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Robertson S, Cooper C, Hoe J, Lord K, Rapaport P, Marston L, Cousins S, Lyketsos CG, Livingston G. Comparing proxy rated quality of life of people living with dementia in care homes. Psychol Med 2020; 50:86-95. [PMID: 30691541 PMCID: PMC6945323 DOI: 10.1017/s0033291718003987] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/13/2018] [Revised: 10/31/2018] [Accepted: 12/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Improving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes. METHODS We compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews. RESULTS Staff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family's (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as 'Poor' (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents' QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia. CONCLUSION Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently.
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Affiliation(s)
- S. Robertson
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - C. Cooper
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - J. Hoe
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - K. Lord
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - P. Rapaport
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - L. Marston
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - S. Cousins
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - C. G. Lyketsos
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - G. Livingston
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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Fennell D, Hudka M, Darlison L, Lord K, Bzura A, Dzialo J, Pritchard C, Harber J, Takata T, Popat S, Krebs M, Nolan L, Greystoke A, Richards C, Wells-Jordan P, Branson A, Gaba A, Bhundia V, Scotland M, Mohamed S, Dawson A, Poille C, Cowley C, Walter H, King A, Thomas A. P2.06-02 Mesothelioma Stratified Therapy (MiST): A Phase IIA Umbrella Trial for Accelerating the Development of Precision Medicines. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Richardson A, Downs M, Blenkinsopp A, Lord K. UK NURSES’ VIEWS ON THEIR ROLE IN HOSPITAL TO CARE HOME TRANSITIONS FOR PEOPLE LIVING WITH DEMENTIA. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Richardson
- University of Bradford, Bradford, England, United Kingdom
| | - M Downs
- University of Bradford, Bradford, UK
| | | | - K Lord
- University of Bradford, Bradford
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Lord K, Livingston G, Cooper C. HOW TO DEVELOP AND EVALUATE A DECISION AID FOR FAMILY CARERS OF PEOPLE WITH DEMENTIA. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Lord
- Centre for Applied Dementia Studies, University of Bradford, Bradford, England, UK., Bradford, England, United Kingdom
| | - G Livingston
- Division of Psychiatry, University College London (UCL), England, UK
| | - C Cooper
- Division of Psychiatry, University College London (UCL), England, UK
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Tod A, Warnock C, Lord K, Darlison L. MA12.01 The Information Pathway to Randomisation: Patients Experience of the Mesothelioma and Radical Surgery (MARS2) Feasibility Trial. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.412] [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: 10/28/2022]
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Oh A, Rothenberg C, Lord K, Dinh D, Williams J, Parwani V, Ulrich A, Venkatesh A. 138 Assessment of the Cost of Reducing Drug Waste Through Supply Optimization. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.164] [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: 10/18/2022]
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Lord K, D'Onofrio G, Venkatesh A. 228 The Repeal of Connecticut Sunday Alcohol Sale Restrictions did not Increase Emergency Department Visitation. Ann Emerg Med 2014. [DOI: 10.1016/j.annemergmed.2014.07.255] [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: 11/27/2022]
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Vickerstaff V, Sampson EL, Scott S, Davis S, Lord K, Harrington J, Elliott M, Kupeli N, Jones L. SATISFACTION OF CARERS OF PEOPLE WITH ADVANCED DEMENTIA: THEIR EXPERIENCES AT THE OF END OF LIFE. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000653.9] [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: 11/04/2022]
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Symonds RP, Lord K, Mitchell AJ, Raghavan D. Recruitment of ethnic minorities into cancer clinical trials: experience from the front lines. Br J Cancer 2012; 107:1017-21. [PMID: 23011540 PMCID: PMC3461149 DOI: 10.1038/bjc.2012.240] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [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: 11/28/2011] [Revised: 04/20/2012] [Accepted: 05/03/2012] [Indexed: 11/29/2022] Open
Abstract
Throughout the world there are problems recruiting ethnic minority patients into cancer clinical trials. A major barrier to trial entry may be distrust of research and the medical system. This may be compounded by the regulatory framework governing research with an emphasis on written consent, closed questions and consent documentation, as well as fiscal issues. The Leicester UK experience is that trial accrual is better if British South Asian patients are approached by a senior doctor rather than someone of perceived lesser hierarchical status and a greater partnership between the hospital and General Practitioner may increase trial participation of this particular ethnic minority. In Los Angeles, USA, trial recruitment was improved by a greater utilisation of Hispanic staff and a Spanish language-based education programme. Involvement of community leaders is essential. While adhering to national, legal and ethnical standards, information sheets and consent, it helps if forms can be tailored towards the local ethnic minority population. Written translations are often of limited value in the recruitment of patients with no or limited knowledge of English. In some cultural settings, tape-recorded verbal consent (following approval presentations) may be an acceptable substitute for written consent, and appropriate legislative changes should be considered to facilitate this option. Approaches should be tailored to specific minority populations, taking consideration of their unique characteristics and with input from their community leadership.
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Affiliation(s)
- R P Symonds
- Department of Cancer Studies & Molecular Medicine, University of Leicester, Osborne Building, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
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Lord K, Ibrahim K, Kumar S, Rudd N, Mitchell A, Symonds P. Measuring Trust in Healthcare Professionals—A Study of Ethnically Diverse UK Cancer Patients. Clin Oncol (R Coll Radiol) 2012; 24:13-21. [DOI: 10.1016/j.clon.2011.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 04/19/2011] [Accepted: 04/24/2011] [Indexed: 01/26/2023]
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Lord K, Mitchell AJ, Ibrahim K, Kumar S, Rudd N, Symonds P. The beliefs and knowledge of patients newly diagnosed with cancer in a UK ethnically diverse population. Clin Oncol (R Coll Radiol) 2011; 24:4-12. [PMID: 21741225 DOI: 10.1016/j.clon.2011.05.008] [Citation(s) in RCA: 14] [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] [Received: 12/14/2010] [Revised: 04/19/2011] [Accepted: 04/24/2011] [Indexed: 11/30/2022]
Abstract
AIMS To compare knowledge about the outcome of cancer treatment and beliefs about the causes of cancer among British South Asian (BSA) cancer patients of predominantly Gujarati origin with the beliefs held by British White (BW) cancer patients. We also wanted to determine if these beliefs impacted upon the patients' mental health. MATERIALS AND METHODS We administered a questionnaire about cancer beliefs to 94 BSA and 185 BW newly diagnosed cancer patients at the Leicestershire Cancer Centre. Using a Likert seven-item scale, we analysed patients' views on confidentiality, outcome and cancer treatment and 15 items about beliefs about the causes of cancer. Patients also completed the Hospital Anxiety and Depression Scale, Patient Health Questionnaire, Mini-MAC, Distress Thermometer and newly developed Cancer Insight and Denial, and Physician/Patient Trust questionnaires. RESULTS Most (232/279; 83.2%) believed cancer was curable. However, significantly more BSA (10.6% versus 2.7% BW P=0.001) believed cancer was incurable. Although most (86.4%) agreed that smoking can cause cancer, there was a widespread lack of knowledge of the importance of diet and obesity as contributing causes of cancer. There was, in general, an over-emphasis on pollution, stress and injury as important aetiological agents. There was a strong belief in supernatural involvement in the development of cancer among a minority of BSA patients. Twenty per cent of this sample believed that treatment, especially surgery, caused the cancer to spread and this was associated with significant depression in BSAs (P=0.019) and anxiety in both BW (P=0.006) and BSA (P=0.0134) patients. CONCLUSION Our results show that there is a continual need for education about the causes of cancer both in BW and BSA patients.
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Affiliation(s)
- K Lord
- Department of Oncology, Leicester Royal Infirmary, Leicester, UK
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Pradhan AK, Williams TM, Zhang K, Hunter D, Dadson JB, Lord K, Roy UN, Cui Y, Burger A. Growth of aligned ZnO nanorods. J Nanosci Nanotechnol 2006; 6:1985-9. [PMID: 17025113 DOI: 10.1166/jnn.2006.318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Growth of high-density and aligned ZnO nanorods on ZnO film substrate has been demonstrated using vapor-transport of thermally evaporated Zn metal powders followed by condensation. Morphological studies show that the nanorods grow preferentially from a hexagonal ZnO base with a uniform hexagonal structure following three-dimensional island-like growth mechanism. Structural and spectroscopic properties clearly indicate that the nanorods are relatively good and defect-free in quality. These nanorods have potential for technological implications.
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Affiliation(s)
- A K Pradhan
- Center for Materials Research, Norfolk State University, VA 23504, USA
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Nelson M, Lean ME, Connor H, Thomas BJ, Lord K, Hartland B, Waldron S, McGough N, Walker L, Ryan A, Start K. Survey of dietetic provision for patients with diabetes. Diabet Med 2000; 17:565-71. [PMID: 11073177 DOI: 10.1046/j.1464-5491.2000.00337.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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: 11/20/2022]
Abstract
AIMS To survey dietitians involved in diabetes care regarding the provisions for patients with diabetes. METHODS A national survey of 512 dietitians known to be engaged in provision of diabetes care was conducted in 1997 and 391 (76%) responded. RESULTS Nationally the median provision of dietetic care for diabetes reported was 10.7 h per 100,000 general population per week, but the provision was uneven ranging from 2.0 to 27.6 h per 100,000. Eighty-five per cent of dietitians worked in areas where the provision was less than 22 h per 100,000 general population per week (the current recommended minimum standard). Dietetic provision was greater in secondary care (median 9.1 h per 100,000 general population per week) than in general practice, residential homes and other locations (median 4.4 h per 100,000 general population per week). Provision was greater in those areas in which a designated dietitian had responsibility for co-ordinating the dietetic service for diabetes than in areas where the co-ordinator was not a dietitian or where there was no co-ordinator. Over 90% of dietitians reported following British Diabetic Association (BDA) recommendations regarding advice on carbohydrate, sugar, fat and fibre consumption, but only one-third routinely advised on salt restriction. Of the 17% of dietitians who continue to use carbohydrate exchanges, all combine this method with other approaches. Of the recommendations made by the Clinical Standards Group, only 69% of dietitians reported seeing more than half of newly diagnosed adult patients within four weeks, and less than 50% reported offering half or more of their patients an annual review. Amongst the literature in current use, 98% of dietitians use BDA literature for teaching patients and 90% use BDA publications in their own education. Seventy-six per cent of dietitians believed that there was a role for commercial slimming organizations in weight management of people with diabetes. CONCLUSIONS Given the proven value of dietetic input in diabetes management, there would be advantages to correcting the regional inequalities in dietetic provision for diabetes care in the UK.
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Affiliation(s)
- M Nelson
- Department of Nutrition and Dietetics, King's College London, UK
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Affiliation(s)
- R K Miller
- Departments of Obstetrics and Gynecology and of Environmental Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, New York 14642-8668, USA.
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Miller R, Polliotti B, Lord K, Perez D'Gregodo R, Carniero M, Sheikh A. Vertical transmission of HIV and the role of the placenta. Placenta 1998. [DOI: 10.1016/s0143-4004(98)91079-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thomas BJ, Thomas BJ, Brenchley S, Connor H, Elkeles RS, Govindji A, Hartland BV, Lean M, Lord K, Southgate DAT. Diabetic foods and the diabetic diet: A British Diabetic Association Discussion Paper. J Hum Nutr Diet 1992. [DOI: 10.1111/j.1365-277x.1992.tb00155.x] [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: 11/27/2022]
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Lean MEJ, Brenchley S, Connor H, Elkeles RS, Govindji A, Hartland BV, Lord K, Southgate DAT, Thomas BJ. Dietary recommendations for people with diabetes: an update for the 1990s Nutrition Subcommittee of the British Diabetic Association's Professional Advisory Committee. J Hum Nutr Diet 1991. [DOI: 10.1111/j.1365-277x.1991.tb00123.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kinmonth AL, Magrath G, Reckless J, Connor H, Court S, Govindji A, Hartland B, Hockaday T, Lean M, Lord K, Mann J, Metcalfe J, Southgate D, Thomas B. Dietary recommendations for children and adolescents with diabetes. J Hum Nutr Diet 1989. [DOI: 10.1111/j.1365-277x.1989.tb00049.x] [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: 11/26/2022]
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Affiliation(s)
- M Trus
- Department of Biochemistry and Biophysics, University of Pennsylvania School of Medicine, Philadelphia 19104
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Nicholson B, Lord K, Tibbett P, Borningham J. Professional attitudes of R.N.s to human sexuality. Aust Nurses J 1981; 11:51-3. [PMID: 6916604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
Seven laboratories collaborating in a study of two intermediate purity plasminogen preparations (64/23, 63/6) observed that the amount of activator (urokinase or streptokinase) and the time of activation of plasminogen influenced the amount of plasmin generated. Using casein and a synthetic polypeptide (S-2251) as substrates, the authors subsequently showed that complete activation of plasminogen was difficult to achieve without acitivity losses due to plasmin autodigestion. Comparison of the polypeptide subunits (on SDS electrophoresis) of the various plasminogen activation mixtures with their plasmin activity allowed the conclusion that at maximum generation of plasmin from plasminogen, some plasminogen remains in the form of an inactive plasminogen intermediate (PLG-i).
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Abstract
The subunit fibrin composition of thrombi of both venous and arterial origin was examined by sodium dodecyl sulphate gel electrophoresis. The thrombi were recovered by surgical intervention and all had the same fibrin subunit composition. The alpha chains were cross-linked as alpha-chain polymers alpha (p), the gamma chains as gamma-chain dimers (gamma-gamma) while the beta chains were not crosslinked; a further subunit of molecular weight 33 000 was shown to be present in all the fibrins examined and was a degradation fragment of the beta or gamma chains. This data suggests that the crosslinked alpha chains are rate limiting to the lysis of thrombi in vivo. The digestion of pulmonary emboli by plasmin yielded soluble degradation products which were identified as D dimer and E, the latter fragments being the major products obtained by the lysis of in-vitro made plasma clots. The similarity of the composition and lysis of thrombus fibrin to that formed in vitro augurs well for the justification of in-vitro research on mechanisms in thrombolysis.
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