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Trusson D, Rowley E, Bramley L. Clinical academics' experiences during the COVID-19 pandemic: a qualitative study of challenges and opportunities when working at the clinical frontline. BMJ Lead 2023; 7:266-272. [PMID: 37192094 DOI: 10.1136/leader-2020-000414] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/17/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This study explored the experiences of clinical academics during the COVID-19 pandemic. The aim was to identify challenges and benefits associated with returning to, or increasing hours at, the clinical frontline. DESIGN Qualitative data were gathered from a combination of written responses to questions posed in an email and 10 semi-structured interviews between May and September 2020. SETTING Two higher education institutions and three NHS Trusts in the East Midlands of England. PARTICIPANTS Written responses were received from 34 clinical academics including doctors, nurses, midwives and allied health professionals. A further 10 participants were interviewed either by telephone or online, via Microsoft Teams. RESULTS Participants described challenges experienced in returning full-time to the clinical frontline. These included having to refresh or learn new skills and the pressure of managing the competing priorities of NHS and higher education institutions. Benefits of being on the frontline included having the confidence and flexibility to deal with an evolving situation. Also, the ability to quickly assess and communicate the latest research and guidance to colleagues and patients. In addition, participants reported identifying areas for research during this time. CONCLUSION Clinical academics can contribute their knowledge and skills to frontline patient care in times of pandemic. It is therefore important to ease that process in preparation for potential future pandemics.
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Affiliation(s)
- Diane Trusson
- NIHR Applied Research Collaboration for East Midlands (ARC EM), School of Medicine, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Emma Rowley
- NIHR Applied Research Collaboration for East Midlands (ARC EM), School of Medicine, University of Nottingham, Nottingham, UK
| | - Louise Bramley
- Institute of Nursing and Midwifery Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Trusson D, Rowley E. Qualitative study exploring barriers and facilitators to progression for female medical clinical academics: interviews with female associate professors and professors. BMJ Open 2022; 12:e056364. [PMID: 35288388 PMCID: PMC8921847 DOI: 10.1136/bmjopen-2021-056364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to explore the barriers and facilitators to career progression for female medical clinical academics from the perspectives of female associate professors and professors, with a particular focus on women with caring responsibilities. DESIGN An exploratory qualitative approach was adopted. Data from semistructured interviews conducted via video calls were analysed using thematic analysis. SETTING Two major universities in the East Midlands of England. PARTICIPANTS The sample consisted of 13 female medical clinical academic associate professors and professors representing a range of medical specialties. RESULTS Female medical clinical academics experienced barriers and facilitators to progress at individual, interpersonal, institutional/procedural and societal levels. CONCLUSIONS Many barriers experienced at an individual level by female medical clinical academics are heavily influenced by their interpersonal relationships, the academic environment in which they work and broader institutional and procedural issues which, in turn, are influenced by stereotypical societal views on gender roles. Facilitating factors, including measures to increase the numbers of female leaders, may lead to a change of culture that is supportive to aspiring female clinical academics as well as enabling a healthy work/life balance for women and men with caring responsibilities.
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Affiliation(s)
- Diane Trusson
- School of Medicine, NIHR Applied Research Collaboration East Midlands (ARC EM), University of Nottingham, Nottingham, UK
| | - Emma Rowley
- School of Medicine, NIHR Applied Research Collaboration East Midlands (ARC EM), University of Nottingham, Nottingham, UK
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Trusson D, Rowley E. A qualitative study exploring experiences and challenges of combining clinical academic training with family life. BMC Med Educ 2021; 21:432. [PMID: 34399743 PMCID: PMC8366483 DOI: 10.1186/s12909-021-02849-8] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Concerns are being expressed around the lack of diversity at higher levels of clinical academia. This study aimed to explore experiences and challenges associated with combining clinical academic careers with family life. METHODS Qualitative data were gathered from participants from 4 NHS Trusts and 2 universities in the East Midlands of England using online surveys and semi-structured interviews. RESULTS The survey was completed by 67 nurses, midwives and allied health professionals, and 73 medical clinical academic trainees. Interviews were conducted with 16 participants from each group including equal numbers of men and women. Caring responsibilities differed between the two study populations. Medical clinical academic trainees were younger and either had young children or were yet to start a family. In contrast, nurses, midwives and allied health professionals tended to be older when they embarked on a clinical academic career and often waited until their children were school-age or older. Similar concerns were raised regarding working part-time and childcare, and how their career prospects might be affected in terms of fulfilling promotion criteria and being able to relocate for work purposes. The occupation of their partners also featured in participants' experiences; those who shared childcare with someone who worked 'regular' hours, appeared to be better supported to combine a clinical academic career with family life. Gender stereotyping was identified in some reported experiences highlighting a need for appropriate mentorship and for positive role models who were able to demonstrate that it is possible to survive and thrive as a clinical academic with family responsibilities. CONCLUSIONS Although people manage to find ways to successfully combine clinical academic roles with family life, findings highlight a need to identify ways of supporting and encouraging trainees with caring responsibilities to ensure that they remain on the clinical academic pathway.
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Affiliation(s)
- Diane Trusson
- University of Nottingham, School of Medicine, NIHR Applied Research Collaboration East Midlands (ARC EM), Institute of Mental Health, Triumph Road, Nottingham, NG7 2TU, UK.
| | - Emma Rowley
- University of Nottingham, School of Medicine, NIHR Applied Research Collaboration East Midlands (ARC EM), Institute of Mental Health, Triumph Road, Nottingham, NG7 2TU, UK.
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Trusson D, Rowley E, Barratt J. Multimethods study comparing the experiences of medical clinical academics with nurses, midwives and allied health professionals pursuing a clinical academic career. BMJ Open 2021; 11:e043270. [PMID: 33795298 PMCID: PMC8023736 DOI: 10.1136/bmjopen-2020-043270] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 07/29/2020] [Revised: 01/21/2021] [Accepted: 02/01/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study aimed to compare experiences of medical clinical academics (MCAs) with those of nurses, midwives and allied health professionals (NMAHPs) pursuing a clinical academic career. DESIGN A multimethods approach was used to elicit qualitative data. Both sets of participants completed similar online surveys followed by in-depth interviews to explore emerging themes. SETTING The research was conducted in the East Midlands of England, encompassing two Higher Education Institutions and four National Health Service Trusts. PARTICIPANTS Surveys were completed by 67 NMAHPs and 73 MCA trainees. Sixteen participants from each group were interviewed following a similar interview schedule. RESULTS The survey data revealed notable differences in demographics of the two study populations, reflecting their different career structures. MCAs were younger and they all combined clinical and academic training, lengthening the time before qualification. In contrast, most NMAHPs had been in their clinical post for some years before embarking on a clinical academic pathway. Both routes had financial and personal repercussions and participants faced similar obstacles. However, there was also evidence of wide-ranging benefits from combining clinical and academic roles. CONCLUSIONS Variations in experiences between the two study populations highlight a need for a clear academic pathway for all health professionals, as well as sufficient opportunities post-PhD to enable clinical academics to fully use their dual skills.
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Affiliation(s)
- Diane Trusson
- School of Medicine, NIHR Applied Research Collaboration East Midlands (ARC EM), University of Nottingham, Nottingham, UK
| | - Emma Rowley
- School of Medicine, NIHR Applied Research Collaboration East Midlands (ARC EM), University of Nottingham, Nottingham, UK
| | - Jonathan Barratt
- College of Life Sciences, University of Leicester, Leicester, UK
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Haleema SO, Akbar S, Rowley E, Polski JM, Mneimneh W. A Diagnostically Challinging Case of Primary Thyroid Kappa-restricted Plasma Cell- Rich Hematolymphoid Neoplasm with Focal Plasmablastic Differentiation. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Most low-grade B-cell lymphomas of the thyroid are extranodal marginal cell lymphomas (MZL) and may exhibit focal plasma cell differentiation (PCD). PCD could occasionally be extensive, mimicking a true plasma cell neoplasm (PCN). PCN of the thyroid are extremely rare, representing either a component of plasma cell myeloma (PCM), or a primary thyroid extraosseous plasmacytoma (EOPC). We present a case of primary thyroid plasma cell (PC)-rich neoplasm with considerable diagnostic challenge.
Methods
A 46-year-old male underwent total thyroidectomy for hypothyroidism and compressive symptoms. Microscopically, sheets and nodules of PC with focal plasmablastic features were demonstrated in a background of fibrosing chronic thyroiditis. One benign perithyroidal lymph node was seen. The differential diagnosis included B-cell neoplasm with extensive PCD (ie, MZL or lymphoplasmacytic lymphoma) and PCN.
Results
Immunohistochemically, the PCs were positive for CD79a, MUM1, BCL2 and IgM with Kappa light-chain restriction and partial CD138 expression, and negative for CD20, PAX5, HHV8, Cyclin-D1, SOX11, CD117 and IgG. EBER was negative. Rare reactive-appearing B-cell aggregates with associated T-cells were noted. FISH for API/MALT1-fusion t(11;18) and PCR for MYD-88 mutation were negative. However, polysomy 18 (seen in 15–33% of B-cell lymphomas, including MZL) was detected. Serum proteins and PCM workup were negative.
The findings were consistent with primary thyroid Kappa-restricted PC-rich neoplasm. While the absence of detectable B-cell neoplastic component was suggestive of EOPC, the diagnosis of MZL with extensive PCD was favored due to the thyroid involvement in a background of thyroiditis, absence of lymph node involvement, detection of polysomy 18, and absence of MYD-88. Follow-up of the patient was thought to be most reasonable.
Conclusion
Plasma cell-rich hematolymphoid neoplasms of the thyroid may cause a considerable diagnostic challenge. Differentiating between B-cell lymphomas with extensive PCD and PCN may be difficult or even impossible by morphology alone. Additional ancillary tests may be necessary.
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Affiliation(s)
- S O Haleema
- Pathology, University of South Alabama, Mobile, Alabama, UNITED STATES
| | - S Akbar
- Pathology, University of South Alabama, Mobile, Alabama, UNITED STATES
| | - E Rowley
- Pathology, University of South Alabama, Mobile, Alabama, UNITED STATES
| | - J M Polski
- Pathology, University of South Alabama, Mobile, Alabama, UNITED STATES
| | - W Mneimneh
- Pathology, University of South Alabama, Mobile, Alabama, UNITED STATES
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Patel S, Akhtar A, Malins S, Wright N, Rowley E, Young E, Sampson S, Morriss R. The Acceptability and Usability of Digital Health Interventions for Adults With Depression, Anxiety, and Somatoform Disorders: Qualitative Systematic Review and Meta-Synthesis. J Med Internet Res 2020; 22:e16228. [PMID: 32628116 PMCID: PMC7381032 DOI: 10.2196/16228] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/20/2020] [Accepted: 03/23/2020] [Indexed: 12/20/2022] Open
Abstract
Background The prevalence of mental health disorders continues to rise, with almost 4% of the world population having an anxiety disorder and almost 3.5% having depression in 2017. Despite the high prevalence, only one-third of people with depression or anxiety receive treatment. Over the last decade, the use of digital health interventions (DHIs) has risen rapidly as a means of accessing mental health care and continues to increase. Although there is evidence supporting the effectiveness of DHIs for the treatment of mental health conditions, little is known about what aspects are valued by users and how they might be improved. Objective This systematic review aimed to identify, appraise, and synthesize the qualitative literature available on service users’ views and experiences regarding the acceptability and usability of DHIs for depression, anxiety, and somatoform disorders. Methods A systematic search strategy was developed, and searches were run in 7 electronic databases. Qualitative and mixed methods studies published in English were included. A meta-synthesis was used to interpret and synthesize the findings from the included studies. Results A total of 24 studies were included in the meta-synthesis, and 3 key themes emerged with descriptive subthemes. The 3 key themes were initial motivations and approaches to DHIs, personalization of treatment, and the value of receiving personal support in DHIs. The meta-synthesis suggests that participants’ initial beliefs about DHIs can have an important effect on their engagement with these types of interventions. Personal support was valued very highly as a major component of the success of DHIs. The main reason for this was the way it enabled individual personalization of care. Conclusions Findings from the systematic review have implications for the design of future DHIs to improve uptake, retention, and outcomes in DHIs for depression, anxiety, and somatoform disorders. DHIs need to be personalized to the specific needs of the individual. Future research should explore whether the findings could be generalized to other health conditions.
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Affiliation(s)
- Shireen Patel
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Athfah Akhtar
- School of Social Sciences, Birmingham City University, Birmingham, United Kingdom
| | - Sam Malins
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Nicola Wright
- Faculty of Medicine, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Emma Rowley
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Emma Young
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Stephanie Sampson
- NIHR MindTech MedTech Co-operative, University of Nottingham, Nottingham, United Kingdom
| | - Richard Morriss
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom.,NIHR MindTech MedTech Co-operative, University of Nottingham, Nottingham, United Kingdom
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Trusson D, Rowley E, Bramley L. A mixed-methods study of challenges and benefits of clinical academic careers for nurses, midwives and allied health professionals. BMJ Open 2019; 9:e030595. [PMID: 31594886 PMCID: PMC6797317 DOI: 10.1136/bmjopen-2019-030595] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 03/28/2019] [Revised: 08/15/2019] [Accepted: 09/13/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The clinical academic trajectory for doctors and dentists is well-established, with research embedded in their career development. Recent years have also seen a burgeoning interest and push for nurses, midwives and allied health professionals (NMAHPs) to pursue a clinical academic career. However, the National Institute for Health Research (NIHR) 10-year review suggested that there may be problems with progression post Master's degree level for this group, with nurses and midwives receiving less NIHR funding than allied health professionals. This study responds to these concerns, tracking the progression and exploring experiences of NMAHPs in the East Midlands region of England. DESIGN An online survey and in-depth interviews were used to capture a wide range of experiences. PARTICIPANTS 67 NMAHPs who were pursuing a clinical academic career were surveyed, supplemented by 16 semi-structured in-depth interviews. RESULTS Three themes emerged during data analysis: Embarking on a clinical academic career, overcoming barriers and benefits. CONCLUSIONS NMAHPs are motivated to pursue a clinical academic career by a drive to improve services for the benefit of patients and the National Health Service more widely, as well as for personal development and career progression. People working in these roles have opportunities to explore possible solutions to issues that they encounter in their clinical role through academic study. Findings reveal benefits emanating from the individual level through to (inter)national levels, therefore academic study should be encouraged and supported. However, investment is needed to establish more clinical academic roles to enable NMAHPs to continue to use their experience and expertise post-PhD, otherwise the full extent of their value will not be recognised.
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Affiliation(s)
- Diane Trusson
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Emma Rowley
- Business School, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Louise Bramley
- Institute of Nursing and Midwifery Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
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Morriss R, Patel S, Malins S, Guo B, Higton F, James M, Wu M, Brown P, Boycott N, Kaylor-Hughes C, Morris M, Rowley E, Simpson J, Smart D, Stubley M, Kai J, Tyrer H. Clinical and economic outcomes of remotely delivered cognitive behaviour therapy versus treatment as usual for repeat unscheduled care users with severe health anxiety: a multicentre randomised controlled trial. BMC Med 2019; 17:16. [PMID: 30670044 PMCID: PMC6343350 DOI: 10.1186/s12916-019-1253-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/07/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND It is challenging to engage repeat users of unscheduled healthcare with severe health anxiety in psychological help and high service costs are incurred. We investigated whether clinical and economic outcomes were improved by offering remote cognitive behaviour therapy (RCBT) using videoconferencing or telephone compared to treatment as usual (TAU). METHODS A single-blind, parallel group, multicentre randomised controlled trial was undertaken in primary and general hospital care. Participants were aged ≥18 years with ≥2 unscheduled healthcare contacts within 12 months and scored >18 on the Health Anxiety Inventory. Randomisation to RCBT or TAU was stratified by site, with allocation conveyed to a trial administrator, research assessors masked to outcome. Data were collected at baseline, 3, 6, 9 and 12 months. The primary outcome was change in HAI score from baseline to six months on an intention-to-treat basis. Secondary outcomes were generalised anxiety, depression, physical symptoms, function and overall health. Health economics analysis was conducted from a health service and societal perspective. RESULTS Of the 524 patients who were referred and assessed for trial eligibility, 470 were eligible and 156 (33%) were recruited; 78 were randomised to TAU and 78 to RCBT. Compared to TAU, RCBT significantly reduced health anxiety at six months, maintained to 9 and 12 months (mean change difference HAI -2.81; 95% CI -5.11 to -0.50; P = 0.017). Generalised anxiety, depression and overall health was significantly improved at 12 months, but there was no significant change in physical symptoms or function. RCBT was strictly dominant with a net monetary benefit of £3,164 per participant at a willingness to pay threshold of £30,000. No treatment-related adverse events were reported in either group. CONCLUSIONS RCBT may reduce health anxiety, general anxiety and depression and improve overall health, with considerable reductions in health and informal care costs in repeat users of unscheduled care with severe health anxiety who have previously been difficult to engage in psychological treatment. RCBT may be an easy-to-implement intervention to improve clinical outcome and save costs in one group of repeat users of unscheduled care. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov on 19 Nov 2014 with reference number NCT02298036.
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Affiliation(s)
- Richard Morriss
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK.
| | - Shireen Patel
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Sam Malins
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Boliang Guo
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Fred Higton
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Marilyn James
- Division of Rehabilitation and Ageing, University of Nottingham, School of Medicine, Nottingham, NG7 2UH, UK
| | - Mengjun Wu
- Division of Rehabilitation and Ageing, University of Nottingham, School of Medicine, Nottingham, NG7 2UH, UK
| | - Paula Brown
- Nottinghamshire Healthcare NHS Foundation Trust, Duncan MacMillan House, Porchester Road, Nottingham, NG3 6AA, UK
| | - Naomi Boycott
- Nottinghamshire Healthcare NHS Foundation Trust, Duncan MacMillan House, Porchester Road, Nottingham, NG3 6AA, UK
| | - Catherine Kaylor-Hughes
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Martin Morris
- Leicestershire Partnership NHS Trust, Plaza, Riverside House Bridge Park, Bridge Park Road, Thurmaston, Leicester, LE4 8PQ, UK
| | - Emma Rowley
- Business School, University of Nottingham, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Jayne Simpson
- Nottinghamshire Healthcare NHS Foundation Trust, Duncan MacMillan House, Porchester Road, Nottingham, NG3 6AA, UK
| | - David Smart
- Leicester Terrace Health Centre, Adelaide St, Northampton, NN2 6AL, UK
| | - Michelle Stubley
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Joe Kai
- Division of Primary Care, University of Nottingham, School of Medicine, Nottingham, NG7 2UH, UK
| | - Helen Tyrer
- Department of Psychiatry, Imperial College, South Kensington Campus, London, SW7 2AZ, UK
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Goss PW, Middlehurst A, Acerini CL, Anderson BJ, Bratina N, Brink S, Calliari L, Forsander G, Goss JL, Maahs D, Milosevic R, Pacaud D, Paterson MA, Pitman L, Rowley E, Wolfsdorf J. ISPAD Position Statement on Type 1 Diabetes in Schools. Pediatr Diabetes 2018; 19:1338-1341. [PMID: 30295419 DOI: 10.1111/pedi.12781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Patel S, Malins S, Guo B, James M, Kai J, Kaylor-Hughes C, Rowley E, Simpson J, Smart D, Stubley M, Tyrer H, Morriss R. Protocol investigating the clinical outcomes and cost-effectiveness of cognitive-behavioural therapy delivered remotely for unscheduled care users with health anxiety: randomised controlled trial. BJPsych Open 2016; 2:81-87. [PMID: 27703758 PMCID: PMC4995569 DOI: 10.1192/bjpo.bp.115.002220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/10/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Health anxiety and medically unexplained symptoms cost the National Health Service (NHS) an estimated £3 billion per year in unnecessary costs with little evidence of patient benefit. Effective treatment is rarely taken up due to issues such as stigma or previous negative experiences with mental health services. An approach to overcome this might be to offer remotely delivered psychological therapy, which can be just as effective as face-to-face therapy and may be more accessible and suitable. AIMS To investigate the clinical outcomes and cost-effectiveness of remotely delivered cognitive-behavioural therapy (CBT) to people with high health anxiety repeatedly accessing unscheduled care (trial registration: NCT02298036). METHOD A multicentre randomised controlled trial (RCT) will be undertaken in primary and secondary care providers of unscheduled care across the East Midlands. One hundred and forty-four eligible participants will be equally randomised to receive either remote CBT (6-12 sessions) or treatment as usual (TAU). Two doctoral research studies will investigate the barriers and facilitators to delivering the intervention and the factors contributing to the optimisation of therapeutic outcome. RESULTS This trial will be the first to test the clinical outcomes and cost-effectiveness of remotely delivered CBT for the treatment of high health anxiety. CONCLUSIONS The findings will enable an understanding as to how this intervention might fit into a wider care pathway to enhance patient experience of care. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
| | | | - Boliang Guo
- , PhD, Collaboration for Leadership in Applied Health Research and Care (CLAHRC)
| | | | - Joe Kai
- , MD, FRCGP, Faculty of Medicine & Health Sciences
| | | | | | | | - David Smart
- , MB ChB, MRCGP, Leicester Terrace Health Care Centre, Northampton
| | | | - Helen Tyrer
- , PhD, Department of Medicine, Imperial College London, London
| | - Richard Morriss
- , MD, FRCPsych, CLAHRC, University of Nottingham, Nottingham, UK
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Bancroft EK, Castro E, Bancroft GA, Ardern-Jones A, Moynihan C, Page E, Taylor N, Eeles RA, Rowley E, Cox K. The psychological impact of undergoing genetic-risk profiling in men with a family history of prostate cancer. Psychooncology 2015; 24:1492-9. [PMID: 25872100 DOI: 10.1002/pon.3814] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 10/21/2014] [Revised: 02/12/2015] [Accepted: 02/13/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND The ability to identify men at genetically high-risk of prostate cancer (PrCa) would enable screening to be targeted at those most in need. This study explored the psychological impact (in terms of general and PrCa-specific worry and risk perceptions) on men with a family history of PrCa, undergoing prostate screening and genetic-risk profiling, within a research study. METHODS A prospective exploratory approach was adopted, incorporating a sequential mixed-method design. Questionnaires were completed at two time points to measure the impact of undergoing screening and genetic-risk profiling. In-depth interviews were completed in a subgroup after all study procedures were completed and analysed using a framework approach. RESULTS Ninety-five men completed both questionnaires, and 26 were interviewed. No measurable psychological distress was detectable in the group as a whole. The interview findings fell into two categories: 'feeling at risk' and 'living with risk'. The feeling of being at risk of PrCa is a part of men's lives, shaped by assumptions and information gathered over many years. Men used this information to communicate about PrCa risk to their peers. Men overestimate their risk of PrCa and have an innate assumption that they will develop PrCa. The interviews revealed that men experienced acute anxiety when waiting for screening results. CONCLUSIONS Personalised genetic-risk assessments do not prevent men from overestimating their risk of PrCa. Screening anxiety is common, and timeframes for receiving results should be kept to a minimum. Methods of risk communication in men at risk of PrCa should be the subject of future research.
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Affiliation(s)
- Elizabeth K Bancroft
- Cancer Genetics Unit & Academic Urology Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - Elena Castro
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - Gordon A Bancroft
- Department of Mathematics and Statistics, Staffordshire University, Stafford, UK
| | - Audrey Ardern-Jones
- Cancer Genetics Unit & Academic Urology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Clare Moynihan
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - Elizabeth Page
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - Natalie Taylor
- Cancer Genetics Unit & Academic Urology Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - Rosalind A Eeles
- Cancer Genetics Unit & Academic Urology Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - Emma Rowley
- Centre for Health Innovation, Leadership & Learning, Nottingham University Business School, Nottingham, UK
| | - Karen Cox
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Wright N, Rowley E, Chopra A, Gregoriou K, Waring J. From admission to discharge in mental health services: a qualitative analysis of service user involvement. Health Expect 2015; 19:367-76. [PMID: 25817297 DOI: 10.1111/hex.12361] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 03/01/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND User involvement and recovery are now widely used terms within the mental health policy, research and practice discourse. However, there is a question mark about the impact these ideas have in everyday practice. Of interest is the degree of involvement in key transitions of care. In particular, admission to and discharge from acute inpatient mental health wards. OBJECTIVE To explore the nature of service user involvement in the admission and discharge process into and out of acute inpatient mental health care. DESIGN A qualitative study using focus groups. SETTING AND PARTICIPANTS One acute, inpatient mental health ward was the focus of the study. Seven uniprofessional focus group interviews were conducted with ward staff, community staff and service users (total number of participants = 52). Conventional, thematic qualitative techniques were used to analyse the data. RESULTS The data analysed and presented in this article relate to the loss of the service user voice at the key transition points into and out of acute inpatient care. Due to the lack of resources (inpatient beds and community care follow-up), the role service users could play was diminished. In their narratives, clinical staff associated the person with the process and used language which dehumanized the individual. CONCLUSION Service users experience numerous care transitions into and out of hospital. As there is the potential for these encounters to have a lasting negative effect, the importance of ensuring service users have a voice in what is happening to them is crucial.
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Affiliation(s)
- Nicola Wright
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Emma Rowley
- Nottingham University Business School, University of Nottingham, Nottingham, UK
| | - Arun Chopra
- Nottinghamshire Healthcare NHS Trust, Nottingham, UK
| | | | - Justin Waring
- Nottingham University Business School, University of Nottingham, Nottingham, UK
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Bancroft EK, Castro E, Ardern-Jones A, Moynihan C, Page E, Taylor N, Eeles RA, Rowley E, Cox K. "It's all very well reading the letters in the genome, but it's a long way to being able to write": Men's interpretations of undergoing genetic profiling to determine future risk of prostate cancer. Fam Cancer 2014; 13:625-35. [PMID: 24980079 DOI: 10.1007/s10689-014-9734-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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] [Indexed: 10/25/2022]
Abstract
A family history of prostate cancer (PC) is one of the main risk factors for the disease. A number of common single nucleotide polymorphisms (SNPs) that confer small but cumulatively substantial risks of PC have been identified, opening the possibility for the use of SNPs in PC risk stratification for targeted screening and prevention in the future. The objective of this study was to explore the psychosocial impact of receiving information about genetic risk of PC. The participants were men who had a family history of PC and were enrolled in a screening study providing research genetic profiling alongside screening for PC. A combination of questionnaires and in-depth interviews were used. Questionnaires were completed by men at two time points: both before and after joining the study and going through the genetic profiling process. The interviews were completed after all study process were complete and were analysed using a framework analysis. In total 95 men completed both questionnaires and 26 men were interviewed. A number of issues facing men at risk of PC were identified. The results fell into two main categories: personal relevance and societal relevance. The strength of men's innate beliefs about their risk, shaped by genetic and environmental assumptions, outweigh the information provided by genetic testing. Men felt genetic profile results would have future use for accessing prostate screening, being aware of symptoms and in communicating with others. The findings reinforce the importance of providing contextual information alongside genetic profiling test results, and emphasises the importance of the counselling process in providing genetic risk information. This research raises some key issues to facilitate clinical practice and future research related to the use of genetic profiling to determine risk of PC and other diseases.
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Affiliation(s)
- Elizabeth K Bancroft
- Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, London, SM2 5PT, UK,
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Abstract
INTRODUCTION Strategies to reduce hospital admissions for mental health service users have received vast amounts of attention, yet the transfer of care from hospital to the community has been ignored. The discharge process is complex, messy, disjointed and inefficient, relying on cross-agency and organisational working. Focusing on one acute mental health admission ward, we will investigate whether the discharge process for people with severe mental health problems can be enhanced through the creation, implementation and utilisation of a knowledge sharing proforma that is used on their admission to the ward. METHODS AND ANALYSIS The project uses qualitative interviews to understand the complex processes associated with being admitted and discharged from inpatient mental health wards. Practitioners will be asked to identify and map the relevant stakeholders involved in admission and discharge, and discuss any problems with the process. The study team will work with clinicians to develop a knowledge collection proforma, which will be piloted for 2 months. Qualitative interviews will be carried out to collect reflections on the experiences of using the tool, with data used for further refinement of the intervention. Baseline and repeat quantitative measures will be taken to illustrate any changes to length of stay and readmission rates achieved as a result of the study. ETHICS AND DISSEMINATION A key issue is that participants are able to comment frankly on something that is a core part of their work, without fear or reprise. It is equally important that all participants are offered the opportunity to develop and coproduce the knowledge collection proforma, in order that the intervention produced is fit for purpose and usable in the real world, away from a research environment. The study has received ethical approval from Nottingham University Business School ethics committee, and has all appropriate National Health Service research governance clearances.
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Affiliation(s)
- Emma Rowley
- Centre for Health Innovation, Leadership & Learning, Nottingham University Business School, Nottingham, UK
| | - Nicola Wright
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Justin Waring
- Centre for Health Innovation, Leadership & Learning, Nottingham University Business School, Nottingham, UK
| | - Kyri Gregoriou
- Adult Mental Health Services, Nottinghamshire Healthcare NHS Trust, Nottingham, UK
| | - Arun Chopra
- Adult Mental Health Services, Nottinghamshire Healthcare NHS Trust, Nottingham, UK
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Jordan M, Rowley E, Morriss R, Manning N. An analysis of the Research Team-Service User relationship from the Service User perspective: a consideration of 'The Three Rs' (Roles, Relations, and Responsibilities) for healthcare research organisations. Health Expect 2014; 18:2693-703. [PMID: 25059530 DOI: 10.1111/hex.12243] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 06/30/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This article debates interview data from service users who engaged with the work of a Collaboration for Leadership in Applied Health Research and Care (CLAHRC). The evidence base, to date, concerning the nature of CLAHRC work at the frontline (i.e. What is it actually like to do CLAHRC work?) is meagre; thus, this article represents an original contribution to that literature. Further, this article analyses service users' participation in research - as members of the research team - and so contributes to the body of developing literature regarding involvement too. OBJECTIVE This article explores the nature of the Research Team-Service User relationship, plus associated roles, relations and responsibilities of collaborative health research. DESIGN Qualitative social science research was undertaken in a health-care research organization utilizing interview method and a medical sociology and organizational sociology theoretical framework for analysis. Data utilized originate from a larger evaluation study that focuses on the CLAHRC as an iterative organization and explores members' experiences. RESULTS There can be a disparity between initial expectations and actual experiences of involvement for service users. Therefore, as structured via 'The Three Rs' (Roles, Relations and Responsibilities), aspects of the relationship are evaluated (e.g. motivation, altruism, satisfaction, transparency, scope, feedback, communication, time). Regarding the inclusion of service users in health research teams, a careful consideration of 'The Three Rs' is required to ensure expectations match experiences.
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Affiliation(s)
- Melanie Jordan
- National Institute for Health Research CLAHRC-NDL, Nottinghamshire Healthcare NHS Trust & University of Nottingham, Nottingham, UK
| | - Emma Rowley
- NIHR CLAHRC East Midlands & Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, UK
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Nick Manning
- Institute of Mental Health, Nottinghamshire Healthcare NHS Trust & University of Nottingham, Nottingham, UK
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Rowley E. Protocol for a qualitative study exploring the roles of 'Diffusion Fellows' in bridging the research to practice gap in the Nottinghamshire, Derbyshire and Lincolnshire Collaboration for Leadership in Applied Health Research and Care (CLAHRC-NDL). BMJ Open 2012; 2:e000604. [PMID: 22267711 PMCID: PMC3269053 DOI: 10.1136/bmjopen-2011-000604] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Evidence produced by researchers is not comprehensibly used in practice. National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire's strategy for closing the research to practice gap relies on the use of 'Diffusion Fellows' (DFs). DFs are seconded from the local healthcare economy to act as champions for change, translating and disseminating knowledge from practice into the research studies and vice versa, taking the knowledge developed by academics back into their own practice environments. This paper outlines the rationale and design of a qualitative evaluation study of the DF role. Methods and analysis The evaluation responds to the research question: what are the barriers and facilitators to DFs acting as knowledge brokers and boundary spanners? Interviews will be carried out annually with DFs, the research team they work with and their line managers in the employing organisations. Interviews with DFs will be supplemented with a creative mapping component, offering them the opportunity to construct a 3D model to creatively illustrate some of the barriers precluding them from successfully carrying out their role. This method is popular for problem solving and is valuable for both introducing an issue that might be difficult to initially verbalise and to reflect upon experiences. Ethics and dissemination DFs have an important role within the CLAHRC and are central to our implementation and knowledge mobilisation strategies. It is important to understand as much about their activities as possible in order for the CLAHRC to support the DFs in the most appropriate way. Dissemination will occur through presentations and publications in order that learning from the use of DFs can be shared as widely as possible. The study has received ethical approval from Nottingham 2 Research Ethics Committee and has all appropriate NHS governance clearances.
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Affiliation(s)
- Emma Rowley
- CLAHRC-NDL, University of Nottingham Innovation Park, Nottingham, UK
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Kendrick D, O'Brien C, Christie N, Coupland C, Quinn C, Avis M, Barker M, Barnes J, Coffey F, Joseph S, Morris A, Morriss R, Rowley E, Sleney J, Towner E. The impact of injuries study. multicentre study assessing physical, psychological, social and occupational functioning post injury--a protocol. BMC Public Health 2011; 11:963. [PMID: 22208707 PMCID: PMC3332304 DOI: 10.1186/1471-2458-11-963] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 12/31/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Large numbers of people are killed or severely injured following injuries each year and these injuries place a large burden on health care resources. The majority of the severely injured are not fully recovered 12-18 months later. Psychological disorders are common post injury and are associated with poorer functional and occupational outcomes. Much of this evidence comes from countries other than the UK, with differing health care and compensation systems. Early interventions can be effective in treating psychological morbidity, hence the scale and nature of the problem and its impact of functioning in the UK must be known before services can be designed to identify and manage psychological morbidity post injury. METHODS/DESIGN A longitudinal multi-centre study of 680 injured patients admitted to hospital in four areas across the UK: Nottingham, Leicester/Loughborough, Bristol and Surrey. A stratified sample of injuries will ensure a range of common and less common injuries will be included. Participants will complete a baseline questionnaire about their injury and pre-injury quality of life, and follow-up questionnaires 1, 2, 4, and 12 months post injury. Measures will include health and social care utilisation, perceptions of recovery, physical, psychological, social and occupational functioning and health-related quality of life. A nested qualitative study will explore the experiences of a sample of participants, their carers and service providers to inform service design. DISCUSSION This study will quantify physical, psychological, social and occupational functioning and health and social care utilisation following a range of different types of injury and will assess the impact of psychological disorders on function and health service use. The findings will be used to guide the development of interventions to maximise recovery post injury.
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Affiliation(s)
- Denise Kendrick
- Division of Primary Care, Tower Building, University Park, NG7 2RD Nottingham, UK
| | - Claire O'Brien
- Division of Primary Care, Tower Building, University Park, NG7 2RD Nottingham, UK
| | - Nicola Christie
- Centre for Transport Studies, Dept of Civil, Environmental and Geomatic Engineering, UCL, Gower Street, London WC1E 6BT, UK
| | - Carol Coupland
- Division of Primary Care, Tower Building, University Park, NG7 2RD Nottingham, UK
| | - Casey Quinn
- Division of Primary Care, Tower Building, University Park, NG7 2RD Nottingham, UK
| | - Mark Avis
- Nursing, Midwifery & Physiotherapy Department, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Nottingham NG7 2UH, UK
| | - Marcus Barker
- Division of Psychiatry, Institute of Mental Health, B Floor, Sir Colin Campbell Building, University of Nottingham Innovation Park, Triumph Road, Nottingham NG7 2TU, UK
| | - Jo Barnes
- Transport Safety Research Centre, Loughborough Design School, Loughborough University, Ashby Road, Loughborough LE11 3UZ, UK
| | - Frank Coffey
- Emergency Department, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Nottingham NG7 2UH, UK
| | - Stephen Joseph
- Sociology & Social Policy Department, University Park, Nottingham NG7 2RD, UK
| | - Andrew Morris
- Transport Safety Research Centre, Loughborough Design School, Loughborough University, Ashby Road, Loughborough LE11 3UZ, UK
| | - Richard Morriss
- Division of Psychiatry, Institute of Mental Health, B Floor, Sir Colin Campbell Building, University of Nottingham Innovation Park, Triumph Road, Nottingham NG7 2TU, UK
| | - Emma Rowley
- CLAHRC NDL, Sir Colin Campbell Building, University of Nottingham Innovation Park, Nottingham NG7 2TU, UK
| | - Jude Sleney
- Department of Sociology Faculty of Arts and Human Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - Elizabeth Towner
- Centre for Child & Adolescent Health, University of the West of England, Oakfield House, Oakfield Grove, Clifton, Bristol BS8 2BN, UK
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O'Neill R, Rowley E, Smith F. The emergency supply of prescription-only medicines: a survey of requests to community pharmacists and their views on the procedures. International Journal of Pharmacy Practice 2011. [DOI: 10.1111/j.2042-7174.2002.tb00591.x] [Citation(s) in RCA: 2] [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: 11/26/2022]
Abstract
Abstract
Objectives
The provisions of the Medicines Act for the emergency supply of prescription-only medicines (POMs) represent circumstances in which pharmacists in the UK may lawfully supply a patient with a POM without having a prescription. The objectives of this research were to establish the frequency of requests for emergency supplies from doctors and patients, and the characteristics of the requests, to investigate the procedures for emergency supply from the perspective of community pharmacists and to survey their views on the subject.
Method
Data were gathered in a self-administered structured postal questionnaire. The sample comprised community pharmacists in three health authority areas in Greater London and the surrounding area.
Key findings
Over two-thirds of the 243 respondents reported receiving requests for emergency supplies of POMs from patients at least monthly. The most commonly requested items were inhalers for asthma, followed by medication for cardiovascular disease. Many pharmacists had refused to make supplies on the basis that the situation did not constitute an emergency and/or that a prescription could be obtained. They also experienced cases in which they doubted the suitability of the requested product. Over half of the respondents reported receiving at least monthly requests from doctors to dispense an emergency supply. Refusals to supply were most commonly because the requested product was a Controlled Drug and therefore disallowed. Most respondents believed that the emergency supply procedures provided an opportunity to exercise professional judgment and were an important “safety net” for patients.
Discussion
The provisions for the emergency supply of medicines are a common resort of both prescribers and patients and present pharmacists with an opportunity to exercise professional judgment. However, many pharmacists considered the procedures restrictive, believing that they should have more discretion in supplying POMs to regular patients and their representatives.
Conclusion
Professional developments as envisaged by the British government and the pharmacy profession will require greater flexibility regarding the arrangements for supply of POMs.
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Affiliation(s)
- Richard O'Neill
- Centre for Practice and Policy, School of Pharmacy, University of London, Brunswick Square, London, England WC1N 1AX
| | - Emma Rowley
- Centre for Practice and Policy, School of Pharmacy, University of London, Brunswick Square, London, England WC1N 1AX
| | - Felicity Smith
- Centre for Practice and Policy, School of Pharmacy, University of London, Brunswick Square, London, England WC1N 1AX
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19
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Smith F, Francis SA, Rowley E. Group interviews with people taking long-term medication: comparing the perspectives of people with arthritis, respiratory disease and mental health problems. International Journal of Pharmacy Practice 2011. [DOI: 10.1111/j.2042-7174.2000.tb00991.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Objective
To examine experiences of medicine use, advice and support from the perspectives of people taking medicines long term for arthritis, respiratory disease and mental health problems.
Method
Twelve group interviews were conducted, four with each of the three chronic illness groups.
Setting
Interviews were arranged through national and local voluntary organisations and conducted as part of their regular meetings.
Key findings
The most prominent issue for all the Arthritis Care groups was information about side effects. People discussed the benefits of having this information and the reasons they believed that it was not generally provided. People with respiratory disease described difficulties of obtaining information as a problem in the operation of the health service in Britain, where participants may or may not find out about different products by chance. In all these discussions there were examples of how people used their regular group meetings to inform each other. For people with mental health problems, participation in decisions concerning medicines and the attitudes of health professionals were the most prominent issues. Members of all groups, across all chronic illnesses, claimed that adequate information was not shared with them during consultations with professionals. However, different perspectives of involvement in decision-making regarding therapy were distinguishable. Pharmacy services did not feature prominently in any of the group discussions.
Conclusion
The study revealed differences between the illness groups in the emphasis participants placed on different issues. However, there were also common concerns, in particular relating to obtaining information and the attitudes of professionals. While pharmacy services were not prominent in discussions, a range of unmet needs concerning medicines were identified. This indicates that opportunities exist for pharmacists to provide more responsive services that would be valued by people taking long-term medication.
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Affiliation(s)
- Felicity Smith
- School of Pharmacy, University of London, 29/39 Brunswick Square, London, England WC1N 1AX
| | - Sally-Anne Francis
- School of Pharmacy, University of London, 29/39 Brunswick Square, London, England WC1N 1AX
| | - Emma Rowley
- School of Pharmacy, University of London, 29/39 Brunswick Square, London, England WC1N 1AX
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20
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Abstract
OBJECTIVES The UK Patient Safety Research Portfolio (PSRP) commissioned 38 studies investigating the threats to patient safety in various clinical settings and evaluating safety-related service interventions. This paper reviews 27 of these studies, drawing out emergent and cross-cutting themes in terms of theory, research methods and thematic findings. METHODS Given the diversity of PSRP studies, the paper takes a narrative approach that allows for qualitative description, interpretation and synthesis of the studies and their findings. RESULTS The theoretical review shows the majority of PSRP studies draw upon a patient safety 'orthodoxy', developed from the concepts and models associated with the human factors approach. The methodological review shows that a diverse range of research designs and techniques have been utilized. Although many follow in the 'scientific' tradition, interpretative, mixed and innovative methods have been integral to research. The thematic review of findings highlights significant contributions to knowledge in the areas of 'people', 'organizations', and 'technology'. As well as identifying the various sources of risk in the organization and delivery of patient care, the studies also evaluate and make recommendations about service change and improvement. CONCLUSIONS The PSRP has provided the foundations for significant theoretical, methodological and empirical advances in the area of patient safety. The findings and recommendations make important contributions to policy formulation and implementation as well as professional and managerial practice. Through this body of research the PSRP has supported the formation and growth of a thriving research community across academic, policy and professional communities.
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Affiliation(s)
- Justin Waring
- Nottingham University Business School, University of Nottingham, Nottingham, UK.
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Plagnol AC, Rowley E, Martin P, Livesey F. Industry perceptions of barriers to commercialization of regenerative medicine products in the UK. Regen Med 2009; 4:549-59. [PMID: 19580404 DOI: 10.2217/rme.09.21] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS Regenerative medicine is an emerging field with the potential to provide widespread improvement in healthcare and patient wellbeing via the delivery of therapies that can restore, regenerate or repair damaged tissue. As an industry, it could significantly contribute to economic growth if products are successfully commercialized. However, to date, relatively few products have reached the market owing to a variety of barriers, including a lack of funding and regulatory hurdles. The present study analyzes industry perceptions of the barriers to commercialization that currently impede the success of the regenerative medicine industry in the UK. MATERIALS & METHODS The analysis is based on 20 interviews with leading industrialists in the field. RESULTS The study revealed that scientific research in regenerative medicine is thriving in the UK. Unfortunately, lack of access to capital, regulatory hurdles, lack of clinical evidence leading to problems with reimbursement, as well as the culture of the NHS do not provide a good environment for the commercialization of regenerative medicine products. CONCLUSION Policy interventions, including increased translational government funding, a change in NHS and NICE organization and policies, and regulatory clarity, would likely improve the general outcomes for the regenerative medicine industry in the UK.
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Affiliation(s)
- Anke C Plagnol
- Faculty of Politics, Psychology, Sociology & International Studies, University of Cambridge, Cambridge, CB2 3RQ, UK
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Currie G, Humpreys M, Waring J, Rowley E. Narratives of professional regulation and patient safety: The case of medical devices in anaesthetics. Health, Risk & Society 2009. [DOI: 10.1080/13698570902784257] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rhodes P, Small N, Rowley E, Langdon M, Ariss S, Wright J. Electronic medical records in diabetes consultations: participants' gaze as an interactional resource. Qual Health Res 2008; 18:1247-1263. [PMID: 18689537 DOI: 10.1177/1049732308321743] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Two routine consultations in primary care diabetes clinics are compared using extracts from video recordings of interactions between nurses and patients. The consultations were chosen to present different styles of interaction, in which the nurse's gaze was either primarily toward the computer screen or directed more toward the patient. Using conversation analysis, the ways in which nurses shift both gaze and body orientation between the computer screen and patient to influence the style, pace, content, and structure of the consultation were investigated. By examining the effects of different levels of engagement between the electronic medical record and the embodied patient in the consultation room, we argue for the need to consider the contingent nature of the interface of technology and the person in the consultation. Policy initiatives designed to deliver what is considered best-evidenced practice are modified in the micro context of the interactions of the consultation.
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Affiliation(s)
- Penny Rhodes
- Bradford Institute for Health Research, Royal Infirmary, Duckworth Lane, Bradford, West Yorkshire, United Kingdom.
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Nagai M, Karunakara U, Rowley E, Burnham G. Violence against refugees, non-refugees and host populations in southern Sudan and northern Uganda. Glob Public Health 2008. [DOI: 10.1080/17441690701768904] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Single-use devices are designed, manufactured and sold to be used once and then discarded. This paper addresses growing concerns about the quality of some devices. Single-use devices, manufactured at a lower cost to justify their disposal, are perceived to have a lesser efficacy, which may threaten patient safety through iatrogenic harm. There is, in addition, growing scepticism about the actual risk of contracting variant Creutzfeldt-Jakob disease and other blood-borne diseases from reused surgical instruments. Interview data suggests that when choosing to use a single-use device, clinicians balance concerns about the risk of infection against those about the risk of injury. However, despite reservations about induced harm and the unknown risk of an iatrogenic disease, most clinicians would want single-use devices used on themselves and their family if they were patients.
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Affiliation(s)
- E Rowley
- Institute for Science and Society, West Wing, Law and Social Sciences Building, University Park, University of Nottingham NG7 2RD, UK.
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26
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Rhodes P, Langdon M, Rowley E, Wright J, Small N. What does the use of a computerized checklist mean for patient-centered care? The example of a routine diabetes review. Qual Health Res 2006; 16:353-76. [PMID: 16449686 DOI: 10.1177/1049732305282396] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The authors examine the interaction between nurses and patients with type 2 diabetes during routine consultations in primary care settings in the United Kingdom. Through preconsultation interviews, the authors identified the patients' expectations. The article draws on videotaped consultations with 25 patients with type 2 diabetes. Using conversation analysis, the authors examine the use of a rigid agenda, imposed via a computerized checklist, and consider how far this is able to suppress the patient's agenda. They consider the potential impact for the patient and the factors that might encourage the clinician, and the nurse specifically, to adopt a narrowly task-based approach to the consultation. They identify two potentially conflicting strands within contemporary diabetes care, patient-centered practice and an emphasis on biomedical audit, and suggest that achievement of the former might be compromised by the demands of the latter.
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Affiliation(s)
- Penny Rhodes
- Bradford Teaching Hospitals NHS Trust, United Kingdom
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Iwamoto J, Yeh JK, Schmidt A, Rowley E, Stanfield L, Takeda T, Sato M. Raloxifene and vitamin K2 combine to improve the femoral neck strength of ovariectomized rats. Calcif Tissue Int 2005; 77:119-26. [PMID: 16059775 DOI: 10.1007/s00223-004-0277-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2004] [Accepted: 04/04/2005] [Indexed: 10/25/2022]
Abstract
We evaluated the skeletal effects of two osteoporosis therapies in an ovariectomized rat model, raloxifene and vitamin K2, as well as the vitamin K2 plus raloxifene (K + Ral) combination. In two studies, 6-month-old rats were ovariectomized, except for sham-ovariectomy controls (Sham), and dosed orally with vehicle, 30 mg/kg vitamin K2, 1 mg/kg raloxifene, or the combination of K + Ral for 6 weeks following surgery. Vitamin K2 had no effect on serum estrogen, low-density lipoprotein cholesterol (LDL-C), or urinary deoxypyridinoline levels, but slightly increased osteocalcin levels compared to Ovx. Raloxifene lowered total cholesterol, LDL-C, osteocalcin, and urinary deoxypyridinoline levels to below Ovx levels, while having no effect on estrogen levels. Raloxifene, but not vitamin K2, prevented ovariectomy-induced loss of bone in the distal femoral metaphysis and proximal tibial metaphysis, as did the K + Ral combination. Raloxifene, but not vitamin K2, partially prevented, loss of vertebral bone mineral density (BMD), whereas K + Ral had BMD greater than that of Ovx. Vitamin K2 increased bone formation rate to above Ovx, whereas raloxifene and K + Ral reduced bone formation rate to Sham levels. Vitamin K2 had no effect on eroded surface compared to Ovx, while raloxifene and K + Ral reduced eroded surface to Sham levels. Groups were not different in the BMD of femoral midshaft; however vitamin K2 was observed to increase periosteal mineralizing surface of the tibial shaft to above Ovx, while raloxifene reduced periosteal mineralizing surface toward Sham levels. Femoral neck strength was not different between groups, indicating no significant beneficial effect of either raloxifene or vitamin K2 at this site. However, K + Ral had reproducibly greater femoral neck strength than Ovx or Sham. Raloxifene, but not vitamin K2, partially prevented loss of lumbar vertebra strength; but K + Ral was not different from Sham or Ovx. Therefore, raloxifene and vitamin K2 had complementary effects on bone resorption and formation activities, respectively, resulting in a reproducible, significant improvement of femoral neck strength. These rat data suggest interesting therapeutic possibilities that may require clinical verification.
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Affiliation(s)
- J Iwamoto
- Department of Sports Medicine, Keio University School of Medicine, Tokyo, Japan
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Sato M, Vahle J, Schmidt A, Westmore M, Smith S, Rowley E, Ma LY. Abnormal bone architecture and biomechanical properties with near-lifetime treatment of rats with PTH. Endocrinology 2002; 143:3230-42. [PMID: 12193534 DOI: 10.1210/en.2002-220149] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Skeletal effects are described for near-lifetime treatment of young, female rats with recombinant human PTH (1-34) (PTH). Rats (5-8 wk of age) were administered 0, 5, 30, or 75 microg/kg x d sc PTH for up to 2 yr, as part of an oncogenicity evaluation, which is required by regulatory agencies for potential chronic therapies. Proliferative lesions were observed in the skeleton as described in Vahle et al. (1 ); in this paper, we describe the quantitative bone data for this study. In the appendicular skeleton, PTH stimulated trabecular and endocortical mineral apposition to the near exclusion of marrow spaces at 5 microg/kg, with some periosteal apposition at 30 microg/kg, followed by considerable periosteal apposition and altered geometry at 75 microg/kg. Increased bone mass was observed for all treatment groups that substantially exceeded normal levels attained by vehicle controls and exceeded skeletal efficacy reported previously for similar doses in shorter-term studies. Dose-dependent increases in osteocalcin levels and a linear increase in wet weight of femora were observed for the entire treatment duration, suggesting nearly continuous PTH stimulation of osteoblasts and skeletal growth throughout life. Histology showed many osteocytes and prominent osteoblasts, but a conspicuous absence of osteoclasts. Morphometry showed a lack of distinction between trabecular and cortical bone. Biomechanics of vehicle controls showed that optimal mechanical integrity for the normal skeleton is observed at about 11 months of age. PTH greatly strengthened and stiffened vertebra and femora; however, the midshaft showed reduced toughness and increased brittleness with treatment, which was not the case for vertebra. Related studies of 6 and 9 months duration showed that the optimal duration for PTH skeletal efficacy was about 6 months in rats, based on toughness, strength, ultimate displacement, and architecture, especially for cortical bone. Therefore, treatment duration is an under appreciated aspect of PTH pharmacology; and PTH skeletal effects are a complex function of dose and duration. Comparative analyses showed that short-term treatment (6 months or less) is more advantageous than near-lifetime treatment, because PTH stimulates skeletal growth throughout life, resulting in abnormal architecture and untoward biomechanical properties in rats.
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Affiliation(s)
- M Sato
- Lilly Research Laboratories, Indianapolis, Indiana 46285, USA.
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Stubbs RJ, Hughes DA, Johnstone AM, Rowley E, Ferris S, Elia M, Stratton R, King N, Blundell JE. Description and evaluation of a Newton-based electronic appetite rating system for temporal tracking of appetite in human subjects. Physiol Behav 2001; 72:615-9. [PMID: 11282147 DOI: 10.1016/s0031-9384(00)00440-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study assessed the reliability and validity of a palm-top-based electronic appetite rating system (EARS) in relation to the traditional paper and pen method. Twenty healthy subjects [10 male (M) and 10 female (F)] - mean age M=31 years (S.D.=8), F=27 years (S.D.=5); mean BMI M=24 (S.D.=2), F=21 (S.D.=5) - participated in a 4-day protocol. Measurements were made on days 1 and 4. Subjects were given paper and an EARS to log hourly subjective motivation to eat during waking hours. Food intake and meal times were fixed. Subjects were given a maintenance diet (comprising 40% fat, 47% carbohydrate and 13% protein by energy) calculated at 1.6xResting Metabolic Rate (RMR), as three isoenergetic meals. Bland and Altman's test for bias between two measurement techniques found significant differences between EARS and paper and pen for two of eight responses (hunger and fullness). Regression analysis confirmed that there were no day, sex or order effects between ratings obtained using either technique. For 15 subjects, there was no significant difference between results, with a linear relationship between the two methods that explained most of the variance (r(2) ranged from 62.6 to 98.6). The slope for all subjects was less than 1, which was partly explained by a tendency for bias at the extreme end of results on the EARS technique. These data suggest that the EARS is a useful and reliable technique for real-time data collection in appetite research but that it should not be used interchangeably with paper and pen techniques.
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Affiliation(s)
- R J Stubbs
- Aberdeen Centre for Energy Regulation and Obesity, Rowett Research Institute, Greenburn Road, Bucksburn, Aberdeen, Scotland AB21 9SB, UK.
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Stubbs RJ, Hughes DA, Johnstone AM, Rowley E, Reid C, Elia M, Stratton R, Delargy H, King N, Blundell JE. The use of visual analogue scales to assess motivation to eat in human subjects: a review of their reliability and validity with an evaluation of new hand-held computerized systems for temporal tracking of appetite ratings. Br J Nutr 2000; 84:405-15. [PMID: 11103211 DOI: 10.1017/s0007114500001719] [Citation(s) in RCA: 449] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This present paper reviews the reliability and validity of visual analogue scales (VAS) in terms of (1) their ability to predict feeding behaviour, (2) their sensitivity to experimental manipulations, and (3) their reproducibility. VAS correlate with, but do not reliably predict, energy intake to the extent that they could be used as a proxy of energy intake. They do predict meal initiation in subjects eating their normal diets in their normal environment. Under laboratory conditions, subjectively rated motivation to eat using VAS is sensitive to experimental manipulations and has been found to be reproducible in relation to those experimental regimens. Other work has found them not to be reproducible in relation to repeated protocols. On balance, it would appear, in as much as it is possible to quantify, that VAS exhibit a good degree of within-subject reliability and validity in that they predict with reasonable certainty, meal initiation and amount eaten, and are sensitive to experimental manipulations. This reliability and validity appears more pronounced under the controlled (but more artificial) conditions of the laboratory where the signal:noise ratio in experiments appears to be elevated relative to real life. It appears that VAS are best used in within-subject, repeated-measures designs where the effect of different treatments can be compared under similar circumstances. They are best used in conjunction with other measures (e.g. feeding behaviour, changes in plasma metabolites) rather than as proxies for these variables. New hand-held electronic appetite rating systems (EARS) have been developed to increase reliability of data capture and decrease investigator workload. Recent studies have compared these with traditional pen and paper (P&P) VAS. The EARS have been found to be sensitive to experimental manipulations and reproducible relative to P&P. However, subjects appear to exhibit a significantly more constrained use of the scale when using the EARS relative to the P&P. For this reason it is recommended that the two techniques are not used interchangeably.
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Affiliation(s)
- R J Stubbs
- Rowett Research Institute, Bucksburn, Aberdeen, UK.
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Abstract
LY353381 x HCl is a benzothiophene analog that is structurally related to raloxifene with potent selective estrogen receptor modulator activity in the ovariectomized rat model of postmenopausal osteoporosis. The effects of LY353381 x HCl on bones, body weight, and uterine weight were evaluated in 7-month-old rats with osteopenia that was induced by ovariectomizing animals for 1 month before initiation of treatment with several agents individually, in combination, or in sequence. LY353381 x HCl was administered daily by itself for 90 days, in combination with the amino-terminal fragment of PTH-(1-34) (PTH) for 90 days, or sequentially after PTH when PTH was discontinued after 45 days of treatment. Additionally, comparisons were made of animals treated with PTH alone, 17alpha-ethynyl estradiol alone, equine estrogens (Premarin) alone, raloxifene alone, or combinations of PTH and equine estrogens or raloxifene. Ovariectomy induced increases in the rate of bone turnover and body weight while decreasing bone mineral density, bone mineral content, bone strength, trabecular bone volume, trabecular thickness, trabecular number, and uterine weight. LY353381 x HCl at 0.01-1 mg/kg had marginal effects on body weight and no effect on uterine weight compared with those in ovariectomized controls, in contrast to 17alpha-ethynyl estradiol or equine estrogens. LY353381 x HCl prevented further bone loss due to ovariectomy in tibia, femora, and lumbar vertebra, like 17alpha-ethynyl estradiol but unlike equine estrogens. LY353381 x HCl prevented the resorption of trabecular bone spicules, like 17alpha-ethynyl estradiol, but inhibited bone formation activity to a lesser extent than 17alpha-ethynyl estradiol. In this model, 17alpha-ethynyl estradiol appeared to be more efficacious after 3 months of treatment than equine estrogens in the proximal tibia metaphysis, suggesting efficacy differences between metabolites of 17beta-estradiol in bone. PTH at 10 microg/kg had no effect on body weight or uterine weight, but significantly increased bone mass to beyond those in sham-operated controls, baseline controls, and groups receiving other individual treatments at both axial and appendicular sites. The combination of LY353381 x HCl and PTH increased bone mass at a faster rate and to a greater extent than PTH alone or the combinations of equine estrogens/PTH and raloxifene/PTH at trabecular bone sites. The LY353381 x HCl/PTH combination improved bone mass and quality beyond any agent alone in regions enriched for cancellous bone, but was not significantly better than PTH alone on cortical bone. Additionally, when PTH was discontinued at 45 days, LY353381 x HCl prevented the rapid loss of bone observed in controls. Therefore, LY353381 x HCl appears to be useful by itself, in combination, or in sequence with PTH to replace lost bone in postmenopausal women.
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Affiliation(s)
- M Sato
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, USA.
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Sato M, Turner CH, Wang T, Adrian MD, Rowley E, Bryant HU. LY353381.HCl: a novel raloxifene analog with improved SERM potency and efficacy in vivo. J Pharmacol Exp Ther 1998; 287:1-7. [PMID: 9765314] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Body weight, uteri, serum cholesterol and bones were shown previously in vivo to be sensitive to circulating levels of estrogen, as well as to synthetic, nonsteroidal ligands termed selective estrogen receptor modulators (SERM). In this study, we examined the in vivo effects of a new potent SERM on these tissues in 6-month-old, ovariectomized rats that were orally dosed with 0.0001-10 mg/kg/day LY353381.HCl for 5 weeks. LY353381.HCl prevented the ovariectomy-induced increase in body weight and serum cholesterol levels of treated rats and lowered them to below sham levels in a dose dependent manner, with maximum efficacy similar to estrogen or raloxifene. However, LY353381.HCl was consistently more potent than raloxifene, with a half maximal efficacious dose of 0.001 mg/kg for the reduction of body weight and cholesterol. In the uterus, LY353381.HCl had marginal effects on uterine weight compared to ovariectomized controls (OVX) like raloxifene, but unlike estrogen. Histological examination of uterine epithelial cell height showed little to no stimulatory effect of LY353381.HCl on the endometrium. Quantitative computed tomographic analyses (pQCT) of tibiae showed that LY353381.HCl prevented loss of bone due to ovariectomy with an ED50 of about 0.01 mg/kg with maximal efficacy observed at 0.1-1 mg/kg/day. Maximally attainable bone mineral density and content with LY353381.HCl were not significantly different from Sham or ovariectomized rats treated with estrogen or raloxifene. Interestingly, assessment of bone quality by biomechanical analyses showed that LY353381.HCl preserved the strength of the femora neck and midshaft, while improving the Young's modulus of cortical bone to beyond estrogen, raloxifene or sham levels. In uteri of immature rats treated with estrogen, LY353381.HCl antagonized the estrogen-induced elevation in uterine weight down to vehicle-dosed control levels with ED50 of 0.03 mg/kg/day. Therefore, LY353381.HCl was 30-100 times more potent than raloxifene in preventing ovariectomy effects on body weight, serum cholesterol and bone, while maintaining estrogen antagonist effects on the uterus. These animal data suggest that LY353381.HCl may have advantages over estrogen or raloxifene in the prevention of bone loss and treatment of other tissues in postmenopausal women.
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Affiliation(s)
- M Sato
- Department of Endocrine Research, Lilly Corporate Center, Indianapolis, Indiana, USA.
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Otto RM, Wygand J, Flanagan K, Rowley E, McPhilliamy M, Stewart B. A COMPARISON OF THE METABOLIC RESPONSE TO WALKING ON MOTORIZED AND NON-MOTORIZED TREADMILLS 1156. Med Sci Sports Exerc 1997. [DOI: 10.1097/00005768-199705001-01154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rowley E. Developing local projects in primary health care in Wales. Nurs Times 1995; 91:32-33. [PMID: 7885868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The Edwards' report, a review of community nursing in Wales, offered significant pointers to enhancing the contribution of nurses in the community. In this article, the author describes how nurses in Wales, together with other primary health-care team members, responded to the challenge and achieved good results.
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