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Zeh P, Young A, Gholap N, Randeva H, Robbins T, Johal K, Patel S, O'Hare JP. Diabetes specialist intervention in general practices in areas of deprivation and ethnic diversity: A qualitative evaluation (QUAL-ECLIPSE). Prim Care Diabetes 2024; 18:37-43. [PMID: 37926590 DOI: 10.1016/j.pcd.2023.10.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/21/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
AIM To assess patients' and healthcare professionals' perspectives of a specialist-led Diabetes Risk-based Assessment Clinic (DIRAC) for people with diabetes at high risk of complications (PWDHRC) in areas of deprivation in Coventry, UK. METHODS A qualitative evaluation of a pilot trial, comprising a specialist team intervention (DIRAC), was undertaken in seven GP practices through observations of weekly virtual or occasional face-to-face patient consultations and monthly interventionists' meetings. Semi-structured interviews were carried out post-intervention, with PWDHRC, primary care clinicians and diabetes specialists (interventionists). Thematic analyses of observations and interviews were undertaken. KEY FINDINGS Over 12 months, 28 DIRAC clinics comprising 154 patient consultations and five interventionists' meetings, were observed. 19 interviews were undertaken, PWDHRC experienced 'culturally-sensitive care from a specialist-led clinic intervention encompassing integrated care. This model of care was recommended at GP practice level, all participants (PWDHRC, primary care clinicians and diabetes specialist interventionists) felt upskilled to deal with complex diabetes care. The EMIS and ECLIPSE technologies utilised during the intervention were perceived to positively contribute to diabetes management of PWDHRC despite reservations around cost and database. CONCLUSION The specialist-led DIRACs were largely appreciated by study participants. These qualitative data support the trial progressing to a full-service evaluation.
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Affiliation(s)
- Peter Zeh
- Centre for Healthcare Research, Faculty of Health & Life Sciences, Coventry University, Coventry CV1 5RW, UK; Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK.
| | - Annie Young
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Nitin Gholap
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Harpal Randeva
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Timothy Robbins
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Kam Johal
- Henley Green Medical Centre, Coventry CV2 1AB, UK
| | - Shweta Patel
- University Hospitals of Leicester NHS Trust, LE5 4PW Leicester, UK
| | - J Paul O'Hare
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
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Hoverd E, Cooper J, Shortland S, Zeh P, Bowers B, Tomlinson L, Dyer S, Boyer P, Charlewood J, Finney A. Editorial: Developing research potential in the primary and community-nursing workforce: the impact of a community of practice. Prim Health Care Res Dev 2023; 24:e64. [PMID: 38014428 PMCID: PMC10689090 DOI: 10.1017/s1463423623000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/04/2023] [Accepted: 09/05/2023] [Indexed: 11/29/2023] Open
Affiliation(s)
- Eleanor Hoverd
- Unit of Academic Primary Care, University of Warwick, Warwick Medical School, Coventry, UK
| | - Joanne Cooper
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | | | - Lee Tomlinson
- Kent Community Health NHS Foundation Trust, Ashford, UK
| | - Sandra Dyer
- Royal Free London NHS Foundation Trust, London, UK
| | - Paula Boyer
- Rotherham NHS Foundation Trust, Rotherham, UK
| | - Jen Charlewood
- NHS South of England: NHS England and NHS Improvement South West, Gloucestershire, UK
| | - Andrew Finney
- Keele University School of Nursing and Midwifery, Newcastle-under-Lyme, UK
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He Q, Chen X, Zeh P. Promoting Self-care and Management for Patients With Type 2 Diabetes Based on Lifestyle Changes Under the Concept of Person-centered Care: A Review. Altern Ther Health Med 2023:AT8182. [PMID: 37083654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Context Diabetes, a metabolic disease, can affect multiple organs and systems, including the heart, brain, kidneys, and nerves, and is the seventh leading cause of human death. Professional health education can help modify urbanization-related lifestyle habits, such as diet and physical activity, and is the foundation for self-management of type 2 diabetes. Objective The current review aimed to (1) examine policies and guidelines related to type 2 diabetes in the UK and China; (2) identify lifestyle impacts of the disease; (3) evaluate the barriers and challenges to patients' self-management; (4) investigate diabetes-related health education; (5) investigate methods of support for disease promotion; (6) evaluate the efficacy of self-care; (7) explore various treatment options when diabetes is comorbid with other diseases; and (8) describe the contributions of the health, social, and tertiary sectors involved in chronic disease management. Design The research team performed a narrative review by searching Scopus, PubMed, CINAHL, PsycINFO and Academic Search Complete databases. The search employed the keywords, such as Type 2 Diabetes, lifestyle changes person-centred care, self-care and management. Setting The research is based on the clinical environment in China and the United Kingdom. Results Recently published guidelines on diabetes nutrition and physical activity in the United Kingdom and China encouraged patients to self-manage their diabetes. Although patients are more aware of the need for disease self-management, they need more professional knowledge to manage the disease through lifestyle modifications, such as diet and exercise. Conclusion Managing diabetes necessitates long-term treatments, guidance, and follow-up, with the support of the patients' families, caregivers, and the entire community.
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Lamb SE, Mistry D, Alleyne S, Atherton N, Brown D, Copsey B, Dosanjh S, Finnegan S, Fordham B, Griffiths F, Hennings S, Khan I, Khan K, Lall R, Lyle S, Nichols V, Petrou S, Zeh P, Sheehan B. Aerobic and strength training exercise programme for cognitive impairment in people with mild to moderate dementia: the DAPA RCT. Health Technol Assess 2019; 22:1-202. [PMID: 29848412 DOI: 10.3310/hta22280] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Approximately 670,000 people in the UK have dementia. Previous literature suggests that physical exercise could slow dementia symptom progression. OBJECTIVES To estimate the clinical effectiveness and cost-effectiveness of a bespoke exercise programme, in addition to usual care, on the cognitive impairment (primary outcome), function and health-related quality of life (HRQoL) of people with mild to moderate dementia (MMD) and carer burden and HRQoL. DESIGN Intervention development, systematic review, multicentred, randomised controlled trial (RCT) with a parallel economic evaluation and qualitative study. SETTING 15 English regions. PARTICIPANTS People with MMD living in the community. INTERVENTION A 4-month moderate- to high-intensity, structured exercise programme designed specifically for people with MMD, with support to continue unsupervised physical activity thereafter. Exercises were individually prescribed and progressed, and participants were supervised in groups. The comparator was usual practice. MAIN OUTCOME MEASURES The primary outcome was the Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-Cog). The secondary outcomes were function [as measured using the Bristol Activities of Daily Living Scale (BADLS)], generic HRQoL [as measured using the EuroQol-5 Dimensions, three-level version (EQ-5D-3L)], dementia-related QoL [as measured using the Quality of Life in Alzheimer's Disease (QoL-AD) scale], behavioural symptoms [as measured using the Neuropsychiatric Inventory (NPI)], falls and fractures, physical fitness (as measured using the 6-minute walk test) and muscle strength. Carer outcomes were HRQoL (Quality of Life in Alzheimer's Disease) (as measured using the EQ-5D-3L) and carer burden (as measured using the Zarit Burden Interview). The economic evaluation was expressed in terms of incremental cost per quality-adjusted life-year (QALY) gained from a NHS and Personal Social Services perspective. We measured health and social care use with the Client Services Receipt Inventory. Participants were followed up for 12 months. RESULTS Between February 2013 and June 2015, 494 participants were randomised with an intentional unequal allocation ratio: 165 to usual care and 329 to the intervention. The mean age of participants was 77 years [standard deviation (SD) 7.9 years], 39% (193/494) were female and the mean baseline ADAS-Cog score was 21.5 (SD 9.0). Participants in the intervention arm achieved high compliance rates, with 65% (214/329) attending between 75% and 100% of sessions. Outcome data were obtained for 85% (418/494) of participants at 12 months, at which point a small, statistically significant negative treatment effect was found in the primary outcome, ADAS-Cog (patient reported), with a mean difference of -1.4 [95% confidence interval (CI) -2.62 to -0.17]. There were no treatment effects for any of the other secondary outcome measures for participants or carers: for the BADLS there was a mean difference of -0.6 (95% CI -2.05 to 0.78), for the EQ-5D-3L a mean difference of -0.002 (95% CI -0.04 to 0.04), for the QoL-AD scale a mean difference of 0.7 (95% CI -0.21 to 1.65) and for the NPI a mean difference of -2.1 (95% CI -4.83 to 0.65). Four serious adverse events were reported. The exercise intervention was dominated in health economic terms. LIMITATIONS In the absence of definitive guidance and rationale, we used a mixed exercise programme. Neither intervention providers nor participants could be masked to treatment allocation. CONCLUSIONS This is a large well-conducted RCT, with good compliance to exercise and research procedures. A structured exercise programme did not produce any clinically meaningful benefit in function or HRQoL in people with dementia or on carer burden. FUTURE WORK Future work should concentrate on approaches other than exercise to influence cognitive impairment in dementia. TRIAL REGISTRATION Current Controlled Trials ISRCTN32612072. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full programme and will be published in full in Health Technology Assessment Vol. 22, No. 28. See the NIHR Journals Library website for further project information. Additional funding was provided by the Oxford NIHR Biomedical Research Centre and the Oxford NIHR Collaboration for Leadership in Applied Health Research and Care.
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Affiliation(s)
- Sarah E Lamb
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.,Centre for Rehabilitation Research In Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Dipesh Mistry
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sharisse Alleyne
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Nicky Atherton
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Deborah Brown
- Centre for Rehabilitation Research In Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Bethan Copsey
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Centre for Rehabilitation Research In Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sukhdeep Dosanjh
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Susanne Finnegan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Beth Fordham
- Centre for Rehabilitation Research In Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Frances Griffiths
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Susie Hennings
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Iftekhar Khan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kamran Khan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Samantha Lyle
- Centre for Rehabilitation Research In Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Vivien Nichols
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Zeh
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Bart Sheehan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Zeh P, Cannaby AM, Sandhu HK, Warwick J, Sturt JA. A cross-sectional survey of general practice health workers' perceptions of their provision of culturally competent services to ethnic minority people with diabetes. Prim Care Diabetes 2018; 12:501-509. [PMID: 30145188 DOI: 10.1016/j.pcd.2018.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/26/2018] [Accepted: 07/28/2018] [Indexed: 12/01/2022]
Abstract
AIMS To explore General Practice teams cultural-competence, in particular, ethnicity, linguistic skillset and cultural awareness. The practice teams' access to diabetes-training, and overall perception of cultural-competence were also assessed. METHODS A cross-sectional single-city-survey with one in three people with diabetes from an ethnic minority group, using 35 semi-structured questions was completed. Self-reported data analysed using descriptive statistics, interpreted with reference to the Culturally-Competent-Assessment-Tool. RESULTS Thirty-four (52%) of all 66 practices in Coventry responded between November 2011 and January 2012. KEY FINDINGS (1) One in five practice staff was from a minority group in contrast with one in ten of Coventry's population, (2) 164 practice staff (32%) spoke a second language relevant to the practice's minority population, (3) 56% of practices were highly culturally-competent at providing diabetes services for minority populations, (4) 94% of practices reported the ethnicity of their populations, and (5) the most frequently stated barriers to culturally-competent service delivery were language and knowledge of nutritional habits. CONCLUSIONS Culturally-competent diabetes care is widespread across the city. Language barriers are being addressed, cultural knowledge of diabetes-related-nutrition requires further improvement. Further studies should investigate if structured cultural-competence training for diabetes service providers produces positive effects in diabetes-related outcome-measures in minority populations.
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Affiliation(s)
- Peter Zeh
- Faculty of Health and Life Sciences, Coventry University, Coventry, CV1 5RW, UK; Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK; University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV2 2DX, UK.
| | - Ann-Marie Cannaby
- School of Nursing and Midwifery, Birmingham City University, Birmingham B15 3TN, UK; The Royal Wolverhampton Trust, Wolverhampton WV10 0QP, UK.
| | | | - Jane Warwick
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Jackie A Sturt
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College, London, SE1 8WA, UK.
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Zeh P, Sandhu HK, Cannaby AM, Warwick J, Sturt JA. Exploring culturally competent primary care diabetes services: a single-city survey. Diabet Med 2016; 33:786-93. [PMID: 26484398 PMCID: PMC5063109 DOI: 10.1111/dme.13000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/18/2015] [Accepted: 10/15/2015] [Indexed: 01/08/2023]
Abstract
AIMS To determine the cultural competence of diabetes services delivered to minority ethnic groups in a multicultural UK city with a diabetes prevalence of 4.3%. METHODS A semi-structured survey comprising 35 questions was carried out across all 66 general practices in Coventry between November 2011 and January 2012. Data were analysed using descriptive statistics. The cultural competence of diabetes services reported in the survey was assessed using a culturally competent assessment tool (CCAT). RESULTS Thirty-four general practices (52%) responded and six important findings emerged across those practices. (1) Ninety-four per cent of general practices reported the ethnicity of their populations. (2) One in three people with diabetes was from a minority ethnic group. (3) Nine (26.5%) practices reported a diabetes prevalence of between 55% and 96% in minority ethnic groups. (4) The cultural competences of diabetes services were assessed using CCAT; 56% of practices were found to be highly culturally competent and 26% were found to be moderately culturally competent. (5) Ten practices (29%) reported higher proportionate attendance at diabetes annual checks in the majority white British population compared with minority ethnic groups. (6) Cultural diversity in relation to language and strong cultural traditions around food were most commonly reported as barriers to culturally competent service delivery. CONCLUSIONS Seven of the eight cultural barriers identified in the global evidence were present in the city. Use of the CCAT to assess existing service provision and the good baseline recording of ethnicity provide a sound basis for commissioning culturally competent interventions in the future.
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Affiliation(s)
- P Zeh
- Warwick Medical School, University of Warwick, Coventry, UK
| | - H K Sandhu
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - J Warwick
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J A Sturt
- Florence Nightingale Faculty of Nursing & Midwifery, King's College, London, UK
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Atherton N, Bridle C, Brown D, Collins H, Dosanjh S, Griffiths F, Hennings S, Khan K, Lall R, Lyle S, McShane R, Mistry D, Nichols V, Petrou S, Sheehan B, Slowther AM, Thorogood M, Withers E, Zeh P, Lamb SE. Dementia and Physical Activity (DAPA) - an exercise intervention to improve cognition in people with mild to moderate dementia: study protocol for a randomized controlled trial. Trials 2016; 17:165. [PMID: 27015659 PMCID: PMC4807539 DOI: 10.1186/s13063-016-1288-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia is more common in older than in younger people, and as a result of the ageing of the population in developed countries, it is becoming more prevalent. Drug treatments for dementia are limited, and the main support offered to people with dementia and their families is generally services to mitigate against loss of function. Physical exercise is a candidate non-pharmacological treatment for dementia. METHODS/DESIGN DAPA is a randomised controlled trial funded by the National Institute for Health Research Health Technology Assessment programme to estimate the effect of a 4-month, moderate- to hard-intensity exercise training programme and subsequent advice to remain active, on cognition (primary outcome) at 12 months in people with mild to moderate dementia. Community-dwelling participants (with their carers where possible), who are able to walk 3 metres without human assistance, able to undertake an exercise programme and do not have any unstable or terminal illness are recruited. Participants are then randomised by an independent statistician using a computerised random number generator to usual care or exercise at a 2:1 ratio in favour of exercise. The exercise intervention comprises 29, 1-hour-long exercise classes, run twice weekly at suitable venues such as leisure centres, which include aerobic exercise (on static bikes) and resistance exercise (using weights). Goals for independent exercise are set while the classes are still running, and supported thereafter with phone calls. The primary outcome is measured using ADAS-cog. Secondary outcome measures include behavioural symptoms, functional ability, quality of life and carer burden. Primary and secondary outcomes will be measured at baseline and at 6 and 12 months after randomisation, by researchers masked to participant randomisation in the participants' own homes. An economic evaluation will be carried out in parallel to the RCT, as will a qualitative study capturing the experiences of participants, carers and staff delivering the intervention. DISCUSSION The DAPA study will be the first large, randomised trial of the cognitive effects of exercise on people with dementia. The intervention is designed to be capable of being delivered within the constraints of NHS service provision, and the economic evaluation will allow assessment of its cost-effectiveness. TRIAL REGISTRATION DAPA was registered with the ISRCTN database on 29 July 2011, registration number ISRCTN32612072 .
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Affiliation(s)
- Nicky Atherton
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Chris Bridle
- Lincoln Institute for Health, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Deborah Brown
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Helen Collins
- John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK
| | - Sukhdeep Dosanjh
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Frances Griffiths
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Susie Hennings
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Kamran Khan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Samantha Lyle
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Rupert McShane
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Dipesh Mistry
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Vivien Nichols
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Bart Sheehan
- John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK
| | - Anne-Marie Slowther
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Margaret Thorogood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Emma Withers
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Peter Zeh
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Sarah E Lamb
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK. .,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
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Zeh P, Sandhu HK, Cannaby AM, Sturt JA. Cultural barriers impeding ethnic minority groups from accessing effective diabetes care services: a systematic review of observational studies. ACTA ACUST UNITED AC 2014. [DOI: 10.21767/2049-5471.100001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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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Zeh P, Sandhu HK, Cannaby AM, Sturt JA. The impact of culturally competent diabetes care interventions for improving diabetes-related outcomes in ethnic minority groups: a systematic review. Diabet Med 2012; 29:1237-52. [PMID: 22553954 DOI: 10.1111/j.1464-5491.2012.03701.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [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: 12/16/2022]
Abstract
AIM To examine the evidence on culturally competent interventions tailored to the needs of people with diabetes from ethnic minority groups. METHODS MEDLINE (NHS Evidence), CINAHL and reference lists of retrieved papers were searched from inception to September 2011; two National Health Service specialist libraries were also searched. Google, Cochrane and DARE databases were interrogated and experts consulted. Studies were included if they reported primary research on the impact of culturally competent interventions on outcome measures of any ethnic minority group with diabetes. Paper selection and appraisal were conducted independently by two reviewers. The heterogeneity of the studies required narrative analysis. A novel culturally competent assessment tool was used to systematically assess the cultural competency of each intervention. RESULTS Three hundred and twenty papers were retrieved and 11 included. Study designs varied with a diverse range of service providers. Of the interventions, 64% were found to be highly culturally competent (scoring 90-100%) and 36% moderately culturally competent (70-89%). Data were collected from 2616 participants on 22 patient-reported outcome measures. A consistent finding from 10 of the studies was that any structured intervention, tailored to ethnic minority groups by integrating elements of culture, language, religion and health literacy skills, produced a positive impact on a range of patient-important outcomes. CONCLUSIONS Benefits in using culturally competent interventions with ethnic minority groups with diabetes were identified. The majority of interventions described as culturally competent were confirmed as so, when assessed using the culturally competent assessment tool. Further good quality research is required to determine effectiveness and cost-effectiveness of culturally competent interventions to influence diabetes service commissioners.
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Affiliation(s)
- P Zeh
- Warwick Medical School, University of Warwick, Coventry University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
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Artinger R, Buckau G, Zeh P, Geraedts K, Vancluysen J, Maes A, Kim JI. Humic colloid mediated transport of tetravalent actinides and technetium. RADIOCHIM ACTA 2009. [DOI: 10.1524/ract.91.12.743.23420] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
The humic colloid mediated transport of tetravalent actinide and technetium ions is discussed. Numerous published and new results are used from comparable experimental systems and conditions. The results originate from investigations on two humic rich Gorleben groundwater/sediment systems under near-natural conditions. The conditioning time between groundwater and radionuclides vary from few minutes to four years. The migration time (residence time in the column) is varied from four hours to three days. The concentration of radionuclides added is varied between about 10-12 and 10-4mol/L. Humic colloids in natural groundwater contain trace metal ions in varying concentrations. In addition to studying the behavior of radionuclides added to the groundwater in the laboratory, the dissociation behavior of these natural tetravalent trace metal ions is studied by scavenging dissociating ions with a cation exchanger. The results show a kinetic behavior of the trace metal ion interaction as frequently reported in the literature, i.e. with increasing contact time, slow dissociation modes are progressively populated resulting in an enhanced radionuclide transport. The strong dependency of the radionuclide transport on the radionuclide concentration shows that humic colloid mediated transport may be overestimated if radionuclide concentrations used in laboratory studies are too high. Dissociation of the natural inventory of humic associated tetravalent trace metal ions proceeds with a kinetics comparable to the radionuclides added. This, however, is only observed for a small portion of the inventory and extrapolation beyond the observation range is not permissible. Therefore, the key question for application to predictive modeling of the mobility of tetravalent radionuclides in natural groundwater is if the behavior of the natural trace element inventory is applicable or the behavior of radionuclides added in laboratory studies.
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Kim JI, Delakowitz B, Zeh P, Klotz D, Lazik D. A Column Experiment for the Study of Colloidal Radionuclide Migration in Gorleben Aquifer Systems. RADIOCHIM ACTA 2009. [DOI: 10.1524/ract.1994.6667.s1.165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J. I. Kim
- Institut für Radiochemie, TU München, 85747 Garching, Germany
- Kernforschungszentrum Karlsruhe, Institut für Nukleare Entsorgungstechnik, 76021 Karlsruhe, Germany
| | - B. Delakowitz
- Institut für Radiochemie, TU München, 85747 Garching, Germany
| | - P. Zeh
- Institut für Radiochemie, TU München, 85747 Garching, Germany
| | - D. Klotz
- Institut für Hydrologie, GSF, 85764 Oberschleißheim, Germany
| | - D. Lazik
- Umweltforschungszentrum Leipzig-Halle GmbH, 06246 Bad Lauchstädt, Germany
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Affiliation(s)
- P. Zeh
- echnische Universität München, Institut für Radiochemie, D-85478 Garching, Germany
| | - J. I. Kim
- Forschungszentrum Karlsruhe, Institut für Nukleare Entsorgungstechnik, D-76021 Karlsruhe, Germany
| | - C. M. Marquardt
- Forschungszentrum Karlsruhe, Institut für Nukleare Entsorgungstechnik, D-76021 Karlsruhe, Germany
| | - R. Artinger
- Forschungszentrum Karlsruhe, Institut für Nukleare Entsorgungstechnik, D-76021 Karlsruhe, Germany
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Affiliation(s)
- P. Zeh
- Institut für Radiochemie, Technische Universität München, 85747 Garching
| | - K. R. Czerwinski
- Institut für Radiochemie, Technische Universität München, 85747 Garching
| | - J. I. Kim
- Institut für Radiochemie, Technische Universität München, 85747 Garching
- Forschungszentrum Karlsruhe, Institut für Nukleare Entsorgungstechnik, 76021 Karlsruhe, Germany
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Affiliation(s)
- J. I. Kim
- Institut für Radiochemie, TU München, 8046 Garching, Federal Republic of Germany
| | - P. Zeh
- Institut für Radiochemie, TU München, 8046 Garching, Federal Republic of Germany
| | - Β. Delakowitz
- Institut für Radiochemie, TU München, 8046 Garching, Federal Republic of Germany
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Metzen G, Schultheis R, Zeh P. Verweilzeitmessungen an künstlichen Blutfiltern. BIOMED ENG-BIOMED TE 1980. [DOI: 10.1515/bmte.1980.25.s1.283] [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: 11/15/2022]
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Zeh P, Schultheis R. Ein mathematisches Modell zum Verweilzeitverhalten im künstlichen Teilherzen und Blutpumpen. BIOMED ENG-BIOMED TE 1978. [DOI: 10.1515/bmte.1978.23.s1.280] [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: 11/15/2022]
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