivery. Although acceptable, the EPC delivery was challenging for nurses (e.g. the ability to allocate sufficient time within existing workloads) and the intervention was modified accordingly. Between December 2014 and February 2015, 8 out of 20 teams approached agreed to participate in the pilot RCT [five were randomised to the EPC arm and three were randomised to the usual-care (UC) arm]. Of the 614 patients screened, 55 were eligible and 29 took part (the target was 43 participants). At baseline, the trial arms were well matched for sex and ethnicity, although the EPC arm participants were younger, from more deprived areas and had higher depression scores than the UC participants. A total of 27 out of 29 participants were followed up at 5 months. Interviews with 18 participants (12 in the EPC arm and six in the UC arm) and seven nurses who delivered EPC identified that both groups acknowledged the importance of receiving psychological support embedded within routine cardiac rehabilitation. For those experiencing/delivering EPC, the intervention was broadly acceptable, albeit challenging to deliver within existing care. LIMITATIONS Both the feasibility and the pilot studies encountered significant challenges in recruiting patients, which limited the power of the pilot study analyses. CONCLUSIONS Cardiac rehabilitation nurses can be trained to deliver EPC. Although valued by both patients and nurses, organisational and workload constraints were significant barriers to implementation in participating teams, suggesting that future research may require a modified approach to intervention delivery within current service arrangements. We obtained important data informing definitive research regarding participant recruitment and retention, and optimal methods of data collection. FUTURE RESEARCH Consideration should be given to the delivery of EPC by dedicated mental health practitioners, working closely with cardiac rehabilitation services. TRIAL REGISTRATION Current Controlled Trials ISRCTN34701576. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 30. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Suzanne H Richards
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - John L Campbell
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Christopher Dickens
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Rob Anderson
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Manish Gandhi
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andy Gibson
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - David Kessler
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Luke Knight
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Willem Kuyken
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - David A Richards
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Rod S Taylor
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK.,Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Katrina Turner
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Obioha C Ukoumunne
- NIHR Collaborations for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Antoinette Davey
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Fiona C Warren
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Rachel E Winder
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Christine A Wright
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
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O'Shaughnessy J, Wright GS, Thummala AR, Danso MA, Popovic L, Pluard TJ, Cheung E, Han HS, Daniel BR, Vojnovic Z, Vasev N, Ling M, Richards DA, Wilks ST, Milenkovic D, Sorrentino JA, Roberts PJ, Bomar M, Yang Z, Antal JM, Malik RK, Morris SR, Tan A. Abstract PD1-01: Trilaciclib (T), a CDK4/6 inhibitor, dosed with gemcitabine (G), carboplatin (C) in metastatic triple negative breast cancer (mTNBC) patients: Preliminary phase 2 results. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd1-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Cytotoxic chemotherapy-induced damage of hematopoietic stem and progenitor cells (HSPCs) results in acute toxicities consisting of multi-lineage myelosuppression, and late onset toxicities consisting of progressive bone marrow suppression with increased incidence of therapy-related myeloid neoplasms. T is an IV CDK4/6 inhibitor in development to preserve HSPC and immune system function during cytotoxic chemotherapy (myelopreservation). Proof of concept for myelopreservation with T was observed in a randomized, placebo-controlled Phase 2 trial in small-cell lung cancer patients receiving 1st-line chemotherapy. This trial in mTNBC patients (NCT02978716) was designed to explore the utility of T in combination with GC.
Methods: This Phase 2, randomized, open-label study enrolled patients in the US and EU with mTNBC who had received 0-2 prior systemic cytotoxic therapies in the locally recurrent or metastatic setting and had no symptomatic brain metastases. Patients were randomized (1:1:1) to GC alone (Group 1) or T plus GC (Group 2) using a standard schedule (D1, 8 every 21 days) or to an alternative schedule (T on D1, 2, 8 and 9 with GC on D2 and 9 every 21 days; Group 3). On those days when both T and GC were scheduled, T was administered iv prior to GC infusion. Prophylactic growth factors were not administered in cycle 1; otherwise supportive care was allowed as needed. Primary objectives were safety and tolerability; tumor response was evaluated using RECIST v1.1 and PFS and OS were assessed. Myelopreservation endpoints reflecting the potential effects of T on multiple cellular lineages include occurrence of Grade 4 neutropenia (primary), RBC and platelet transfusions (primary), and lymphocyte counts with immune profiling (secondary and exploratory). A signature of CDK4/6 independence developed from preclinical data will be used to evaluate archival tumor tissue samples and data analysis is ongoing.
Results: 95 patients were dosed; median age 57 years (range 32,86), ECOG PS 0 (53%) or 1 (47%), 25% had liver metastases at baseline, and approximately 50% had received no systemic therapy in the recurrent/metastatic setting. Fifty-five patients remain on treatment. Disease progression was the most common reason for drug discontinuation (22/40; 55%). Overall the most common (≥ 25%) TEAEs were anemia (47%), nausea (35%), fatigue (34%), neutropenia (32%), platelet count decreased (25%), and vomiting (25%). The most frequent (≥ 15%) Grade 3 or 4 TEAEs were hematologic toxicities, i.e. neutropenia (28%), anemia (21%), neutrophil count decreased (21%) and thrombocytopenia (16%). These were also the most frequent drug-related TEAEs observed. Tumor efficacy data are being evaluated.
Conclusions: This trial, assessing the myelopreservation effects of T when combined with GC in patients with mTNBC, has completed enrollment. Myelopreservation data, immune profiling, as well as ORR and preliminary PFS results will be presented by study arm at the meeting.
Citation Format: O'Shaughnessy J, Wright GS, Thummala AR, Danso MA, Popovic L, Pluard TJ, Cheung E, Han HS, Daniel BR, Vojnovic Z, Vasev N, Ling M, Richards DA, Wilks ST, Milenkovic D, Sorrentino JA, Roberts PJ, Bomar M, Yang Z, Antal JM, Malik RK, Morris SR, Tan A. Trilaciclib (T), a CDK4/6 inhibitor, dosed with gemcitabine (G), carboplatin (C) in metastatic triple negative breast cancer (mTNBC) patients: Preliminary phase 2 results [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD1-01.
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Affiliation(s)
- J O'Shaughnessy
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - GS Wright
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - AR Thummala
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - MA Danso
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - L Popovic
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - TJ Pluard
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - E Cheung
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - HS Han
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - BR Daniel
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - Z Vojnovic
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - N Vasev
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - M Ling
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - DA Richards
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - ST Wilks
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - D Milenkovic
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - JA Sorrentino
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - PJ Roberts
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - M Bomar
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - Z Yang
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - JM Antal
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - RK Malik
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - SR Morris
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - A Tan
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
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Haugstvedt A, Hernar I, Strandberg RB, Richards DA, Nilsen RM, Tell GS, Graue M. Use of patient-reported outcome measures (PROMs) in clinical diabetes consultations: study protocol for the DiaPROM randomised controlled trial pilot study. BMJ Open 2019; 9:e024008. [PMID: 30782722 PMCID: PMC6340474 DOI: 10.1136/bmjopen-2018-024008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/28/2018] [Accepted: 12/05/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Although diabetes distress is found to be associated with decreased glycaemic control among adults with type 1 diabetes, the psychological and emotional impact of living with the condition is often not recognised and often under-reported in diabetes care. Therefore, regular assessment of diabetes distress is recommended. Assessment of diabetes distress using patient-reported outcome measures (PROMs) in clinical practice has the potential to enhance care for people with diabetes by identifying problems and improving patient-clinician communication. In this study protocol, we describe a pilot randomised controlled trial (RCT) aiming to test the feasibility of all components of an empowerment-based intervention using PROMs as dialogue support in clinical diabetes consultations, and to address the uncertainties associated with running a fully powered evaluation study. METHODS AND ANALYSIS We will undertake a two-arm pilot RCT of an intervention using the Problem Areas In Diabetes (PAID) scale in clinical diabetes consultations in order to conclude whether a fully powered trial is appropriate and/or feasible. The study will also include qualitative indepth interviews with participants and healthcare providers. Our objectives are to (1) evaluate the recruitment procedures and attrition rates; (2) evaluate the performance of the randomisation procedure; (3) evaluate the participants' mean scores on the outcome measures before and after the intervention; (4) evaluate if the intervention consultations are acceptable and feasible; and (5) explore patients' and healthcare providers' experiences with the use of PAID as dialogue support and empowerment-based communication skills in clinical diabetes consultations. The quantitative data analysis includes descriptive statistics (frequencies, percentages, means, SD and CI). For the qualitative data, we will perform thematic analysis. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Western Norway Regional Committee for Medical and Health Research Ethics (2017/1506/REC west). We will present the findings from the study phases at national and international conferences and submit manuscripts to peer-reviewed journals and popular science journals. TRIAL REGISTRATION NUMBER NCT03471104; Pre-results.
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Affiliation(s)
- Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ingvild Hernar
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - David A Richards
- Institute for Health Research, University of Exeter Medical School, Exeter, UK
| | - Roy Miodini Nilsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Abstract
In this article we ask our profession to consider whether something is rotten at the core of modern nursing. We will use our own experiences as patients, together with published literature, to ask questions of our profession in perpetrating what one of our colleagues recently, and with great embarrassment, referred to as 'shitty nursing'. Our intention is most certainly not to offend any readers, for this term has been used in literature for more than one hundred years to describe bad situations, including those where events or people's behaviour are of a low standard. Our intention instead, is to challenge ourselves, the profession and you the reader by raising a measured debate which seems at present to be missing within the profession. We examine the potential idea that poor nursing care may not be the exception, but horrifyingly, may be the new normal. We are particularly concerned that patients' fundamental care needs may be falling into an ever widening gap between assistant and registered nurses. Whilst we acknowledge the potential causes of poor nursing care, causes that are often cited by nurses themselves, we come to the conclusion that a mature profession including clinicians, educators, administrators, researchers and regulators cannot continually blame contextual factors for its failings. A mature profession with an intact contract between itself and society must shoulder some of the responsibility for its own problems. We do suggest a way forward, including a mix of reconciliation, refocus and research, underpinned by what we argue is a much needed dose of professional humility. Readers may take us to task for potentially overstating the problem, ignoring non-nursing drivers, and downplaying other significant factors. You may think that there is much in nursing to glory in. However, we make no apology for presenting our views. Our lived experiences tell us something different. As professional nurses our main aim is to ensure that our adverse experiences as patients are statistical anomalies, and our future encounters with nursing care represent all that we know to be excellent in our profession. We leave you to judge and comment.
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Affiliation(s)
- David A Richards
- University of Exeter, College of Medicine and Health, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Gunilla Borglin
- Department of Care Science, Faculty of Health and Society, Malmo University, Malmo, Sweden
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36
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Dunne JA, Martin PG, Yamashiki Y, Ang IXY, Scott TB, Richards DA. Spatial pattern of plutonium and radiocaesium contamination released during the Fukushima Daiichi nuclear power plant disaster. Sci Rep 2018; 8:16799. [PMID: 30429490 PMCID: PMC6235829 DOI: 10.1038/s41598-018-34302-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 10/04/2018] [Indexed: 11/12/2022] Open
Abstract
Plutonium and radiocaesium are hazardous contaminants released by the Fukushima Daiichi nuclear power plant (FDNPP) disaster and their distribution in the environment requires careful characterisation using isotopic information. Comprehensive spatial survey of 134Cs and 137Cs has been conducted on a regular basis since the accident, but the dataset for 135Cs/137Cs atom ratios and trace isotopic analysis of Pu remains limited because of analytical challenges. We have developed a combined chemical procedure to separate Pu and Cs for isotopic analysis of environmental samples from contaminated catchments. Ultra-trace analyses reveal a FDNPP Pu signature in environmental samples, some from further afield than previously reported. For two samples, we attribute the dominant source of Pu to Reactor Unit 3. We review the mechanisms responsible for an emergent spatial pattern in 134,135Cs/137Cs in areas northwest (high 134Cs/137Cs, low 135Cs/137Cs) and southwest (low 134Cs/137Cs, high 135Cs/137Cs) of FDNPP. Several samples exhibit consistent 134,135Cs/137Cs values that are significantly different from those deposited on plant specimens collected in previous works. A complex spatial pattern of Pu and Cs isotopic signature is apparent. To confidently attribute the sources of mixed fallout material, future studies must focus on analysis of individual FDNPP-derived particles.
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Affiliation(s)
- James A Dunne
- School of Geographical Sciences, University of Bristol, University Road, Bristol, BS8 1SS, UK. .,Bristol Isotope Group, University of Bristol, Wills Memorial Building, Queen's Road, Bristol, BS8 1RJ, UK.
| | - Peter G Martin
- Interface Analysis Centre, HH Wills Physics Laboratory, University of Bristol, Bristol, BS8 1TL, UK
| | - Yosuke Yamashiki
- Graduate School of Advanced Integrated Studies in Human Survivability, Kyoto University, Kyoto, 606-8501, Japan
| | - Ian X Y Ang
- Interface Analysis Centre, HH Wills Physics Laboratory, University of Bristol, Bristol, BS8 1TL, UK
| | - Tom B Scott
- Interface Analysis Centre, HH Wills Physics Laboratory, University of Bristol, Bristol, BS8 1TL, UK
| | - David A Richards
- School of Geographical Sciences, University of Bristol, University Road, Bristol, BS8 1SS, UK. .,Bristol Isotope Group, University of Bristol, Wills Memorial Building, Queen's Road, Bristol, BS8 1RJ, UK.
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Richards DA, Hanssen TA, Borglin G. The Second Triennial Systematic Literature Review of European Nursing Research: Impact on Patient Outcomes and Implications for Evidence-Based Practice. Worldviews Evid Based Nurs 2018; 15:333-343. [PMID: 30129094 DOI: 10.1111/wvn.12320] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND European research in nursing has been criticized as overwhelmingly descriptive, wasteful and with little relevance to clinical practice. This second triennial review follows our previous review of articles published in 2010, to determine whether the situation has changed. OBJECTIVE To identify, appraise, and synthesize reports of European nursing research published during 2013 in the top 20 nursing research journals. METHODS Systematic review with descriptive results synthesis. RESULTS We identified 2,220 reports, of which 254, from 19 European countries, were eligible for analysis; 215 (84.7%) were primary research, 36 (14.2%) secondary research, and three (1.2%) mixed primary and secondary. Forty-eight (18.9%) of studies were experimental: 24 (9.4%) randomized controlled trials, 11 (4.3%) experiments without randomization, and 13 (5.1%) experiments without control group. A total of 106 (41.7%) articles were observational: 85 (33.5%) qualitative research. The majority (158; 62.2%) were from outpatient and secondary care hospital settings. One hundred and sixty-five (65.0%) articles reported nursing intervention studies: 77 (30.3%) independent interventions, 77 (30.3%) interdependent, and 11 (4.3%) dependent. This represents a slight increase in experimental studies compared with our previous review (18.9% vs. 11.7%). The quality of reporting remained very poor. LINKING EVIDENCE TO ACTION European research in nursing remains overwhelmingly descriptive. We call on nursing researchers globally to raise the level of evidence and, therefore, the quality of care and patient outcomes. We urge them to replicate our study in their regions, diagnose reasons for the lack of appropriate research, identify solutions, and implement a deliberate, targeted, and systematic global effort to increase the number of experimental, high quality, and relevant studies into nursing interventions. We also call on journal editors to mandate an improvement in the standards of research reporting in nursing journals.
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Affiliation(s)
- David A Richards
- Head of Nursing University of Exeter, College of Medicine and Health, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,Hogskulen pa Vestlandet, Faculty of Health and Social Sciences, Bergen, Hordaland, Norway
| | - Tove Aminda Hanssen
- Universitetssykehuset Nord-Norge, Department of Heart Disease, and University of Tromsø-The Arctic University of Norway, Cardiovascular Research Group, Institute of Clinical Medicine, Tromsø, Norway
| | - Gunilla Borglin
- Department of Care Science, Faculty of Health and Society, Malmo University, Malmo, Sweden
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Abstract
OBJECTIVE To address uncertainties prior to conducting a fully powered randomised controlled trial of Morita Therapy plus treatment as usual (TAU) versus TAU alone, or to determine that such a trial is not appropriate and/or feasible. DESIGN Pilot parallel group randomised controlled feasibility trial. SETTING AND PARTICIPANTS Participants aged ≥18 years with Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV major depressive disorder, with or without DSM-IV anxiety disorder(s), recruited from general practice record searches in Devon, UK. INTERVENTIONS We randomised participants on a 1:1 basis stratified by symptom severity, concealing allocation using a secure independent web-based system, to receive TAU (control) or 8-12 sessions of Morita Therapy, a Japanese psychological therapy, plus TAU (intervention). OUTCOMES Rates of recruitment, retention and treatment adherence; variance and estimated between-group differences in follow-up scores (on the Patient Health Questionnaire 9 (PHQ-9) (depressive symptoms); Generalised Anxiety Disorder Questionnaire 7 (anxiety symptoms); Short Form 36 Health Survey Questionnaire/Work and Social Adjustment Scale (quality of life); Morita Attitudinal Scale for Arugamama (attitudes)) and their correlation with baseline scores. RESULTS We recruited 68 participants, 5.1% (95% CI 3.4% to 6.6%) of those invited (34 control; 34 intervention); 64/68 (94%; 95% CI 88.3% to 99.7%) provided 4-month follow-up data. Participants had a mean age of 49 years and mean PHQ-9 score of 16.8; 61% were female. Twenty-four of 34 (70.6%) adhered to the minimum treatment dose. The follow-up PHQ-9 (future primary outcome measure) pooled SD was 6.4 (95% CI 5.5 to 7.8); the magnitude of correlation between baseline and follow-up PHQ-9 scores was 0.42 (95% CI 0.19 to 0.61). Of the participants, 66.7% and 30.0% recovered in the intervention and control groups, respectively; 66.7% and 13.3% responded to treatment in the intervention and control groups, respectively. CONCLUSIONS A large-scale trial of Morita Therapy would require 133 participants per group and is feasible with minor modifications to the pilot trial protocol. Morita Therapy shows promise in treating depression and may provide patients with a distinct alternative to current treatments. TRIAL REGISTRATION NUMBER ISRCTN17544090; Pre-results.
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Affiliation(s)
| | - David A Richards
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Julia Frost
- University of Exeter Medical School, University of Exeter, Exeter, UK
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Bosanquet K, Adamson J, Atherton K, Bailey D, Baxter C, Beresford-Dent J, Birtwistle J, Chew-Graham C, Clare E, Delgadillo J, Ekers D, Foster D, Gabe R, Gascoyne S, Haley L, Hamilton J, Hargate R, Hewitt C, Holmes J, Keding A, Lewis H, McMillan D, Meer S, Mitchell N, Nutbrown S, Overend K, Parrott S, Pervin J, Richards DA, Spilsbury K, Torgerson D, Traviss-Turner G, Trépel D, Woodhouse R, Gilbody S. CollAborative care for Screen-Positive EldeRs with major depression (CASPER plus): a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness. Health Technol Assess 2018; 21:1-252. [PMID: 29171379 DOI: 10.3310/hta21670] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Depression in older adults is common and is associated with poor quality of life, increased morbidity and early mortality, and increased health and social care use. Collaborative care, a low-intensity intervention for depression that is shown to be effective in working-age adults, has not yet been evaluated in older people with depression who are managed in UK primary care. The CollAborative care for Screen-Positive EldeRs (CASPER) plus trial fills the evidence gap identified by the most recent guidelines on depression management. OBJECTIVES To establish the clinical effectiveness and cost-effectiveness of collaborative care for older adults with major depressive disorder in primary care. DESIGN A pragmatic, multicentred, two-arm, parallel, individually randomised controlled trial with embedded qualitative study. Participants were automatically randomised by computer, by the York Trials Unit Randomisation Service, on a 1 : 1 basis using simple unstratified randomisation after informed consent and baseline measures were collected. Blinding was not possible. SETTING Sixty-nine general practices in the north of England. PARTICIPANTS A total of 485 participants aged ≥ 65 years with major depressive disorder. INTERVENTIONS A low-intensity intervention of collaborative care, including behavioural activation, delivered by a case manager for an average of six sessions over 7-8 weeks, alongside usual general practitioner (GP) care. The control arm received only usual GP care. MAIN OUTCOME MEASURES The primary outcome measure was Patient Health Questionnaire-9 items score at 4 months post randomisation. Secondary outcome measures included depression severity and caseness at 12 and 18 months, the EuroQol-5 Dimensions, Short Form questionnaire-12 items, Patient Health Questionnaire-15 items, Generalised Anxiety Disorder-7 items, Connor-Davidson Resilience Scale-2 items, a medication questionnaire, objective data and adverse events. Participants were followed up at 12 and 18 months. RESULTS In total, 485 participants were randomised (collaborative care, n = 249; usual care, n = 236), with 390 participants (80%: collaborative care, 75%; usual care, 86%) followed up at 4 months, 358 participants (74%: collaborative care, 70%; usual care, 78%) followed up at 12 months and 344 participants (71%: collaborative care, 67%; usual care, 75%) followed up at 18 months. A total of 415 participants were included in primary analysis (collaborative care, n = 198; usual care, n = 217), which revealed a statistically significant effect in favour of collaborative care at the primary end point at 4 months [8.98 vs. 10.90 score points, mean difference 1.92 score points, 95% confidence interval (CI) 0.85 to 2.99 score points; p < 0.001], equivalent to a standard effect size of 0.34. However, treatment differences were not maintained in the longer term (at 12 months: 0.19 score points, 95% CI -0.92 to 1.29 score points; p = 0.741; at 18 months: < 0.01 score points, 95% CI -1.12 to 1.12 score points; p = 0.997). The study recorded details of all serious adverse events (SAEs), which consisted of 'unscheduled hospitalisation', 'other medically important condition' and 'death'. No SAEs were related to the intervention. Collaborative care showed a small but non-significant increase in quality-adjusted life-years (QALYs) over the 18-month period, with a higher cost. Overall, the mean cost per incremental QALY for collaborative care compared with usual care was £26,016; however, for participants attending six or more sessions, collaborative care appears to represent better value for money (£9876/QALY). LIMITATIONS Study limitations are identified at different stages: design (blinding unfeasible, potential contamination), process (relatively low overall consent rate, differential attrition/retention rates) and analysis (no baseline health-care resource cost or secondary/social care data). CONCLUSION Collaborative care was effective for older people with case-level depression across a range of outcomes in the short term though the reduction in depression severity was not maintained over the longer term of 12 or 18 months. Participants who received six or more sessions of collaborative care did benefit substantially more than those who received fewer treatment sessions but this difference was not statistically significant. FUTURE WORK RECOMMENDATIONS Recommendations for future research include investigating the longer-term effect of the intervention. Depression is a recurrent disorder and it would be useful to assess its impact on relapse and the prevention of future case-level depression. TRIAL REGISTRATION Current Controlled Trials ISRCTN45842879. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 67. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Joy Adamson
- Department of Health Sciences, University of York, York, UK
| | - Katie Atherton
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | | | | | | | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Emily Clare
- Northumberland, Tyne and Wear NHS Foundation Trust, National Institute for Health Research Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | - Jaime Delgadillo
- Department of Health Sciences, University of York, York, UK.,Primary Care Mental Health Service, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - David Ekers
- Mental Health Research Group, Durham University, Durham, UK.,Research and Development Department, Tees, Esk & Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Deborah Foster
- Department of Health Sciences, University of York, York, UK
| | - Rhian Gabe
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | | | - Lesley Haley
- Research and Development Department, Tees, Esk & Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Jahnese Hamilton
- Northumberland, Tyne and Wear NHS Foundation Trust, National Institute for Health Research Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | | | | | - John Holmes
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ada Keding
- Department of Health Sciences, University of York, York, UK
| | - Helen Lewis
- Department of Health Sciences, University of York, York, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Shaista Meer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Sarah Nutbrown
- Department of Health Sciences, University of York, York, UK
| | - Karen Overend
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Jodi Pervin
- Department of Health Sciences, University of York, York, UK
| | - David A Richards
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | | | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
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Richards DA, Rhodes S, Ekers D, McMillan D, Taylor RS, Byford S, Barrett B, Finning K, Ganguli P, Warren F, Farrand P, Gilbody S, Kuyken W, O'Mahen H, Watkins E, Wright K, Reed N, Fletcher E, Hollon SD, Moore L, Backhouse A, Farrow C, Garry J, Kemp D, Plummer F, Warner F, Woodhouse R. Cost and Outcome of BehaviouRal Activation (COBRA): a randomised controlled trial of behavioural activation versus cognitive-behavioural therapy for depression. Health Technol Assess 2018; 21:1-366. [PMID: 28857042 DOI: 10.3310/hta21460] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Depression is a common, debilitating and costly disorder. The best-evidenced psychological therapy - cognitive-behavioural therapy (CBT) - is complex and costly. A simpler therapy, behavioural activation (BA), may be an effective alternative. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of BA compared with CBT for depressed adults at 12 and 18 months' follow-up, and to investigate the processes of treatments. DESIGN Randomised controlled, non-inferiority trial stratified by depression severity, antidepressant use and recruitment site, with embedded process evaluation; and randomisation by remote computer-generated allocation. SETTING Three community mental health services in England. PARTICIPANTS Adults aged ≥ 18 years with major depressive disorder (MDD) recruited from primary care and psychological therapy services. INTERVENTIONS BA delivered by NHS junior mental health workers (MHWs); CBT by NHS psychological therapists. OUTCOMES Primary: depression severity (as measured via the Patient Health Questionnaire-9; PHQ-9) at 12 months. Secondary: MDD status; number of depression-free days; anxiety (as measured via the Generalised Anxiety Disorder-7); health-related quality of life (as measured via the Short Form questionnaire-36 items) at 6, 12 and 18 months; and PHQ-9 at 6 and 18 months, all collected by assessors blinded to treatment allocation. Non-inferiority margin was 1.9 PHQ-9 points. We undertook intention-to-treat (ITT) and per protocol (PP) analyses. We explored cost-effectiveness by collecting direct treatment and other health- and social-care costs and calculating quality-adjusted life-years (QALYs) using the EuroQol-5 Dimensions, three-level version, at 18 months. RESULTS We recruited 440 participants (BA, n = 221; CBT, n = 219); 175 (79%) BA and 189 (86%) CBT participants provided ITT data and 135 (61%) BA and 151 (69%) CBT participants provided PP data. At 12 months we found that BA was non-inferior to CBT {ITT: CBT 8.4 PHQ-9 points [standard deviation (SD) 7.5 PHQ-9 points], BA 8.4 PHQ-9 points (SD 7.0 PHQ-9 points), mean difference 0.1 PHQ-9 points, 95% confidence interval (CI) -1.3 to 1.5 PHQ-9 points, p = 0.89; PP: CBT 7.9 PHQ-9 points (SD 7.3 PHQ-9 points), BA 7.8 PHQ-9 points (SD 6.5 PHQ-9 points), mean difference 0.0 PHQ-9 points, 95% CI -1.5 to 1.6 PHQ-9 points, p = 0.99}. We found no differences in secondary outcomes. We found a significant difference in mean intervention costs (BA, £975; CBT, £1235; p < 0.001), but no differences in non-intervention (hospital, community health, social care and medication costs) or total (non-intervention plus intervention) costs. Costs were lower and QALY outcomes better in the BA group, generating an incremental cost-effectiveness ratio of -£6865. The probability of BA being cost-effective compared with CBT was almost 80% at the National Institute for Health and Care Excellence's preferred willingness-to-pay threshold of £20,000-30,000 per QALY. There were no trial-related adverse events. LIMITATIONS In this pragmatic trial many depressed participants in both groups were also taking antidepressant medication, although most had been doing so for a considerable time before entering the trial. Around one-third of participants chose not to complete a PP dose of treatment, a finding common in both psychotherapy trials and routine practice. CONCLUSIONS We found that BA is as effective as CBT, more cost-effective and can be delivered by MHWs with no professional training in psychological therapies. FUTURE WORK Settings and countries with a paucity of professionally qualified psychological therapists, might choose to investigate the delivery of effective psychological therapy for depression without the need to develop an extensive and costly professional infrastructure. TRIAL REGISTRATION Current Controlled Trials ISRCTN27473954. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David A Richards
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Shelley Rhodes
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - David Ekers
- Psychological Therapy, Tees, Esk & Wear Valleys NHS Foundation Trust, County Durham, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
| | - Rod S Taylor
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Barbara Barrett
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Katie Finning
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Poushali Ganguli
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Fiona Warren
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Paul Farrand
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Willem Kuyken
- Oxford Mindfulness Centre, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Heather O'Mahen
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Ed Watkins
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Kim Wright
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Nigel Reed
- Lived Experience Group, care of Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Emily Fletcher
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Lucy Moore
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Amy Backhouse
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Claire Farrow
- Psychological Therapy, Tees, Esk & Wear Valleys NHS Foundation Trust, County Durham, UK
| | - Julie Garry
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Deborah Kemp
- Psychological Therapy, Tees, Esk & Wear Valleys NHS Foundation Trust, County Durham, UK
| | - Faye Plummer
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary, Bradford, UK
| | - Faith Warner
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
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Richards SH, Dickens C, Anderson R, Richards DA, Taylor RS, Ukoumunne OC, Turner KM, Gandhi M, Kuyken W, Gibson A, Davey A, Warren F, Winder R, Campbell J. Assessing the effectiveness of Enhanced Psychological Care for patients with depressive symptoms attending cardiac rehabilitation compared with treatment as usual (CADENCE): a pilot cluster randomised controlled trial. Trials 2018; 19:211. [PMID: 29609644 PMCID: PMC5880097 DOI: 10.1186/s13063-018-2576-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/08/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Around 17% of people attending UK cardiac rehabilitation programmes have depression. Optimising psychological wellbeing is a rehabilitation goal, but provision of psychological care is limited. We developed and piloted an Enhanced Psychological Care (EPC) intervention embedded within cardiac rehabilitation, aiming to test key areas of uncertainty to inform the design of a definitive randomised controlled trial (RCT) and economic evaluation. METHODS An external pilot randomised controlled trial (RCT) randomised eight cardiac rehabilitation teams (clusters) to either usual care of cardiac rehabilitation provision (UC), or EPC in addition to UC. EPC comprised mental health care coordination and patient-led behavioural activation with nurse support. Adults eligible for cardiac rehabilitation following an acute coronary syndrome and identified with new-onset depressive symptoms during an initial nurse assessment were eligible. Measures were performed at baseline and 5- and 8-month follow-ups and compared between EPC and UC. Team and participant recruitment and retention rates, and participant outcomes (clinical events, depression, anxiety, health-related quality of life, patient experiences, and resource use) were assessed. RESULTS Eight out of twenty teams were recruited and randomised. Of 614 patients screened, 55 were eligible and 29 took part (5%, 95% CI 3 to 7% of those screened), with 15 patient participants cluster randomised to EPC and 14 to UC. Nurse records revealed that 8/15 participants received the maximum number of EPC sessions offered; and 4/15 received no sessions. Seven out of fifteen EPC participants were referred to another NHS psychological service compared to none in UC. We followed up 27/29 participants at 5 months and 17/21 at 8 months. The mean difference (EPC minus UC) in depressive symptoms (Beck Depression Inventory) at follow-up (adjusting for baseline score) was 1.7 (95% CI - 3.8 to 7.3; N = 26) at 5 months and 4.4 (95% CI - 1.4 to 10.2; N = 17) at 8 months. DISCUSSION While valued by patients and nurses, organisational and workload constraints are significant barriers to EPC implementation. There remains a need to develop and test new models of psychological care within cardiac rehabilitation. Our study offers important data to inform the design of future trials of similar interventions. TRIAL REGISTRATION ISRCTN34701576 . Registered on 29 May 2014. Funding details: UK NIHR HTA Programme (project 12/189/09).
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Affiliation(s)
- Suzanne H. Richards
- University of Exeter Medical School, Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
- University of Leeds Institute of Health Sciences, University of Leeds, Level 10 Worsley Building, Leeds, LS2 9JN UK
| | - Chris Dickens
- University of Exeter Medical School, Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Rob Anderson
- University of Exeter Medical School, Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - David A. Richards
- University of Exeter Medical School, Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Rod S. Taylor
- University of Exeter Medical School, Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Obioha C. Ukoumunne
- NIHR Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, University of Exeter Medical School, Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Katrina M. Turner
- Population Health Sciences, University of Bristol, Canynge Hall, Whatley Road, Bristol, BS8 2PS UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Manish Gandhi
- Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK
| | - Willem Kuyken
- University Department of Psychiatry, University of Oxford, Warneford Hospital, 0X3 7JX, Oxford, UK
| | - Andrew Gibson
- Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY UK
| | - Antoinette Davey
- University of Exeter Medical School, Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Fiona Warren
- University of Exeter Medical School, Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Rachel Winder
- University of Exeter Medical School, Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - John Campbell
- University of Exeter Medical School, Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
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Pentecost C, Richards DA, Frost J. Amalgamation of Marginal Gains (AMG) as a potential system to deliver high-quality fundamental nursing care: A qualitative analysis of interviews from high-performance AMG sports and healthcare practitioners. J Clin Nurs 2018; 27:2387-2402. [DOI: 10.1111/jocn.14186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Claire Pentecost
- Institute of Health Research; University of Exeter Medical School; South Cloisters Exeter UK
| | - David A. Richards
- Institute of Health Research; University of Exeter Medical School; South Cloisters Exeter UK
| | - Julia Frost
- Institute of Health Research; University of Exeter Medical School; South Cloisters Exeter UK
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Richards DA, Hilli A, Pentecost C, Goodwin VA, Frost J. Fundamental nursing care: A systematic review of the evidence on the effect of nursing care interventions for nutrition, elimination, mobility and hygiene. J Clin Nurs 2018; 27:2179-2188. [PMID: 29156087 PMCID: PMC6001513 DOI: 10.1111/jocn.14150] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To determine the effects of nursing interventions for people's nutrition, elimination, mobility and hygiene needs. BACKGROUND Patient experience of health care is sensitive to nursing quality. A refocus on fundamental nursing care is undermined by lack of evidence of effectiveness for interventions in core areas such as elimination, nutrition, mobility and hygiene. DESIGN Systematic review. METHODS We searched for and included experimental studies on interventions by professionally qualified and unregistered nurses that addressed participants' nutrition, elimination, mobility and hygiene needs. We extracted data on scope, quality and results of studies followed by descriptive narrative synthesis of included study outcomes using a novel form of harvest plots. RESULTS We included 149 studies, 35 nutrition, 56 elimination, 16 mobility, 39 hygiene and three addressing two or more areas simultaneously (67 randomised controlled trials, 32 non-randomised controlled trials and 50 uncontrolled trials). Studies into interventions on participant self-management of nutrition (n = 25), oral health (n = 26), catheter care (n = 23) and self-management of elimination (n = 21) were the most prevalent. Most studies focussed their outcomes on observational or physiological measures, with very few collecting patient-reported outcomes, such as quality of life, experience or self-reported symptoms. All but 13 studies were of low quality and at significant risk of bias. The majority of studies did not define primary outcomes, included multiple measures of identical concepts, used inappropriate analyses and did not conform to standard reporting quality criteria. CONCLUSIONS The current evidence for fundamental nursing care interventions is sparse, of poor quality and unfit to provide evidence-based guidance to practising nurses. RELEVANCE TO CLINICAL PRACTICE Researchers in nursing internationally should now undertake a programme of work to produce evidence for clinical practice in the fundamentals of care that is reliable, replicable and robust.
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Affiliation(s)
- David A Richards
- Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, UK
| | - Angelique Hilli
- Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, UK
| | - Claire Pentecost
- Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, UK
| | - Victoria A Goodwin
- Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, UK
| | - Julia Frost
- Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, UK
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Backhouse A, Richards DA, McCabe R, Watkins R, Dickens C. Stakeholders perspectives on the key components of community-based interventions coordinating care in dementia: a qualitative systematic review. BMC Health Serv Res 2017; 17:767. [PMID: 29166898 PMCID: PMC5700484 DOI: 10.1186/s12913-017-2725-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions aiming to coordinate services for the community-based dementia population vary in components, organisation and implementation. In this review we aimed to investigate the views of stakeholders on the key components of community-based interventions coordinating care in dementia. METHODS We searched four databases from inception to June 2015; Medline, The Cochrane Library, EMBASE and PsycINFO, this was aided by a search of four grey literature databases, and backward and forward citation tracking of included papers. Title and abstract screening was followed by a full text screen by two independent reviewers, and quality was assessed using the CASP appraisal tool. We then conducted thematic synthesis on extracted data. RESULTS A total of seven papers from five independent studies were included in the review, and encompassed the views of over 100 participants from three countries. Through thematic synthesis we identified 32 initial codes that were grouped into 5 second-order themes: (1) case manager had four associated codes and described preferences for the case manager personal and professional attributes, including a sound knowledge in dementia and availability of local services; (2) communication had five associated codes and emphasized the importance stakeholders placed on multichannel communication with service users, as well as between multidisciplinary teams and across organisations; (3) intervention had 11 associated codes which focused primarily on the practicalities of implementation such as the contact type and frequency between case managers and service users, and the importance of case manager training and service evaluation; (4) resources had five associated codes which outlined stakeholder views on the required resources for coordinating interventions and potential overlap with existing resources, as well as arising issues when available resources do not meet those required for successful implementation; and (5) support had seven associated codes that reflect the importance that was placed on the support network around the case manager and the investment of professionals involved directly in care as well as the wider professional network. CONCLUSION The synthesis of relevant qualitative studies has shown how various stakeholder groups considered dementia care coordination interventions to be acceptable, useful and appropriate for dementia care, and have clear preferences for components, implementation methods and settings of these interventions. By incorporating stakeholders' perspectives and preferences when planning and developing coordinating interventions we may increase the likelihood of successful implementation and patient benefits.
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Affiliation(s)
- Amy Backhouse
- University of Exeter Medical School, College House, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
- National Institute for Health Research (NIHR) South West Peninsula Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Exeter, UK
| | - David A. Richards
- University of Exeter Medical School, College House, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
- National Institute for Health Research (NIHR) South West Peninsula Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Exeter, UK
| | - Rose McCabe
- University of Exeter Medical School, College House, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Ross Watkins
- University of Exeter Medical School, College House, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
- National Institute for Health Research (NIHR) South West Peninsula Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Exeter, UK
| | - Chris Dickens
- University of Exeter Medical School, College House, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
- National Institute for Health Research (NIHR) South West Peninsula Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Exeter, UK
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Backhouse A, Ukoumunne OC, Richards DA, McCabe R, Watkins R, Dickens C. The effectiveness of community-based coordinating interventions in dementia care: a meta-analysis and subgroup analysis of intervention components. BMC Health Serv Res 2017; 17:717. [PMID: 29132353 PMCID: PMC5683245 DOI: 10.1186/s12913-017-2677-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/03/2017] [Indexed: 11/28/2022] Open
Abstract
Background Interventions aiming to coordinate services for the community-based dementia population vary in components, organisation and implementation. In this review we aimed to evaluate the effectiveness of community-based care coordinating interventions on health outcomes and investigate whether specific components of interventions influence their effects. Methods We searched four databases from inception to April 2017: Medline, The Cochrane Library, EMBASE and PsycINFO. This was aided by a search of four grey literature databases, and backward and forward citation tracking of included papers. Title and abstract screening was followed by a full text screen by two independent reviewers, and quality was assessed using the CASP appraisal tool. We then conducted meta-analyses and subgroup analyses. Results A total of 14 randomised controlled trials (RCTs) involving 10,372 participants were included in the review. Altogether we carried out 12 meta-analyses and 19 subgroup analyses. Meta-analyses found coordinating interventions showed a statistically significant improvement in both patient behaviour measured using the Neuropsychiatric Inventory (NPI) (mean difference (MD) = −9.5; 95% confidence interval (CI): −18.1 to −1.0; p = 0.03; number of studies (n) = 4; I2 = 88%) and caregiver burden (standardised mean difference (SMD) = −0.54; 95% CI: -1.01 to −0.07; p = 0.02; n = 5, I2 = 92%) compared to the control group. Subgroup analyses found interventions using a case manager with a nursing background showed a greater positive effect on caregiver quality of life than those that used case managers from other professional backgrounds (SMD = 0.94 versus 0.03, respectively; p < 0.001). Interventions that did not provide supervision for the case managers showed greater effectiveness for reducing the percentage of patients that are institutionalised compared to those that provided supervision (odds ratio (OR) = 0.27 versus 0.96 respectively; p = 0.02). There was little evidence of effects on other outcomes, or that other intervention components modify the intervention effects. Conclusion Results show that coordinating interventions in dementia care has a positive impact on some outcomes, namely patient behaviour and caregiver burden, but the evidence is inconsistent and results were not strong enough to draw definitive conclusions on general effectiveness. With the rising prevalence of dementia, effective complex interventions will be necessary to provide high quality and effective care for patients, and facilitate collaboration of health, social and third sector services. Electronic supplementary material The online version of this article (10.1186/s12913-017-2677-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy Backhouse
- University of Exeter Medical School, College House, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. .,National Institute for Health Research (NIHR) South West Peninsula Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Exeter, Devon, UK.
| | - Obioha C Ukoumunne
- University of Exeter Medical School, College House, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,National Institute for Health Research (NIHR) South West Peninsula Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Exeter, Devon, UK
| | - David A Richards
- University of Exeter Medical School, College House, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,National Institute for Health Research (NIHR) South West Peninsula Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Exeter, Devon, UK
| | - Rose McCabe
- University of Exeter Medical School, College House, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Ross Watkins
- University of Exeter Medical School, College House, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,National Institute for Health Research (NIHR) South West Peninsula Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Exeter, Devon, UK
| | - Chris Dickens
- University of Exeter Medical School, College House, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,National Institute for Health Research (NIHR) South West Peninsula Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Exeter, Devon, UK
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Dunne JA, Richards DA, Chen HW. Procedures for precise measurements of 135Cs/137Cs atom ratios in environmental samples at extreme dynamic ranges and ultra-trace levels by thermal ionization mass spectrometry. Talanta 2017; 174:347-356. [PMID: 28738591 DOI: 10.1016/j.talanta.2017.06.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/07/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
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Sugg HVR, Richards DA, Frost J. Optimising the acceptability and feasibility of novel complex interventions: an iterative, person-based approach to developing the UK Morita therapy outpatient protocol. Pilot Feasibility Stud 2017; 3:37. [PMID: 29026639 PMCID: PMC5625699 DOI: 10.1186/s40814-017-0181-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this paper is to showcase best practice in intervention development by illustrating a systematic, iterative, person-based approach to optimising intervention acceptability and feasibility, as applied to the cross-cultural adaptation of Morita therapy for depression and anxiety. Methods We developed the UK Morita therapy outpatient protocol over four stages integrating literature synthesis and qualitative research. Firstly, we conducted in-depth interviews combining qualitative and cognitive interviewing techniques, utilising vignettes of Morita therapy being delivered and analysed using Framework analysis to investigate potential patients and therapists’ perceptions of Morita therapy. Secondly, we developed qualitative themes into recommendations for optimising Morita therapy and synthesised Morita therapy literature in line with these to develop a draft protocol. Thirdly, we conducted repeat interviews with therapists to investigate their views of the protocol. Finally, we responded to these qualitative themes through protocol modification and tailoring our therapist training programme. Results As a consequence of literature describing Morita therapy and participants’ perceptions of the approach, we developed both a therapy protocol and therapist training programme which were fit for purpose in proceeding to a UK-based Morita therapy feasibility study. As per our key qualitative findings and resulting recommendations, we structured our protocol according to the four-phased model of Morita therapy, included detailed guidance and warning points, and supported therapists in managing patients’ expectations of the approach. Conclusions Our systematic approach towards optimising intervention acceptability and feasibility prioritises the perspectives of those who will deliver and receive the intervention. Thus, we both showcase best practice in intervention development and demonstrate the application of this process to the careful cross-cultural adaptation of an intervention in which balancing both optimisation of and adherence to the approach are key. This presentation of a generalisable process in a transparent and replicable manner will be of interest to those both developing and evaluating complex interventions in the future. Electronic supplementary material The online version of this article (10.1186/s40814-017-0181-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Holly Victoria Rose Sugg
- Complex Interventions Research Group, University of Exeter Medical School, University of Exeter, Room 1.33 South Cloisters, St Luke's Campus, Exeter, EX1 2LU UK
| | - David A Richards
- Complex Interventions Research Group, University of Exeter Medical School, University of Exeter, Room 1.33 South Cloisters, St Luke's Campus, Exeter, EX1 2LU UK
| | - Julia Frost
- Complex Interventions Research Group, University of Exeter Medical School, University of Exeter, Room 1.33 South Cloisters, St Luke's Campus, Exeter, EX1 2LU UK
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Turner KM, Winder R, Campbell JL, Richards DA, Gandhi M, Dickens CM, Richards S. Patients' and nurses' views on providing psychological support within cardiac rehabilitation programmes: a qualitative study. BMJ Open 2017; 7:e017510. [PMID: 28864707 PMCID: PMC5589022 DOI: 10.1136/bmjopen-2017-017510] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To explore patients' and nurses' views on the feasibility and acceptability of providing psychological care within cardiac rehabilitation services. DESIGN In-depth interviews analysed thematically. PARTICIPANTS 18 patients and 7 cardiac nurses taking part in a pilot trial (CADENCE) of an enhanced psychological care intervention delivered within cardiac rehabilitation programmes by nurses to patients with symptoms of depression. SETTING Cardiac services based in the South West of England and the East Midlands, UK. RESULTS Patients and nurses viewed psychological support as central to good cardiac rehabilitation. Patients' accounts highlighted the significant and immediate adverse effect a cardiac event can have on an individual's mental well-being. They also showed that patients valued nurses attending to both their mental and physical health, and felt this was essential to their overall recovery. Nurses were committed to providing psychological support, believed it benefited patients, and advocated for this support to be delivered within cardiac rehabilitation programmes rather than within a parallel healthcare service. However, nurses were time-constrained and found it challenging to provide psychological care within their existing workloads. CONCLUSIONS Both patients and nurses highly value psychological support being delivered within cardiac rehabilitation programmes but resource constraints raise barriers to implementation. Consideration, therefore, should be given to alternative forms of delivery which do not rely solely on nurses to enable patients to receive psychological support during cardiac rehabilitation. TRIAL REGISTRATION NUMBER ISCTRN34701576.
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Affiliation(s)
- Katrina M Turner
- Population Health Sciences, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), Bristol, UK
| | - Rachel Winder
- University of Exeter Medical School, Exeter, Devon, UK
| | | | | | - Manish Gandhi
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Suzanne Richards
- University of Exeter Medical School, Exeter, Devon, UK
- Leeds Institute of Health Research, Leeds, UK
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Wang J, Richards DA. The actin binding protein scinderin acts in PC12 cells to tether dense-core vesicles prior to secretion. Mol Cell Neurosci 2017; 85:12-18. [PMID: 28823945 DOI: 10.1016/j.mcn.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/07/2017] [Accepted: 08/16/2017] [Indexed: 11/18/2022] Open
Abstract
Mechanistic understanding of the control of vesicle motion from within a secretory cell to the site of exocytosis remains incomplete. In this work, we have used total internal reflection (TIRF) microscopy to examine the mobility of secretory vesicles at the plasma membrane. Under resting conditions, we found vesicles showed little lateral mobility. Anchoring of vesicles in this membrane proximal compartment could be disrupted with latrunculin A, indicating an apparent actin dependent process. A candidate intermediary between vesicles and the actin skeleton is the actin binding protein scinderin. Co-transfection of an shRNA construct against scinderin blocked secretion, and also increased the mobility of vesicles in the membrane-proximal section of the cell, indicating a dual role for scinderin in secretion; tethering vesicles to the cytoskeleton, as well as liberating them following stimulation through the previously described calcium dependent actin severing activity. Analysis of lipid dependence indicates that scinderin exhibits calcium dependent binding to phosphatidyl-inositol monophosphate, providing a possible mechanism for vesicle binding.
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Affiliation(s)
- J Wang
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, MLC2001, 3333 Burnet Avenue, Cincinnati, OH 45229, United States
| | - D A Richards
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, MLC2001, 3333 Burnet Avenue, Cincinnati, OH 45229, United States; Department of Basic Pharmaceutical Sciences, Husson University School of Pharmacy, 1 College Circle, Bangor, ME 04401, United States.
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Polit DF, Sidani S, Richards DA, Willman A, Kitson A, Huijben-Schoenmakers M, Rademaker A, Scherder E, Bjuresäter K, Larsson M, Bergsten U, Smith MC, Pearson C, Tropea S, O’May F, Irvine L, Rush R, Wilson R, Rahn AC, Behncke A, Buhl A, Köpke S, Rodrigues MGDR, Shaha M, Hjelm M, Bohman DM, Willman A, Kristensson J, Holst G, Øverlie A, Machiels M, Zwakhalen SMG, Metzelthin SF, Hamers JPH, Darcy L, Karlsson K, Galvin K, Van Hecke A, Malfait S, Eeckloo K, Råberus A, Holmström IK, Sundler AJ, Dijkstra A, Gesar B, Bååth C, Hedin H, Hommel A, Helou N, Shaha M, Zanchi A, Varsi C, Børøsund E, Mirkovic J, Marcheschi E, Von Koch L, Pessah-Rasmussen H, Elf M, Audulv Å, Kneck Å, Koppitz A, de Wolf-Linder S, Blanc G, Bosshard G, Volken T. European Academy of Nursing Science and the Swedish Society of Nursing Summer Conference 2017: The Future Direction of European Nursing and Nursing Research. BMC Nurs 2017. [PMCID: PMC5498859 DOI: 10.1186/s12912-017-0218-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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