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Flood C, Hirani SP, Mulligan K, Taylor J, Harris S, Wedderburn LR, Newman SP. Economic evaluation of a trial exploring the effects of a web-based support tool for parents of children with juvenile idiopathic arthritis. Rheumatology (Oxford) 2024:keae188. [PMID: 38519117 DOI: 10.1093/rheumatology/keae188] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE To explore the cost-effectiveness of a web-based support tool for parents of children with Juvenile Idiopathic Arthritis. METHODS A multi-centred randomised controlled trial was conducted in paediatric rheumatology centres in England. The WebParC intervention consisted of online information about JIA and its treatment and a toolkit using cognitive-behavioural therapy principles to support parents manage their child's JIA. An economic evaluation was performed alongside the trial involving 220 parents. The primary outcome was the self-report Pediatric Inventory for Parents measure of illness-related parenting stress, with two dimensions; difficulty and frequency. These measures along with costs were assessed post intervention at 4 months and 12 months. Costs were calculated for healthcare usage using a UK NHS economic perspective. Data was collected and analysed on the impact of caring costs on families. Uncertainty around cost effectiveness was explored using bootstrapping and cost-effectiveness acceptability curves. RESULTS The intervention arm showed improved average Pediatric Inventory for Parents scores for the dimensions of frequency and difficulty, of 1.5 and 3.6 respectively at 4 months and. 0.35 and 0.39 at 12 months, representing improved PIP scores for the intervention arm. At both 4 and 12 month follow up the average total cost per case was higher in the control group when compared with the intervention arm with mean differences of £360 (95% CI £29.6 to £691) at 4 months and £203 (95% CI £16 to £390) at 12 months. The probability of the intervention being cost effective ranged between 49% and 54%. CONCLUSION The WebParC intervention led to reductions in primary and secondary healthcare resource use and costs at 4 and 12 months. The intervention demonstrated particular savings for rheumatology services at both follow ups. Future economies of scale could be realised by health providers with increased opportunities for cost effectiveness over time. TRIAL REGISTRATION ISRCTN, ISRCTN13159730.
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Affiliation(s)
- Chris Flood
- Institute of Health and Social Care, London South Bank University, London, UK
- Centre for Health Services Research, School of Health & Psychological Sciences, City, University of London, London, United Kingdom
| | - Shashivadan P Hirani
- Centre for Health Services Research, School of Health & Psychological Sciences, City, University of London, London, United Kingdom
| | - Kathleen Mulligan
- Centre for Health Services Research, School of Health & Psychological Sciences, City, University of London, London, United Kingdom
- East London NHS Foundation Trust, United Kingdom, London
| | - Jo Taylor
- Centre for Health Services Research, School of Health & Psychological Sciences, City, University of London, London, United Kingdom
| | - Sally Harris
- University Hospitals Sussex NHS Trust, Brighton, United Kingdom
| | - Lucy R Wedderburn
- University College London Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Centre for Adolescent Rheumatology Versus Arthritis at University College London Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital, London, United Kingdom
| | - Stanton P Newman
- Centre for Health Services Research, School of Health & Psychological Sciences, City, University of London, London, United Kingdom
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Wong S, Hirani SP, Forbes A, Kumar N, Hariharan R, O'Driscoll J, Sekhar R, Jamous A. Lactobacillus casei Shirota probiotic drinks reduce antibiotic associated diarrhoea in patients with spinal cord injuries who regularly consume proton pump inhibitors: a subgroup analysis of the ECLISP multicentre RCT. Spinal Cord 2024:10.1038/s41393-024-00983-w. [PMID: 38519563 DOI: 10.1038/s41393-024-00983-w] [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] [Received: 06/13/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
STUDY DESIGN This was a sub-group analysis of a multicentre, randomised, placebo-controlled, double-blind trial (ECLISP trial) OBJECTIVES: To assess the efficacy of a probiotic containing at least 6.5 × 109 live Lactobacillus casei Shirota (LcS) in preventing antibiotic associated diarrhoea (AAD) in patients with spinal cord injury (SCI) who consumed proton pump inhibitor (PPI) regularly. LcS or placebo was given once daily for the duration of an antibiotic course and continued for 7 days thereafter. The trial was registered with ISRCTN:13119162. SETTING Three SCI centres (National Spinal Injuries Centre, Midland Centre for Spinal Injuries and Princess Royal Spinal Cord Injuries Centre) in the United Kingdom METHODS: Between November 2014, and November 2019, 95 eligible consenting SCI patients (median age: 57; IQ range: 43-69) were randomly allocated to receive LcS (n = 50) or placebo (n = 45). The primary outcome is the occurrence of AAD up to 30 days after finishing LcS/placebo. RESULTS The LcS group had a significantly lower incidence of AAD at 30 days after finishing the antibiotic course (28.0 v 53.3%, RR: 95% CI: 0.53, 0.31-0.89; z = 2.5, p = 0.01). Multivariate logistic regression analysis identified that LcS can reduce the risk of AAD at 30 days (OR: 0.36, 95% CI 0.13, 0.99, p < 0.05). No intervention-related adverse events were reported during the study. CONCLUSIONS LcS has the potential to prevent AAD in what could be considered a defined vulnerable group of SCI patients on regular PPI. A confirmatory, randomised, placebo-controlled study is needed to confirm this apparent therapeutic success to translate it into appropriate clinical outcomes. SPONSORSHIP Yakult Honsha Co., Ltd.
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Affiliation(s)
- Samford Wong
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK.
- School of Health & Psychological Sciences, City, University of London, London, UK.
- Royal Buckinghamshire Hospital, Aylesbury, UK.
| | - Shashivadan P Hirani
- School of Health & Psychological Sciences, City, University of London, London, UK
| | - Alastair Forbes
- University of Tartu, Estonia, and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Naveen Kumar
- Midland Centre for Spinal Injury, Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, UK
| | - Ramaswamy Hariharan
- The Princess Royal Spinal Injuries Centre, Northern General Hospital, Sheffield, UK
| | - Jean O'Driscoll
- Department of Microbiology, Stoke Mandeville Hospital, Aylesbury, UK
| | - Ravi Sekhar
- Department of Gastroenterology, Stoke Mandeville Hospital, Aylesbury, UK
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Wang W, Tong G, Hirani SP, Newman SP, Halpern SD, Small DS, Li F, Harhay MO. A mixed model approach to estimate the survivor average causal effect in cluster-randomized trials. Stat Med 2024; 43:16-33. [PMID: 37985966 DOI: 10.1002/sim.9939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/05/2023] [Accepted: 10/12/2023] [Indexed: 11/22/2023]
Abstract
In many medical studies, the outcome measure (such as quality of life, QOL) for some study participants becomes informatively truncated (censored, missing, or unobserved) due to death or other forms of dropout, creating a nonignorable missing data problem. In such cases, the use of a composite outcome or imputation methods that fill in unmeasurable QOL values for those who died rely on strong and untestable assumptions and may be conceptually unappealing to certain stakeholders when estimating a treatment effect. The survivor average causal effect (SACE) is an alternative causal estimand that surmounts some of these issues. While principal stratification has been applied to estimate the SACE in individually randomized trials, methods for estimating the SACE in cluster-randomized trials are currently limited. To address this gap, we develop a mixed model approach along with an expectation-maximization algorithm to estimate the SACE in cluster-randomized trials. We model the continuous outcome measure with a random intercept to account for intracluster correlations due to cluster-level randomization, and model the principal strata membership both with and without a random intercept. In simulations, we compare the performance of our approaches with an existing fixed-effects approach to illustrate the importance of accounting for clustering in cluster-randomized trials. The methodology is then illustrated using a cluster-randomized trial of telecare and assistive technology on health-related QOL in the elderly.
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Affiliation(s)
- Wei Wang
- Clinical Trials Methods and Outcomes Lab, Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Guangyu Tong
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
| | | | - Stanton P Newman
- School of Health Sciences, City University London, London, UK
- Division of Medicine, University College London, London, UK
| | - Scott D Halpern
- Clinical Trials Methods and Outcomes Lab, Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dylan S Small
- Department of Statistics and Data Science, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Fan Li
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
| | - Michael O Harhay
- Clinical Trials Methods and Outcomes Lab, Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Giles M, Terblanche M, Wang L, Hirani SP, Wu C(J. The impact of COVID-19 on Australian clinicians' decision making in line with the principles of Choosing Wisely. Nurs Open 2023; 10:7788-7795. [PMID: 37828732 PMCID: PMC10643817 DOI: 10.1002/nop2.2026] [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: 05/24/2023] [Revised: 08/29/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
AIM To explore the perspectives of clinicians' decision-making processes and considerations in line with the Choosing Wisely principles during the first wave of the COVID-19 pandemic. DESIGN An exploratory qualitative approach was used. METHODS Data were collected via semi-structured interviews to encourage participants to discuss their own experience in making clinical decisions during the COVID-19 pandemic. A total of 12 clinicians from across disciplines were interviewed to reach data saturation. Interview data were analysed considering the Choosing Wisely principles. RESULTS Five main themes as they relate to clinician decision-making emerged and included; prioritizing care and treatment, uncertainty regarding best practice as a result of rapidly changing guidelines, organizational challenges to clinical decision-making, the use of telehealth and enabling consumer engagement with health services. CONCLUSION Despite the disruption caused by COVID-19, clinicians were mindful of necessary care and worked to ensure that core care was not compromised during the first wave of the pandemic. The need for clinicians to protect both their own safety and that of their colleagues arose as an additional factor that influenced clinicians' decision-making process during the COVID-19 pandemic.
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Affiliation(s)
- Megan Giles
- Principal Advisor – Quality Improvement, Safety Quality & InnovationSunshine Coast Hospital and Health ServiceQueenslandBirtinyaAustralia
- Sunshine Coast Health InstituteQueenslandBirtinyaAustralia
| | - Morne Terblanche
- Safety Quality & InnovationSunshine Coast Hospital and Health ServiceQueenslandBirtinyaAustralia
| | - Liang Wang
- Nursing Laboratory Technician, School of HealthUniversity of the Sunshine CoastQueenslandPetrieAustralia
| | | | - Chiung‐Jung (Jo) Wu
- School of HealthUniversity of Sunshine CoastQueenslandPetrieAustralia
- Royal Brisbane and Women's Hospital (RBWH)HerstonQueenslandAustralia
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Williams HR, Wood G, Hakim AJ, Birchall M, Hirani SP. Self-reported throat symptoms in Ehlers-Danlos syndromes and hypermobility spectrum disorders: A cross-sectional survey study. Laryngoscope Investig Otolaryngol 2023; 8:1259-1264. [PMID: 37899864 PMCID: PMC10601551 DOI: 10.1002/lio2.1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives This study identified the frequency and severity of dysphagia, dysphonia, and laryngopharyngeal reflux symptoms in people with Ehlers-Danlos syndromes (EDS) or hypermobility spectrum disorders (HSD) and explored differences between diagnostic groups. Methods Participants were recruited via non-probability convenience sampling. Information was gathered via online survey, including the Reflux Symptom Index (RSI; Belafsky et al., J Voice. 2002;16:274-277), the Eating and Drinking Assessment Tool (EAT-10; Belafsky et al., Ann Otol Rhinol Laryngol. 2008;117:919-924), and the Voice Handicap Index (VHI; Jacobson et al., Am J Speech Lang Pathol. 1997;6(3):66-70). These were analyzed using ANOVAs. Results There were 1620 participants (96.6% female, 2.8% male) that met the inclusion criteria. The mean age was 38.09 (SD 12.22). 75.51% had hypermobile EDS (hEDS), 17.83% had HSD and 3.33% had classic EDS (cED). The cohort's mean scores were RSI = 22.95 (SD 9.01), EAT-10 = 11.91 (SD 9.66), and VHI score = 31.99 (SD 24.36). The hEDS group had significantly higher mean scores than the HSD group on RSI score and on some RSI items, on EAT-10 score and on all EAT-10 items, and on one VHI item. Conclusion People with EDS/HSD experience symptoms of acid reflux, dysphagia, and dysphonia to varying degrees with significant differences between hEDS than HSD. Awareness of the impact of EDS/HSD on throat symptoms will enable health care professionals to anticipate throat symptoms more readily in this population, providing individualized and effective management plans. Level of Evidence IV.
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Affiliation(s)
- Hannah R. Williams
- School of Health and Psychological SciencesCity, University of LondonLondonUK
- Surrey and Sussex Healthcare NHS TrustLondonUK
| | - Gary Wood
- University College London HospitalsLondonUK
- UCL Ear InstituteUniversity College London, University of LondonLondonUK
| | - Alan J. Hakim
- University College London HospitalsLondonUK
- The Wellington Hospital, HCA HealthcareUKLondonUK
| | - Martin Birchall
- University College London HospitalsLondonUK
- UCL Ear InstituteUniversity College London, University of LondonLondonUK
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Llahana S, Mulligan K, Hirani SP, Wilson S, Baldeweg SE, Grossman A, Norton C, Sharman P, McBride P, Newman S. Using the behaviour change wheel and person-based approach to develop a digital self-management intervention for patients with adrenal insufficiency: the Support AI study protocol. Front Endocrinol (Lausanne) 2023; 14:1207715. [PMID: 37455898 PMCID: PMC10349524 DOI: 10.3389/fendo.2023.1207715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Most patients with Adrenal insufficiency (AI) require lifelong glucocorticoid replacement. They need to increase glucocorticoids during physical illness or major stressful situations and require parenteral hydrocortisone in the event of an adrenal crisis. Patients with AI have impaired quality of life and high mortality; approximately 1 in 6-12 patients are hospitalised at least once/year from a potentially preventable adrenal crisis. Adoption of self-management behaviours are crucial; these include adherence to medication, following "sick day rules" and associated behaviours that aid prevention and treatment of adrenal crisis such as symptom monitoring, having extra tablets, carrying a medical-alert ID and injection kit, and self-injecting when necessary. Current patient education is ineffective at supporting self-management behaviour change or reducing adrenal crisis-related hospitalisations. This research study aims to gain an in-depth understanding of the barriers and enablers to self-management for patients with AI and to develop an evidence-based digital self-management behaviour change intervention. Methods The study is conducted in accordance with the MRC Framework for developing complex interventions. Underpinned by the Behaviour Change Wheel (BCW), the Theoretical Domains Framework (TDF), and the Person-Based Approach, this research will be conducted in two phases: Phase 1 will involve a sequential qualitative/quantitative mixed-methods study involving focus group interviews followed by a cross-sectional survey with patients with AI recruited from patient advocacy groups and endocrine clinics in the UK. Phase 2 will develop the Support AI, a website-based digital behaviour change intervention (DBCI) informed by Phase 1 findings to support self-management for patients with AI. The most appropriate behaviour change techniques (BCTs) will be selected utilising a nominal group technique with an Expert Panel of 10-15 key stakeholders. The design of the Support AI website will be guided by the Person-Based Approach using an Agile iterative "think-aloud" technique with 12-15 participants over 3 usability testing iterations. Conclusion A theory- and evidence-based digital behaviour change intervention will be developed which will be tested in a feasibility randomised trial following completion of this study. The projected benefit includes cost-effective health care service (reduced hospitalisations and demand for specialist services) and improved health outcomes and quality of life for patients with AI.
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Affiliation(s)
- Sofia Llahana
- School of Health & Psychological Sciences, City, University of London, London, United Kingdom
- Department of Diabetes and Endocrinology, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Kathleen Mulligan
- School of Health & Psychological Sciences, City, University of London, London, United Kingdom
- Community Health Newham, East London National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Shashivadan P. Hirani
- School of Health & Psychological Sciences, City, University of London, London, United Kingdom
| | - Stephanie Wilson
- Centre for Human Computer Interaction (HCI) Design, School of Science and Technology, City, University of London, London, United Kingdom
| | - Stephanie E. Baldeweg
- Department of Diabetes and Endocrinology, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom
- Centre for Obesity and Metabolism, Department of Experimental and Translational Medicine, Division of Medicine, University College London, London, United Kingdom
| | - Ashley Grossman
- Neuroendocrine Tumour (NET) Unit, Royal Free Hospital, London, United Kingdom
- Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Philippa Sharman
- The Addison’s Disease Self-Help Group Patient Advocacy Group, Bristol, United Kingdom
| | - Pat McBride
- The Pituitary Foundation Patient Advocacy Group, Bristol, United Kingdom
| | - Stanton Newman
- School of Health & Psychological Sciences, City, University of London, London, United Kingdom
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Tong G, Li F, Chen X, Hirani SP, Newman SP, Wang W, Harhay MO. A Bayesian Approach for Estimating the Survivor Average Causal Effect When Outcomes Are Truncated by Death in Cluster-Randomized Trials. Am J Epidemiol 2023; 192:1006-1015. [PMID: 36799630 PMCID: PMC10236525 DOI: 10.1093/aje/kwad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/05/2023] [Accepted: 02/18/2023] [Indexed: 02/18/2023] Open
Abstract
Many studies encounter clustering due to multicenter enrollment and nonmortality outcomes, such as quality of life, that are truncated due to death-that is, missing not at random and nonignorable. Traditional missing-data methods and target causal estimands are suboptimal for statistical inference in the presence of these combined issues, which are especially common in multicenter studies and cluster-randomized trials (CRTs) carried out among the elderly or seriously ill. Using principal stratification, we developed a Bayesian estimator that jointly identifies the always-survivor principal stratum in a clustered/hierarchical data setting and estimates the average treatment effect among them (i.e., the survivor average causal effect (SACE)). In simulations, we observed low bias and good coverage with our method. In a motivating CRT, the SACE and the estimate from complete-case analysis differed in magnitude, but both were small, and neither was incompatible with a null effect. However, the SACE estimate has a clear causal interpretation. The option to assess the rigorously defined SACE estimand in studies with informative truncation and clustering can provide additional insight into an important subset of study participants. Based on the simulation study and CRT reanalysis, we provide practical recommendations for using the SACE in CRTs and software code to support future research.
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Affiliation(s)
- Guangyu Tong
- Correspondence to Dr. Guangyu Tong, Department of Biostatistics, Yale School of Public Health, 135 College Street, New Haven, CT 06510 (e-mail: )
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Dwek MR, Newman SP, Brini S, Holder P, Machesney M, Propper D, Rixon LR, Hirani SP, Hurt CS. The impact of chemotherapy on cognitive performance post-surgery in patients with colorectal cancer: A prospective cohort study. Psychooncology 2023. [PMID: 37208950 DOI: 10.1002/pon.6147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/15/2023] [Accepted: 04/16/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Subjective reports of cognitive impairment following chemotherapy are frequent in cancer patients. Objective cognitive impairment has been observed in cancer patients regardless of treatment regimen suggesting the relationship between cognitive impairment and chemotherapy is not clear cut. Little research has explored the effects of chemotherapy on cognition following surgery in colorectal cancer (CRC). The present study explored the effects of chemotherapy on cognitive performance in a sample of CRC patients. METHODS 136 participants were recruited into a prospective cohort study: 78 CRC patients undergoing surgery and adjuvant chemotherapy, 58 CRC patients undergoing surgery only. A battery of neuropsychological tests was administered to participants 4 weeks post-surgery (T1), 12 weeks after first chemotherapy (T2) and 3 months after last chemotherapy (T3) or equivalent time-points. RESULTS Using the criterion of scoring at least two standard-deviations below the group norm on at least one neuropsychological test, 45%-55% of all CRC patients showed cognitive deficits 10 months after surgery (T3) and 14% on at least 3 tests. However, cognition did not significantly differ between patients who had chemotherapy and those who did not. A time by group interaction effect was found on the composite cognition score using multi-level modelling suggesting a greater improvement in cognition in the surgery only group over time (p < 0.05). CONCLUSIONS CRC patients display cognitive impairment 10 months after surgery. Chemotherapy did not worsen cognitive impairment but did appear to slow cognitive recovery relative to those undergoing surgery only. The findings demonstrate a clear need for supportive cognitive interventions for all CRC patients following treatment.
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Affiliation(s)
- Marie-Rose Dwek
- Centre for Health Services Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Stanton P Newman
- Centre for Health Services Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Stefano Brini
- Centre for Health Services Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Pru Holder
- Centre for Health Services Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | | | - David Propper
- Centre for Tumour Microenvironment, Barts Cancer Institute-A CRUK Centre of Excellence, Queen Mary University of London, London, UK
| | - Lorna R Rixon
- Centre for Health Services Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Shashivadan P Hirani
- Centre for Health Services Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Catherine S Hurt
- Centre for Health Services Research, School of Health and Psychological Sciences, City, University of London, London, UK
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Cormican A, Hirani SP, McKeown E. Healthcare professionals' perceived barriers and facilitators of implementing clinical practice guidelines for stroke rehabilitation: A systematic review. Clin Rehabil 2023; 37:701-712. [PMID: 36475911 PMCID: PMC10041573 DOI: 10.1177/02692155221141036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 10/26/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify healthcare professionals' perceived barriers and facilitators to clinical practice guideline implementation within stroke rehabilitation. DATA SOURCES CINAHL, MEDLINE, EMBASE, AMED, Cochrane library, Academic Search Complete and Scopus. Additional papers were identified through hand searching. REVIEW METHODS The review followed the Preferred Reporting Item for Systematic Reviews and Meta-Analysis Protocols systematic review approach. Any empirical research that provided qualitative data on healthcare professionals' perceived factors influencing clinical guideline implementation in stroke rehabilitation was included. One reviewer screened all titles and abstract reviews (n = 669). Another two reviewers independently screened 30% of title and abstract reviews, followed by full-text reviews (n = 61). Study quality was assessed using the mixed-method appraisal tool. RESULTS Data from 10 qualitative, six quantitative and six mixed-method studies published between 2000 and 2022, involving 1576 participants in total, were analysed and synthesised using modified thematic synthesis approach. The majority of participants were therapists n = 1297 (occupational therapists, physiotherapists, speech and language therapists). Organisational factors (time constraints, resources) alongside healthcare professionals' lack of knowledge and skills were the most cited barriers to guideline implementation. Contradictory attitudes and beliefs towards stroke guidelines applicability to real-life clinical practice and their evidence base were reported. Organisational support in the form of training, local protocols, performance monitoring and leadership were reported as perceived facilitators. CONCLUSION Barriers and facilitators are multifactorial and were identified at guideline, individual, team and organisational levels. There is a need to translate perceived barriers and facilitators into implementation interventions especially addressing organisational-level barriers.
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Affiliation(s)
| | | | - Eamonn McKeown
- Health Services Research & Management Division, School of Health Sciences City, University of London, London, UK
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van de Venter R, Skelton E, Matthew J, Tarroni G, Hirani SP, Woznitza N, Kumar A, Malik R, Malamateniou C. A postgraduate introductory module in artificial intelligence for radiographers: experiences of students and educators. J Med Imaging Radiat Sci 2022. [DOI: 10.1016/j.jmir.2022.10.024] [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: 12/03/2022]
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Volkmer B, Lorencatto F, Stanworth SJ, Hirani SP, Francis JJ. Blood transfusion in haematology: A qualitative exploration of patients' and healthcare professionals' perceptions. Br J Health Psychol 2022; 27:1241-1274. [PMID: 35543198 PMCID: PMC9790503 DOI: 10.1111/bjhp.12597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 03/30/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Repeated blood transfusions are indicated for the management of patients with cancer or blood disorders. Patients' perceptions about transfusions may be associated with decision-making and coping, which has been under-explored in the haematology context. This study therefore aimed to explore haematology transfusion patients' and HCPs' perceptions of blood transfusion, drawing on theory and previously identified themes of transfusion perceptions. DESIGN Semi-structured interview study with 14 adult blood transfusion patients and 14 HCPs (consultants, registrars, nurses) at two UK haematology units. METHODS Patient- and HCP-tailored topic guides were developed based on themes of blood transfusion perceptions identified in a systematic review: 'Health benefits', 'Safety/risk', 'Negative emotions', 'Alternatives' 'Decision making' and 'Necessity'. Transcripts were analysed using deductive and thematic analysis. Patient and HCP themes were compared using triangulation methods. Conceptual models (one for patients, one for HCPs) specific to haematology portraying the association between themes were developed. RESULTS Findings for patients and HCPs converged with transfusion reported as beneficial for patients, who were largely involved in the decision-making. Both groups also reported concerns about transfusion, including iron-overload, allergic reactions and challenges to deliver transfusions in time-pressurized services. Themes in the conceptual models included patient 'Burden' of receiving repeated transfusions and 'Supportive relationships', reflective of patients' positive interactions with other patients and HCPs in the haematology unit. CONCLUSION Despite the challenges for patients receiving repeated transfusions, convergent perceptions suggest a shared understanding of patients' transfusion experiences. Identified challenges could inform ways to improve transfusion services and patients' experiences.
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Affiliation(s)
- Brittannia Volkmer
- Centre for Health Services ResearchSchool of Health SciencesCity, University of LondonLondonUK
| | | | - Simon J. Stanworth
- NHS Blood and Transplant/ Oxford University Hospitals NHS Foundation TrustJohn Radcliffe HospitalOxfordUK,Oxford Clinical Research in Transfusion MedicineUniversity of OxfordOxfordUK
| | - Shashivadan P. Hirani
- Centre for Health Services ResearchSchool of Health SciencesCity, University of LondonLondonUK
| | - Jill J. Francis
- School of Health SciencesUniversity of MelbourneMelbourneVictoriaAustralia,Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
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12
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Ramachandran A, Hilari K, Epstein R, Devane N, Hirani SP. Voice Related Coping in Professional Voice Users-A Systematic Review. J Voice 2022:S0892-1997(22)00265-X. [PMID: 36243556 DOI: 10.1016/j.jvoice.2022.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This systematic review explored coping with voice problems in professional voice users. The objectives were to: 1) evaluate how voice-related coping is assessed in professional voice users 2) investigate how they cope with voice problems, and 3) identify factors associated with voice-related coping. DESIGN Systematic review. METHODS A systematic literature search of ten electronic databases using both EBSCOhost and OVID online platforms was conducted following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Only peer-reviewed articles which assessed coping in the context of voice problems in professional voice users were included. Methodological quality was assessed using Johanna-Briggs Institute Critical Appraisal checklists. Data analysis was conducted using narrative synthesis. RESULTS Following deduplication, abstract and full-text screening, seven articles were included in the review. All participants (n=2484) were teachers; no other professional voice users were covered. 98% of the cases studied were females. The tools used to assess voice-related coping were Utrecht Coping List (UCL) and Voice Disability Coping Questionnaire (VDCQ). Studies which used UCL reported a passive coping pattern in teachers with high vocal handicap whereas VDCQ showed increased use of social support. Factors associated with coping were not examined by any of the studies. CONCLUSION Seeking social support was highlighted as a frequently used coping strategy across studies and measures. Teachers with high vocal handicap used a passive coping pattern and active coping styles were not significantly used. Current evidence does not sufficiently specify factors affecting coping in professional voice users. More research on voice-related coping involving all professional voice users is warranted to identify associated factors and further ascertain its influence on vocal health.
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Affiliation(s)
- Aparna Ramachandran
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom.
| | - Katerina Hilari
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Ruth Epstein
- Department of Speech and language therapy (ENT), Royal National Ear Nose and Throat and Eastman Dental Hospital, London, United Kingdom; Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Niamh Devane
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Shashivadan P Hirani
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
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13
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McKeown E, McGraw C, Holder P, Shand J, Hirani SP. Acceptability and Impact of an Educational App (iCare) for Informal Carers Looking After People at Risk of Pressure Ulceration: Mixed Methods Pilot Study. JMIR Form Res 2022; 6:e36517. [PMID: 36112413 PMCID: PMC9526110 DOI: 10.2196/36517] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Pressure ulcers are areas of skin damage resulting from sustained pressure. Informal carers play a central role in preventing pressure ulcers among older and disabled people living at home. Studies highlight the paucity of pressure ulcer training for informal carers and suggest that pressure ulcer risk is linked to high levels of carer burden.
Objective
This pilot study evaluated a smartphone app with a specific focus on pressure ulcer prevention education for informal carers. The app was developed based on the principles of microlearning. The study aimed to explore carer perspectives on the acceptability of the app and determine whether the app increased knowledge and confidence in their caring role.
Methods
In this concurrent mixed methods study, participants completed quantitative questionnaires at baseline and at the end of weeks 2 and 6, which examined caregiving self-efficacy, preparedness for caregiving, caregiver strain, pressure ulcer knowledge, and app acceptability and usability. A subsample of participants participated in a “think aloud” interview in week 1 and semistructured interviews at the end of weeks 2 and 6.
Results
Of the 32 participants, 23 (72%) participants completed the week 2 and 16 (50%) completed the week 6 questionnaires; 66% (21/32) of carers participated in qualitative “think aloud” interviews, and 18 (56%) also participated in semistructured interviews at week 2, and 13 (41%) at week 6. Pressure ulcer knowledge scores significantly changed (F1,6.112=21.624; P=.001) from baseline (mean 37.5; SE 2.926) to the second follow-up (mean 59.72, SE 3.985). Regarding the qualitative data, the theme “I’m more careful now and would react to signs of redness” captured participants’ reflections on the new knowledge they had acquired, the changes they had made to their caring routines, their increased vigilance for signs of skin damage, and their intentions toward the app going forward. There were no significant results pertaining to improved preparedness for caregiving or caregiving self-efficacy or related to the Caregiver Strain Index. Participants reported above average usability scores on a scale of 0 to 100 (mean 69.94, SD 18.108). The app functionality and information quality were also rated relatively high on a scale of 0 to 5 (mean 3.84, SD 0.704 and mean 4.13, SD 0.452, respectively). Overall, 2 themes pertaining to acceptability and usability were identified: “When you’re not used to these things, they take time to get the hang of” and “It’s not a fun app but it is informative.” All participants (n=32, 100%) liked the microlearning approach.
Conclusions
The iCare app offers a promising way to improve informal carers’ pressure ulcer knowledge. However, to better support carers, the findings may reflect the need for future iterations of the app to use more interactive elements and the introduction of gamification and customization based on user preferences.
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Affiliation(s)
- Eamonn McKeown
- School of Health & Psychological Sciences, City, University of London, London, United Kingdom
| | - Caroline McGraw
- School of Health & Psychological Sciences, City, University of London, London, United Kingdom
| | - Pru Holder
- School of Health & Psychological Sciences, City, University of London, London, United Kingdom
| | - Jenny Shand
- Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Shashivadan P Hirani
- School of Health & Psychological Sciences, City, University of London, London, United Kingdom
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14
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Goozee R, Barrable A, Lubenko J, Papadatou-Pastou M, Haddad M, McKeown E, Hirani SP, Martin M, Tzotzoli P. Investigating the feasibility of MePlusMe, an online intervention to support mental health, well-being, and study skills in higher education students. J Ment Health 2022:1-11. [PMID: 35549804 DOI: 10.1080/09638237.2022.2069699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/17/2021] [Accepted: 01/14/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION While there are several web-based mental health interventions, few target higher education (HE) students. Importantly, more research is needed to establish their effectiveness. Here, we provide a pragmatic evaluation of an online intervention (MePlusMe) specifically designed to improve the mental health, well-being, and study skills of HE students. METHODS In accordance with the published protocol for a feasibility study, we recruited a convenience sample of 137 HE students to participate in an eight-week intervention, with 26 participants retained at week 8. Validated measures of mood (depression and anxiety), well-being, and self-efficacy were collected at baseline, 2, 4, and 8 weeks, alongside two feedback forms assessing design and functionality (baseline) and engagement (week 4 and 8). RESULTS We observed significant reductions in levels of anxiety and depression as well as increases in well-being, but no changes in self-efficacy. Participants rated the system design and functionality positively and qualitative findings indicated high levels of satisfaction with MePlusMe. DISCUSSION Findings support both the acceptability and the effectiveness of MePlusMe. Nonetheless, modest retention rates limit the precision and generalisability of these findings. Further investigation should ascertain optimal duration of engagement, most acceptable means of outcome assessment, and further detail about obstacles to utilisation.
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Affiliation(s)
| | - Alexia Barrable
- School of Education and Social Work, University of Dundee, Dundee, UK
| | - Jelena Lubenko
- Department of Health Psychology and Paedagogy, Rīga Stradiņš University, Rīga, Latvia
| | | | - Mark Haddad
- School of Health Sciences, City, University of London, London, UK
| | - Eamonn McKeown
- School of Health Sciences, City, University of London, London, UK
| | | | - Maryanne Martin
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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15
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Kukafka R, Hirani SP, Harris S, Taylor J, Wedderburn LR, Newman S. The Effects of a Web-Based Tool for Parents of Children With Juvenile Idiopathic Arthritis: Randomized Controlled Trial. J Med Internet Res 2022; 24:e29787. [PMID: 35551065 PMCID: PMC9136652 DOI: 10.2196/29787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 12/10/2021] [Accepted: 12/17/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a group of autoinflammatory diseases that cause pain and disability if not controlled by treatment. Parenting a child with JIA is stressful for parents, who express concerns about their child's treatment and may experience anxiety and powerlessness concerning their child's illness. Parenting stress is greater in parents of children with chronic illness than in those with healthy children and is related to poorer psychological adjustment in both parents and children. It is therefore important to develop interventions to support parents. This paper reports the evaluation of a web-based tool that provides information and practical skills to help increase parents' confidence in managing their child's illness and reduce parenting stress. OBJECTIVE The aim of this study is to evaluate the benefits of a web-based tool (WebParC) for parents of children with recently diagnosed JIA. METHODS A multicentered randomized controlled trial was conducted at pediatric rheumatology centers in England. We recruited parents of children aged ≤12 years who had been diagnosed with JIA within the previous 6 months. They were randomized to the intervention (WebParC access plus standard care) or the control (standard care alone) and followed up 4 months and 12 months after randomization. Where both parents participated, they were randomized by household to the same trial arm. The WebParC intervention consists of information about JIA and its treatment plus a toolkit, based on cognitive behavioral therapy, to help parents develop skills to manage JIA-related issues. The primary outcome was the self-report Pediatric Inventory for Parents measure of illness-related parenting stress. The secondary outcomes were parental mood, self-efficacy, coping, effectiveness of participation in their child's health care, satisfaction with health care, and child's health-related quality of life. RESULTS A total of 203 households comprising 220 parents were randomized to the intervention (100/203, 49.3%) or control (103/203, 50.7%) arm. Follow-up assessments were completed by 65.5% (133/203) of the households at 4 months (intervention 60/100, 60%, and control 73/103, 70.9%) and 61.1% (124/203) of the households at 12 months (intervention 58/100, 58%, and control 66/103, 64.1%). A main effect of the trial arm was found on the Pediatric Inventory for Parents: the intervention participants reported less frequency (subscales communication F1,120627=5.37; P=.02, and role function F1,27203=5.40; P=.02) and difficulty (subscales communication F1,2237=7.43; P=.006, medical care F1,2907=4.04; P=.04, and role function F1,821=4.37, P=.04) regarding illness-related stressful events than the control participants. CONCLUSIONS The WebParC website for parents of children with JIA reduced illness-related parenting stress. This web-based intervention offers a feasible preventive approach for parents of children with JIA and potentially could be adapted and evaluated for parents of children with other chronic illnesses. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN) 13159730; http://www.isrctn.com/ISRCTN13159730.
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Affiliation(s)
| | - Shashivadan P Hirani
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, United Kingdom
| | - Sally Harris
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Jo Taylor
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, United Kingdom
| | - Lucy R Wedderburn
- University College London Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,Centre for Adolescent Rheumatology Versus Arthritis, London, United Kingdom.,National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital, London, United Kingdom
| | - Stanton Newman
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, United Kingdom
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16
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Lawes-Wickwar S, McBain H, Brini S, Hirani SP, Hurt CS, Flood C, Dunlop N, Solly D, Crampton B, Newman SP, Ezra DG. A patient-initiated treatment model for blepharospasm and hemifacial spasm: a randomized controlled trial. BMC Neurol 2022; 22:99. [PMID: 35300599 PMCID: PMC8928587 DOI: 10.1186/s12883-022-02603-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/18/2020] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background To test, in a two-arm, single center, superiority, randomized controlled trial, the effectiveness of and costs associated with a patient-initiated treatment model for people with hemifacial spasm (HFS) and blepharospasm (BEB) in comparison to usual care. Methods One hundred and thirty patients with HFS or BEB, aged 18 years or over, were recruited from a nurse-led botulinum toxin type A clinic at an eye hospital in the United Kingdom (UK), completed baseline measures and were randomized (1:1). The intervention group determined their own botulinum toxin type A (BoNT/A) treatment schedule during the trial period (9 months) and received an information leaflet with a “hotline” number to book an appointment. Usual care appointments were scheduled by treating clinicians. Data analysts were blind to study group. The primary outcomes were disease severity and functional disability, as measured by the Jankovic Rating Scale and Blepharospasm Disability Index, respectively. Secondary outcomes included quality of life, anxiety and depression, satisfaction with care, confidence in the service, economic costs and employment days lost. Results Sixty-five patients were randomized to each group. The intervention demonstrated no statistically significant difference to usual care for any of primary outcomes. On secondary outcomes the levels of anxiety differed significantly (F2, 142.39 = 1.65, p = 0.02), with the intervention arm exhibiting a decrease and the control arm an increase (Hedges’ g = − 0.26 [99% CI -0.83, 0.32]). No other statistically significant differences were found for secondary outcomes. Overall healthcare costs and costs to the patient were on average £198.95 less (95% CI -£256.76, £654.67; p = 0.10) per participant for those in the intervention compared to usual care, although this finding was not significant. Conclusions We did not observe differences between the patient-initiated treatment model and usual care for people with BEB or HFS, on any primary outcome measure, quality of life, or depression. The patient-initiated treatment model may, however, have the potential to save healthcare costs and reduce anxiety. Patients using this new model were also equally as satisfied in the service and confident in their care as those receiving treatment as usual. Trial registration
Clinicaltrials.gov ID NCT02577224, 16th October 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02603-7.
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Affiliation(s)
- Sadie Lawes-Wickwar
- City, University of London, School of Health Sciences, 10 Northampton Square, London, EC1V 0HB, UK. .,University College London, Institute of Epidemiology and Health Care, London, UK.
| | - Hayley McBain
- City, University of London, School of Health Sciences, 10 Northampton Square, London, EC1V 0HB, UK
| | - Stefano Brini
- City, University of London, School of Health Sciences, 10 Northampton Square, London, EC1V 0HB, UK
| | - Shashivadan P Hirani
- City, University of London, School of Health Sciences, 10 Northampton Square, London, EC1V 0HB, UK
| | - Catherine S Hurt
- City, University of London, School of Health Sciences, 10 Northampton Square, London, EC1V 0HB, UK
| | - Chris Flood
- London South Bank University, School of Health and Social Care, London, UK
| | - Nicola Dunlop
- Moorfields Eye Hospital NHS Foundation Trust, Adnexal Department, London, UK
| | | | | | - Stanton P Newman
- City, University of London, School of Health Sciences, 10 Northampton Square, London, EC1V 0HB, UK
| | - Daniel G Ezra
- Moorfields Eye Hospital NHS Foundation Trust, Adnexal Department, London, UK
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17
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Forde C, Haddad M, Hirani SP, Keene DJ. Is an individually tailored programme of intense leg resistance and dynamic exercise acceptable to adults with an acute lateral patellar dislocation? A feasibility study. Pilot Feasibility Stud 2021; 7:197. [PMID: 34749823 PMCID: PMC8573884 DOI: 10.1186/s40814-021-00932-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background Lateral patellar dislocations mainly affect active teenagers and young adults. To help people recover, non-surgical exercise-based treatment is often recommended but the optimal exercise-based treatment is unknown. Currently, treatment outcomes after this injury are variable. Common problems include recurrent dislocation, reduced activity levels, and later surgery. A programme of intense leg resistance exercises, and dynamic exercises related to participants’ activity-related goals, has rationale, but has not been previously reported. In line with the Medical Research Council guidance, this study aimed to assess the acceptability of a novel evidence-based exercise programme for adults after acute lateral patellar dislocation and the feasibility of future research evaluating this treatment. Methods A single-group prospective study was conducted at the John Radcliffe Hospital, Oxford, UK. Participants were 16 years or older with an acute first-time or recurrent lateral patellar dislocation. Participants received up to six face-to-face, one-to-one, physiotherapy sessions, over a maximum of 3 months, and performed intensive home exercises independently at least three times per week. Strategies to increase exercise adherence were used. Primary objectives were to determine the number of eligible patients, the recruitment rate (proportion of eligible patients that provided written informed consent), participant adherence to scheduled physiotherapy sessions and self-reported adherence to prescribed exercise, and intervention acceptability to participants measured by attrition and a study-specific questionnaire. Data were analysed using descriptive statistics. Results Fifteen of 22 (68%) patients with a lateral patellar dislocation were eligible. All eligible (100%) were recruited. Two of 15 (13%) participants provided no outcome data, 2/15 (13%) provided partial outcome data, and 11/15 (73%) provided all outcome data. Questionnaire responses demonstrated high intervention acceptability to participants. Participants attended 56/66 (85%) physiotherapy sessions and 10/11 (91%) participants reported they ‘always’ or ‘often’ completed the prescribed exercise. One participant redislocated their patella; another experienced knee pain or swelling lasting more than one week after home exercise on three occasions. Conclusion The intervention appeared acceptable to adults after acute lateral patellar dislocation, and a future randomised pilot trial is feasible. This future pilot trial should estimate attrition with increased precision over a longer duration and assess participants’ willingness to be randomised to different treatments across multiple centres. Trial registration ClinicalTrials.govNCT03798483, registered on January 10, 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00932-x.
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Affiliation(s)
- Colin Forde
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Research Centre, University of Oxford, Kadoorie Centre for Critical Care Research and Education, Level 3, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.
| | - Mark Haddad
- School of Health Sciences, City, University of London, London, UK
| | | | - David J Keene
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Research Centre, University of Oxford, Kadoorie Centre for Critical Care Research and Education, Level 3, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
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18
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Wong S, Hirani SP, Forbes A, Kumar N, Hariharan R, O'Driscoll J, Viswanathan A, Harvey G, Sekhar R, Jamous A. A study into the effect of Lactobacillus casei Shirota in preventing antibiotic associated diarrhoea including Clostridioides difficile infection in patients with spinal cord injuries: a multicentre randomised, double-blind, placebo-controlled trial. EClinicalMedicine 2021; 40:101098. [PMID: 34541475 PMCID: PMC8435694 DOI: 10.1016/j.eclinm.2021.101098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Antibiotic Associated Diarrhoea (AAD) and Clostridioides Difficile Infection (CDI) are of major concern in spinal cord injury (SCI) rehabilitation. METHODS A multi-centre, randomized, double-blind, placebo-controlled (the ECLISP) trial, was conducted in three tertiary spinal cord injury centre in the UK to assess the efficacy of consuming a probiotic beverage containing at least 6.5 × 109 live Lactobacillus casei Shirota (LcS) in preventing AAD and CDI and in patients with SCI and to determine whether proton pump inhibitors (PPI) and under nutrition-risk are risk factors for AAD/CDI. LcS or placebo was given once daily for the duration of an antibiotic course and continued for 7 days thereafter. Follow up was set at 7 and 30 days after the antibiotic course finished. The primary outcome was occurrence of AAD up to 30 days after finishing LcS/placebo. This trial is completed and registered (ISRCTN:13119162). FINDINGS Between November 2014, and November 2019, 359 consenting adult SCI patients (median age: 53.3; range: 18-88 years), from 3 SCI centres responsible for providing approximate 45-50% of UK SCI service, with a requirement for antibiotics due to infection were randomly allocated to receive LcS (n = 181) or placebo (n = 178). Overall, no statistical difference was seen in occurrence of the primary outcomes of AAD at 30 days follow up (45% v 42.1%, RR: 1.071, 0.8-1.4, p = 0.639). In the secondary analyses LcS was associated with a lower risk of AAD at 7 (19% v 35.7%, RR: 0.53, 0.29-0.99, p = 0.040) and 30 days follow up (28% v 52.2%, RR: 0.54, 0.32-0.91, p = 0.015) in the participants who took PPI regularly. Under nutrition-risk was associated with an increased risk of AAD at 7 (RR: 1.76, 1.28-2.44) and 30 days follow up (RR: 1.69, 1.30-2.0). No intervention-related adverse events were reported during the study. INTERPRETATION The present study indicates that LcS could not prevent AAD/CDI in unselected SCI patients. LcS might have the potential to prevent AAD in the higher risk group of patients on regular PPI. Confirmatory studies are needed to allow translation of this apparent therapeutic success into improved clinical outcomes. FUNDING Yakult Honsha Co., Ltd.
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Affiliation(s)
- Samford Wong
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Mandeville Rd, United Kingdom
- School of Health Sciences, City, University of London, London, United Kingdom
- Royal Buckinghamshire Hospital, Aylesbury, United Kingdom
- Corresponding address: Dr Samford Wong, National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, HP21 8AL, UK.
| | | | - Alastair Forbes
- University of Tartu, Estonia, and Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Naveen Kumar
- Midland Centre for Spinal Injury, Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, United Kingdom
| | - Ramaswamy Hariharan
- The Princess Royal Spinal Injuries Centre, Northern General Hospital, Herries Rd, United Kingdom
| | - Jean O'Driscoll
- Department of Microbiology, Stoke Mandeville Hospital, Mandeville Rd, United Kingdom
| | - Anand Viswanathan
- The Princess Royal Spinal Injuries Centre, Northern General Hospital, Herries Rd, United Kingdom
| | - Graham Harvey
- Midland Centre for Spinal Injury, Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, United Kingdom
| | - Ravi Sekhar
- Department of Gastroenterology, Stoke Mandeville Hospital, Mandeville Rd, United Kingdom
| | - Ali Jamous
- Royal Buckinghamshire Hospital, Aylesbury, United Kingdom
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19
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Northcott S, Simpson A, Thomas S, Barnard R, Burns K, Hirani SP, Hilari K. "Now I Am Myself": Exploring How People With Poststroke Aphasia Experienced Solution-Focused Brief Therapy Within the SOFIA Trial. Qual Health Res 2021; 31:2041-2055. [PMID: 34130554 PMCID: PMC8552370 DOI: 10.1177/10497323211020290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Aphasia, a language disability, can profoundly affect a person's mood and identity. The experiences of participants who received Solution-Focused Brief Therapy, a psychological intervention, were explored in the Solution-Focused brief therapy In poststroke Aphasia (SOFIA) Trial. Thirty participants with chronic aphasia, 14 with severe aphasia, participated in in-depth interviews that were analyzed using framework analysis. Two overarching themes emerged: valued therapy components (exploring hopes, noticing achievements, companionship, sharing feelings, and relationship with therapist) and perceptions of progress (mood, identity, communication, relationships, and independence). Participants were categorized into four groups: (a) "changed," where therapy had a meaningful impact on a person's life; (b) "connected," where therapy was valued primarily for companionship; (c) "complemental," where therapy complemented a participant's upward trajectory; and (d) "discordant," where therapy misaligned with participants' preference for impairment-based language work. This study suggests that it is feasible to adapt a psychological therapy for people with aphasia, who perceive it as valuable.
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Affiliation(s)
| | | | | | | | - Kidge Burns
- Expert Independent Practitioner, London, United Kingdom
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20
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Zuriaga A, Kaplan MS, Choi NG, Hodkinson A, Storman D, Brudasca NI, Hirani SP, Brini S. Association of mental disorders with firearm suicides: A systematic review with meta-analyses of observational studies in the United States. J Affect Disord 2021; 291:384-399. [PMID: 34098496 DOI: 10.1016/j.jad.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
In the United States (US), 61% of all suicide cases may involve firearms, and some evidence suggests that mental disorders may play a role in suicide by firearm. We performed the first systematic review and meta-analyses to investigate: (i) whether mental disorders are associated with suicide by firearm, and (ii) whether the risk of using a firearm compared with alternative means is associated with higher levels of suicide in individuals with a mental disorder METHODS AND FINDINGS: We searched twelve databases from inception to the 24th of May 2020. We retrieved 22 observational studies conducted in the US. Random-effects meta-analyses showed individuals who had a diagnosis of a mental disorder had lower odds (odds ratios (OR)= 0.50, 95% CI: 0.36 to 0.69; I2=100 (95% CI: 87 to 100%), of dying by suicide with a firearm than those who did not have a diagnosis of a mental disorder. Secondary analysis showed that decedents who had a mental health diagnosis resulted in lower odds of dying by suicide by using firearms than using other means LIMITATIONS: Risk of bias revealed a heterogeneous and poor definition of mental disorders as well as lack of control for potential demographic confounding factors. In the meta-analyses, studies were combined in the same analytic sample as 77% of these studies did not specify the type of mental disorder CONCLUSION: While our results seem to suggest that having a mental disorder may not be consistently associated with the odds of dying by suicide using a firearm, the presence of substantial heterogeneity and high risk of bias precludes any firm conclusions.
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Affiliation(s)
- Ana Zuriaga
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom.
| | - Mark S Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, United States
| | - Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, United States
| | - Alexander Hodkinson
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Nicoleta I Brudasca
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
| | - Shashivadan P Hirani
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
| | - Stefano Brini
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
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Lawes-Wickwar S, McBain H, Hirani SP, Hurt CS, Dunlop N, Solly D, Crampton B, Newman SP, Ezra DG. Which factors impact on quality of life for adults with blepharospasm and hemifacial spasm? Orbit 2020; 40:110-119. [PMID: 32116098 DOI: 10.1080/01676830.2020.1733028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Benign essential blepharospasm (BEB) and hemifacial spasm (HFS) are debilitating conditions causing spasms to the eyes and/or face and can significantly impact on quality of life (QoL). Initial research has highlighted potential factors impacting on QoL in BEB, but there remains a wealth of demographic, clinical, and psychosocial factors that may contribute to QoL but have not received attention. Methods: Cross-sectional baseline data were collected before a single-masked randomised controlled trial from 130 adults with BEB and HFS recruited from botulinum toxin clinics at Moorfields Eye Hospital, London. QoL was measured using the 24-item Craniocervical Dystonia Questionnaire (CDQ24), which provides a total score and five subscale scores relating to Stigma, Emotional state, Pain, Activities of daily living (ADL), and Social/family life. Treating clinicians provided clinical data. Hierarchical multiple regressions were performed on this baseline data to identify significant predictors of QoL. Results: ADL and Stigma were the areas most impacted upon whilst patients experienced better adjustment in relation to Pain, Social/family life, and Emotional state. CDQ24 Total scores were explained by the model (80% variance) and were significantly associated with appearance concerns, emotional representations, perceived negative consequences of the condition, mood, and dose of botulinum toxin. Conclusions: Patients with BEB and HFS report a detrimental impact on ADL and perceived stigma in relation to their condition. Predominantly, individual perceptions and mood are associated with QoL in this population, rather than demographic and clinical factors, signifying areas to target in the design of future healthcare services or interventions.
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Affiliation(s)
- Sadie Lawes-Wickwar
- Centre for Health Services Research, City, University of London , London, UK.,Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | - Hayley McBain
- Centre for Health Services Research, City, University of London , London, UK
| | | | - Catherine S Hurt
- Centre for Health Services Research, City, University of London , London, UK
| | - Nicola Dunlop
- Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | - Dianne Solly
- Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | | | - Stanton P Newman
- Centre for Health Services Research, City, University of London , London, UK
| | - Daniel G Ezra
- Moorfields Eye Hospital NHS Foundation Trust , London, UK
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22
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Evans JC, Hirani SP, Needle JJ. Nutritional and Post-Transplantation Outcomes of Enteral versus Parenteral Nutrition in Pediatric Hematopoietic Stem Cell Transplantation: A Systematic Review of Randomized and Nonrandomized Studies. Biol Blood Marrow Transplant 2019; 25:e252-e259. [DOI: 10.1016/j.bbmt.2019.02.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/23/2019] [Indexed: 12/12/2022]
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23
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Northcott S, Simpson A, Thomas SA, Hirani SP, Flood C, Hilari K. Solution Focused brief therapy In post-stroke Aphasia (SOFIA Trial): protocol for a feasibility randomised controlled trial. ACTA ACUST UNITED AC 2019. [DOI: 10.12688/amrcopenres.12873.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Around a quarter of people post stroke will experience aphasia, a language disability. Having aphasia places someone at risk of becoming depressed and isolated. There is limited evidence for effective interventions to enhance psychological well-being for this client group. A potential intervention is Solution Focused Brief Therapy (SFBT), which supports a person to build meaningful, achievable change through focusing on a person’s skills and resources rather than their deficits. The SOFIA Trial aims to explore the acceptability of SFBT to people with varying presentations of aphasia, including severe aphasia, and to assess the feasibility of conducting a future definitive trial investigating clinical and cost effectiveness. Methods: The trial is a single-blind, randomised, wait-list controlled feasibility trial with nested qualitative research and pilot economic evaluation comparing SFBT plus usual care to usual care alone. The study will recruit 32 participants with aphasia who are ≥6 months post stroke. All participants will be assessed on psychosocial outcome measures at baseline, three, and six months post randomisation by assessors blinded to treatment allocation. Participants will be randomly assigned to intervention group (start intervention immediately post randomisation) or wait-list group (start intervention six months post randomisation). Wait-list group will additionally be assessed nine months post randomisation. The intervention consists of up to six SFBT sessions delivered over three months by speech and language therapists. Participants and therapists will also take part in in-depth interviews exploring their experiences of the study. The pilot economic evaluation will use the EQ-5D-5L measure and an adapted Client Service Receipt Inventory. People with aphasia have been involved in designing and monitoring the trial. Discussion: Given the high levels of depression and isolation, there is a need to investigate effective interventions that enhance the psychological wellbeing of people with aphasia. Trial registration: ClinicalTrials.gov NCT03245060 10/08/2017.
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24
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Evans J, Needle JJ, Hirani SP. Early outcomes of gastrostomy feeding in paediatric allogenic bone marrow transplantation: A retrospective cohort study. Clin Nutr ESPEN 2019; 31:71-79. [DOI: 10.1016/j.clnesp.2019.02.014] [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] [Received: 02/21/2019] [Accepted: 02/25/2019] [Indexed: 02/02/2023]
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25
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Hirani SP, Rixon L, Cartwright M, Beynon M, Newman SP. The Effect of Telehealth on Quality of Life and Psychological Outcomes Over a 12-Month Period in a Diabetes Cohort Within the Whole Systems Demonstrator Cluster Randomized Trial. JMIR Diabetes 2017; 2:e18. [PMID: 30291060 PMCID: PMC6238866 DOI: 10.2196/diabetes.7128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 05/25/2017] [Accepted: 06/22/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Much is written about the promise of telehealth and there is great enthusiasm about its potential. However, many studies of telehealth do not meet orthodox quality standards and there are few studies examining quality of life in diabetes as an outcome. OBJECTIVE To assess the impact of home-based telehealth (remote monitoring of physiological, symptom and self-care behavior data for long-term conditions) on generic and disease-specific health-related quality of life, anxiety, and depressive symptoms over 12 months in patients with diabetes. Remote monitoring provides the potential to improve quality of life, through the reassurance it provides patients. METHODS The study focused on participant-reported outcomes of patients with diabetes within the Whole Systems Demonstrator (WSD) Telehealth Questionnaire Study, nested within a pragmatic cluster-randomized trial of telehealth (the WSD Telehealth Trial), held across 3 regions of England. Telehealth was compared with usual-care, with general practice as the unit of randomization. Participant-reported outcome measures (Short-Form 12, EuroQual-5D, Diabetes Health Profile scales, Brief State-Trait Anxiety Inventory, and Centre for Epidemiological Studies Depression Scale) were collected at baseline, short-term (4 months) and long-term (12months) follow-ups. Intention-to-treat analyses testing treatment effectiveness, were conducted using multilevel models controlling for practice clustering and a range of covariates. Analyses assumed participants received their allocated treatment and were conducted for participants who completed the baseline plus at least one follow-up assessment (n=317). RESULTS Primary analyses showed differences between telehealth and usual care were small and only reached significance for 1 scale (diabetes health profile-disinhibited eating, P=.006). The magnitude of differences between trial arms did not reach the trial-defined minimal clinically important difference of 0.3 standard deviations for most outcomes. Effect sizes (Hedge's g) ranged from 0.015 to 0.143 for Generic quality of life (QoL) measures and 0.018 to 0.394 for disease specific measures. CONCLUSIONS Second generation home-based telehealth as implemented in the WSD evaluation was not effective in the subsample of people with diabetes. Overall, telehealth did not improve or have a deleterious effect quality of life or psychological outcomes for patients with diabetes over a 12-month period.
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Affiliation(s)
- Shashivadan P Hirani
- Centre for Health Services Research, School of Health Sciences, University of London, London, United Kingdom
| | - Lorna Rixon
- Centre for Health Services Research, School of Health Sciences, University of London, London, United Kingdom
| | - Martin Cartwright
- Centre for Health Services Research, School of Health Sciences, University of London, London, United Kingdom
| | - Michelle Beynon
- Centre for Health Services Research, School of Health Sciences, University of London, London, United Kingdom
| | - Stanton P Newman
- Centre for Health Services Research, School of Health Sciences, University of London, London, United Kingdom
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26
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Wong S, Santullo P, Hirani SP, Kumar N, Chowdhury JR, García-Forcada A, Recio M, Paz F, Zobina I, Kolli S, Kiekens C, Draulans N, Roels E, Martens-Bijlsma J, O'Driscoll J, Jamous A, Saif M. Use of antibiotics and the prevalence of antibiotic-associated diarrhoea in patients with spinal cord injuries: an international, multi-centre study. J Hosp Infect 2017. [PMID: 28647425 DOI: 10.1016/j.jhin.2017.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Indexed: 01/02/2023]
Abstract
BACKGROUND Little is known about the use of antibiotics and the extent of antibiotic-associated diarrhoea (AAD) in patients with spinal cord injuries (SCIs). AIMS To record the use of antibiotics, establish the prevalence of AAD and Clostridium difficile infection (CDI), and assess if there was any seasonal variation in antibiotic use and incidence of AAD in patients with SCIs. METHODS A retrospective study was conducted in six European SCI centres between October 2014 and June 2015. AAD was defined as two or more watery stools (Bristol Stool Scale type 5, 6 or 7) over 24 h. FINDINGS In total, 1267 adults (median age 54 years, 30.7% female) with SCIs (52.7% tetraplegia, 59% complete SCI) were included in this study. Among the 215 (17%) patients on antibiotics, the top three indications for antibiotics were urinary tract infections (UTIs), infected pressure ulcers and other skin infections. Thirty-two of these 215 (14.9%) patients developed AAD and two patients out of the total study population (2/1267; 0.16%) developed CDI. AAD was more common in summer than in spring, autumn or winter (30.3% vs 3.8%, 7.4% and 16.9%, respectively; P<0.01). AAD was associated with age ≥65 years, tetraplegia, higher body mass index, hypoalbuminaemia, polypharmacy, multiple antibiotic use and high-risk antibiotic use. Summer and winter seasons and male sex were identified as independent predictors for the development of AAD. CONCLUSION This survey found that AAD is common in patients with SCIs, and UTI is the most common cause of infection. Summer and winter seasons and male sex are unique predictors for AAD. Both AAD and UTIs are potentially preventable; therefore, further work should focus on preventing the over-use of antibiotics, and developing strategies to improve hospital infection control measures.
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Affiliation(s)
- S Wong
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK; School of Health Science, City, University of London, London, UK.
| | - P Santullo
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | - S P Hirani
- School of Health Science, City, University of London, London, UK
| | - N Kumar
- Midland Centre for Spinal Injuries, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK; School of Medicine, Keele University, Keele, UK
| | - J R Chowdhury
- Midland Centre for Spinal Injuries, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK; School of Medicine, Keele University, Keele, UK
| | - A García-Forcada
- Internal Medicine Department, Hospital Nacional de Parapléjicos, Toledo, Spain
| | - M Recio
- Internal Medicine Department, Hospital Nacional de Parapléjicos, Toledo, Spain
| | - F Paz
- Internal Medicine Department, Hospital Nacional de Parapléjicos, Toledo, Spain
| | - I Zobina
- Welsh Spinal Injuries Rehabilitation Centre, Rookwood Hospital, Cardiff, UK
| | - S Kolli
- Welsh Spinal Injuries Rehabilitation Centre, Rookwood Hospital, Cardiff, UK
| | - C Kiekens
- Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - N Draulans
- Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - E Roels
- Department of Rehabilitation Medicine, Centre for Rehabilitation, University Medical Centre Groningen, Groningen, The Netherlands
| | - J Martens-Bijlsma
- Department of Rehabilitation Medicine, Centre for Rehabilitation, University Medical Centre Groningen, Groningen, The Netherlands
| | - J O'Driscoll
- Department of Microbiology, Stoke Mandeville Hospital, Aylesbury, UK
| | - A Jamous
- Royal Buckinghamshire Hospital, Aylesbury, UK
| | - M Saif
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
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27
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Diab M, Bilkhu R, Soppa G, McGale N, Hirani SP, Newman SP, Jahangiri M. Quality of Life in Relation to Length of Intensive Care Unit Stay After Cardiac Surgery. J Cardiothorac Vasc Anesth 2017; 31:1080-1090. [DOI: 10.1053/j.jvca.2016.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Indexed: 12/24/2022]
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28
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Northcott S, Hirani SP, Hilari K. A Typology to Explain Changing Social Networks Post Stroke. The Gerontologist 2017; 58:500-511. [DOI: 10.1093/geront/gnx011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/16/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah Northcott
- Division of Language and Communication Science, University of London
| | - Shashivadan P Hirani
- Centre for Health Services Research, School of Health Sciences, City, University of London
| | - Katerina Hilari
- Division of Language and Communication Science, University of London
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29
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Beaney KE, Ward CE, Bappa DAS, McGale N, Davies AK, Hirani SP, Li K, Howard P, Vance DR, Crockard MA, Lamont JV, Newman S, Humphries SE. A 19-SNP coronary heart disease gene score profile in subjects with type 2 diabetes: the coronary heart disease risk in type 2 diabetes (CoRDia study) study baseline characteristics. Cardiovasc Diabetol 2016; 15:141. [PMID: 27716211 PMCID: PMC5048451 DOI: 10.1186/s12933-016-0457-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/23/2016] [Indexed: 12/22/2022] Open
Abstract
Background The coronary risk in diabetes (CoRDia) trial (n = 211) compares the effectiveness of usual diabetes care with a self-management intervention (SMI), with and without personalised risk information (including genetics), on clinical and behavioural outcomes. Here we present an assessment of randomisation, the cardiac risk genotyping assay, and the genetic characteristics of the recruits. Methods Ten-year coronary heart disease (CHD) risk was calculated using the UKPDS score. Genetic CHD risk was determined by genotyping 19 single nucleotide polymorphisms (SNPs) using Randox’s Cardiac Risk Prediction Array and calculating a gene score (GS). Accuracy of the array was assessed by genotyping a subset of pre-genotyped samples (n = 185). Results Overall, 10-year CHD risk ranged from 2–72 % but did not differ between the randomisation groups (p = 0.13). The array results were 99.8 % concordant with the pre-determined genotypes. The GS did not differ between the Caucasian participants in the CoRDia SMI plus risk group (n = 66) (p = 0.80) and a sample of UK healthy men (n = 1360). The GS was also associated with LDL-cholesterol (p = 0.05) and family history (p = 0.03) in a sample of UK healthy men (n = 1360). Conclusions CHD risk is high in this group of T2D subjects. The risk array is an accurate genotyping assay, and is suitable for estimating an individual’s genetic CHD risk. Trial registration This study has been registered at ClinicalTrials.gov; registration identifier NCT01891786
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Affiliation(s)
- Katherine E Beaney
- British Heart Foundation Laboratories, Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, University Street, London, UK
| | - Claire E Ward
- Molecular Diagnostics Group, Randox Laboratories Ltd, Crumlin, UK
| | - Dauda A S Bappa
- British Heart Foundation Laboratories, Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, University Street, London, UK
| | - Nadine McGale
- School of Health Sciences, City University London, Northampton Square, London, UK
| | - Anna K Davies
- School of Health Sciences, City University London, Northampton Square, London, UK
| | - Shashivadan P Hirani
- School of Health Sciences, City University London, Northampton Square, London, UK
| | - KaWah Li
- British Heart Foundation Laboratories, Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, University Street, London, UK
| | - Philip Howard
- British Heart Foundation Laboratories, Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, University Street, London, UK
| | - Dwaine R Vance
- Molecular Diagnostics Group, Randox Laboratories Ltd, Crumlin, UK
| | | | - John V Lamont
- Molecular Diagnostics Group, Randox Laboratories Ltd, Crumlin, UK
| | - Stanton Newman
- School of Health Sciences, City University London, Northampton Square, London, UK
| | - Steve E Humphries
- British Heart Foundation Laboratories, Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, University Street, London, UK.
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30
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Wickwar S, McBain H, Newman SP, Hirani SP, Hurt C, Dunlop N, Flood C, Ezra DG. Erratum to: 'Effectiveness and cost-effectiveness of a patient-initiated botulinum toxin treatment model for blepharospasm and hemifacial spasm compared to standard care: study protocol for a randomised controlled trial'. Trials 2016; 17:333. [PMID: 27439615 PMCID: PMC4955264 DOI: 10.1186/s13063-016-1502-2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sadie Wickwar
- Centre for Health Services Research, School of Health Sciences, City University London, London, UK.,Moorfields Eye Hospital, London, UK
| | - Hayley McBain
- Centre for Health Services Research, School of Health Sciences, City University London, London, UK.,Community Health Newham, East London Foundation Trust, London, UK
| | - Stanton P Newman
- Centre for Health Services Research, School of Health Sciences, City University London, London, UK
| | - Shashivadan P Hirani
- Centre for Health Services Research, School of Health Sciences, City University London, London, UK
| | - Catherine Hurt
- Centre for Health Services Research, School of Health Sciences, City University London, London, UK
| | | | - Chris Flood
- Centre for Health Services Research, School of Health Sciences, City University London, London, UK
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Hirani SP, Rixon L, Beynon M, Cartwright M, Cleanthous S, Selva A, Sanders C, Newman SP. Quantifying beliefs regarding telehealth: Development of the Whole Systems Demonstrator Service User Technology Acceptability Questionnaire. J Telemed Telecare 2016; 23:460-469. [DOI: 10.1177/1357633x16649531] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Telehealth (TH) is a potential solution to the increased incidence of chronic illness in an ageing population. The extent to which older people and users with chronic conditions accept and adhere to using assistive technologies is a potential barrier to mainstreaming the service. This study reports the development and validation of the Whole Systems Demonstrator (WSD) Service User Technology Acceptability Questionnaire (SUTAQ). Methods Questionnaires measuring the acceptability of TH, quality of life, well-being and psychological processes were completed by 478 users of TH. The 22 acceptability items were subject to principal components analysis (PCA) to determine sub-scales. Scale scores, relationships between scales and other patient-reported outcome measures (PROMs), and group differences on scales were utilised to check the reliability and validity of the measure. Results PCAs of SUTAQ items produced six TH acceptability scales: enhanced care, increased accessibility, privacy and discomfort, care personnel concerns, kit as substitution and satisfaction. Significant correlations within these beliefs and between these scales and additional PROMs were coherent, and the SUTAQ sub-scales were able to predict those more likely to refuse TH. Discussion The SUTAQ is an instrument that can be used to measure user beliefs about the acceptability of TH, and has the ability to discriminate between groups and predict individual differences in beliefs and behaviour. Measuring acceptability beliefs of TH users can provide valuable information to direct and target provision of services to increase uptake and maintain use of TH.
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Affiliation(s)
| | - Lorna Rixon
- Centre for Health Services Research, City University London, UK
| | - Michelle Beynon
- Centre for Health Services Research, City University London, UK
| | | | | | - Abi Selva
- Centre for Health Services Research, City University London, UK
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Wickwar S, McBain H, Newman SP, Hirani SP, Hurt C, Dunlop N, Flood C, Ezra DG. Effectiveness and cost-effectiveness of a patient-initiated botulinum toxin treatment model for blepharospasm and hemifacial spasm compared to standard care: study protocol for a randomised controlled trial. Trials 2016; 17:129. [PMID: 26961367 PMCID: PMC4784312 DOI: 10.1186/s13063-016-1263-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 02/26/2016] [Indexed: 11/29/2022] Open
Abstract
Background Blepharospasm and hemifacial spasm are debilitating conditions that significantly impact on patient quality of life. Cyclical treatment with botulinum toxin injections offers temporary relief, but the duration of treatment efficacy is variable. The standard model of patient care defines routine fixed-time based scheduled treatment cycles which may lead to unnecessarily frequent treatment for some patients and experience of distressing symptoms in others, if symptoms return before the scheduled follow-up period. Methods/Design A randomised controlled trial will compare a patient-initiated model of care, where patients determine botulinum toxin treatment timing, to the standard model of care in which care is scheduled by the clinical team. A sample of 266 patients with blepharospasm or hemifacial spasm will be recruited from Moorfields Eye Hospital (MEH), London. The trial will be accompanied by a mixed-methods evaluation of acceptability of the new service. Patients who meet eligibility criteria will be assessed at baseline and those in the intervention group will be provided with instructions on how to book their own treatment appointments. Patients in both groups will be followed up 3 and 9 months into the trial and all patients will be returned to usual care after 9 months to meet safety protocols. Primary outcome measures include disease severity (questionnaire), functional disability (questionnaire) and patient satisfaction with care (questionnaire). Secondary outcomes include disease-specific quality of life (questionnaire), mood (questionnaire), illness and treatment perceptions (questionnaire and semi-structured interviews), economic impact (questionnaire) and acceptability (questionnaire and semi-structured interviews). Discussion This trial will assess the effectiveness and cost-effectiveness of a patient-led care model for botulinum toxin therapy. If the new model is shown to be effective in reducing distress and disability in these populations and is found to be acceptable to patients, whilst being cost-effective, this will have significant implications for service organisation across the NHS. Trial registration UK Clinical Research Network (UKCRN) Portfolio 18660. Clinicaltrials.gov ID NCT102577224 (registered 29 October 2015)
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Affiliation(s)
- Sadie Wickwar
- Centre for Health Services Research, School of Health Sciences, City University London, London, UK. .,Moorfields Eye Hospital, London, UK.
| | - Hayley McBain
- Centre for Health Services Research, School of Health Sciences, City University London, London, UK. .,Community Health Newham, East London Foundation Trust, London, UK.
| | - Stanton P Newman
- Centre for Health Services Research, School of Health Sciences, City University London, London, UK.
| | - Shashivadan P Hirani
- Centre for Health Services Research, School of Health Sciences, City University London, London, UK.
| | - Catherine Hurt
- Centre for Health Services Research, School of Health Sciences, City University London, London, UK.
| | | | - Chris Flood
- Centre for Health Services Research, School of Health Sciences, City University London, London, UK.
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Wong S, Graham A, Hirani SP, Charlton D, Coalwood S, McKeown E, Taylor C, Saif M. Review of dietetic service provision and activity in spinal cord injury centres: a multicentre survey in the UK and Republic of Ireland. Spinal Cord 2015; 53:901. [PMID: 26634321 DOI: 10.1038/sc.2015.202] [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: 11/09/2022]
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34
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Davies AK, McGale N, Humphries SE, Hirani SP, Beaney KE, Bappa DAS, McCabe JG, Newman SP. Effectiveness of a self-management intervention with personalised genetic and lifestyle-related risk information on coronary heart disease and diabetes-related risk in type 2 diabetes (CoRDia): study protocol for a randomised controlled trial. Trials 2015; 16:547. [PMID: 26631181 PMCID: PMC4668706 DOI: 10.1186/s13063-015-1073-7] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 11/19/2015] [Indexed: 12/30/2022] Open
Abstract
Background Many patients with type 2 diabetes fail to achieve good glycaemic control. Poor control is associated with complications including coronary heart disease (CHD). Effective self-management and engagement in health behaviours can reduce risks of complications. However, patients often struggle to adopt and maintain these behaviours. Self-management interventions have been found to be effective in improving glycaemic control. Recent developments in the field of genetics mean that patients can be given personalised information about genetic- and lifestyle-associated risk of developing CHD. Such information may increase patients’ motivation to engage in self-management. The Coronary Risk in Diabetes (CoRDia) trial will compare the effectiveness of a self-management intervention, with and without provision of personalised genetic- and lifestyle-associated risk information, with usual care, on clinical and behavioural outcomes, the cognitive predictors of behaviour, and psychological wellbeing. Methods/Design Participants will be adults aged 25–74 years registered with general practices in the East of England, diagnosed with type 2 diabetes, with no history of heart disease, and with a glycated haemoglobin level of ≥6.45 % (47 mmol/mol). Consenting participants will be randomised to one of three arms: usual care control, group self-management only, group self-management plus personalised genetic- and lifestyle-associated risk information. The self-management groups will receive four weekly 2-hour group sessions, focusing on knowledge and information sharing, problem solving, goal setting and action planning to promote medication adherence, healthy eating, and physical activity. Primary outcomes are glycaemic control and CHD risk. Clinical data will be collected from GP records, including HbA1c, weight, body mass index, blood pressure, and HDL and total cholesterol. Self-reported health behaviours, including medication adherence, healthy eating and physical activity, and cognitive outcomes will be assessed by questionnaire. Measures will be taken at baseline, 3 months (questionnaire only), 6 months and 12 months post-baseline. Discussion This study will determine whether the addition of personalised genetic- and lifestyle-associated CHD risk information to a group self-management intervention improves diabetes control and CHD risk compared with group self-management and usual care. Effectiveness of the combined intervention on health behaviours cognitions theorised to predict them, and psychological outcomes will also be investigated. Trial registration This study has been registered at ClinicalTrials.gov; registration identifier NCT01891786, registered 28 June 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1073-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna K Davies
- Centre for Health Services Research, School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK.
| | - Nadine McGale
- Centre for Health Services Research, School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK.
| | - Steve E Humphries
- Centre for Cardiovascular Genetics, British Heart Foundation Laboratories, Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Shashivadan P Hirani
- Centre for Health Services Research, School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK.
| | - Katherine E Beaney
- Centre for Cardiovascular Genetics, British Heart Foundation Laboratories, Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Dauda A S Bappa
- Centre for Cardiovascular Genetics, British Heart Foundation Laboratories, Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK.
| | - John G McCabe
- Wallace House GP Surgery, 5-11 St Andrew Street, Hertford, Hertfordshire, SG14 1HZ, UK.
| | - Stanton P Newman
- Centre for Health Services Research, School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK.
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Oliveira G, Hirani SP, Epstein R, Yazigi L, Behlau M. Validation of the Brazilian Version of the Voice Disability Coping Questionnaire. J Voice 2015; 30:247.e13-21. [PMID: 26474711 DOI: 10.1016/j.jvoice.2015.01.004] [Citation(s) in RCA: 7] [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] [Received: 09/30/2014] [Accepted: 01/21/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To perform the validation of the Brazilian version of the Voice Disability Coping Questionnaire (B-VDCQ) using procedures according to the Scientific Advisory Committee of Medical Outcomes Trust and psychometric analyses to determine the scales validity and reliability. METHODS In the preliminary procedures, the VDCQ was administered to 14 patients to determine if items were culturally valid and propose possible adaptations for a B-VDCQ. The sample of this study consisted of a data set of 178 individuals, 87 with vocal complaint, comprising 19 men and 68 women, with mean age of 34.1 years and 91 without vocal complaint, comprising 29 men and 62 women, with mean age of 32.4 years. To demonstrate validity, the B-VDCQ scores were compared to vocal self-assessment and perceptual analysis. To determine the reliability and test-retest reproducibility, 14 voice patients repeated the measurement between 3 and 14 days after the first administration. RESULTS Principal component analyses of the patients with vocal complaint yielded four coping strategies: venting, support seeking, minimisation, and avoidant acceptance. Subscales of the questionnaire showed acceptable internal consistency and reproducibility values, apart from the minimisation subscale. B-VDCQ validity was demonstrated through relationships with perceptual analyses and vocal self-assessment and subscale score differences between the two groups. CONCLUSIONS The B-VDCQ has been submitted to essential steps necessary for cultural adaptation and validation. It is a simple instrument to administer and shows to be specific for evaluating patients with voice problems. The B-VDCQ can be an important addition to the voice evaluation of patients with dysphonia.
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Affiliation(s)
- Gisele Oliveira
- Touro College, Brooklyn, New York, USA; Centro de Estudos da Voz - CEV, Sao Paulo, Brazil.
| | | | - Ruth Epstein
- University College London, UK; Speech-Language Pathology Services, Royal National Throat Nose & Ear Hospital, London, UK
| | - Latife Yazigi
- Universidade Federal de São Paulo - UNIFESP, Sao Paulo, Brazil
| | - Mara Behlau
- Centro de Estudos da Voz - CEV, Sao Paulo, Brazil; Universidade Federal de São Paulo - UNIFESP, Sao Paulo, Brazil
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Rixon L, Hirani SP, Cartwright M, Beynon M, Doll H, Steventon A, Henderson C, Newman SP. A RCT of telehealth for COPD patient's quality of life: the whole system demonstrator evaluation. Clin Respir J 2015; 11:459-469. [PMID: 26260325 DOI: 10.1111/crj.12359] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/30/2015] [Accepted: 08/03/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION/OBJECTIVES Despite some concerns that the introduction of telehealth (TH) may lead to reductions in quality of life (QoL), lower mood and increased anxiety in response to using assistive technologies to reduce health care utilisation and manage long term conditions, this research focuses on the extent to which providing people with tools to monitor their condition can improve QoL. METHODS The Chronic Obstructive Pulmonary Disease (COPD) cohort of the Whole Systems Demonstrator Trial is a pragmatic General Practitioner (GP) clustered randomised controlled trial (RCT) evaluating TH in the UK from three regions in England. All patients at a participating GP practice were deemed eligible for inclusion in the study if they were diagnosed with COPD. RESULTS 447 participants completed baseline and either a short (4 months) or long term (12 months) follow-up. There was a trend of improved QoL and mood in the TH group at longer-term follow-up, but not short term follow-up. Emotional functioning (g = 0.280 95%CI, 0.051-0.510) and mastery reached (g = 2.979 95%CI, 0-0.46) significance at P < 0.05 (all Hedges g <0.3). CONCLUSIONS TH showed minimal benefit to QoL in COPD patients who were not preselected to be at increased risk of acute exacerbations. Benefits were more likely in disease specific measures at longer term follow-up. TH is a complex intervention and should be embedded in a service that is evidenced based. Outcome measures must be sensitive enough to detect changes in the target population for the specific intervention.
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Affiliation(s)
- Lorna Rixon
- Health Services Research, School of Health Sciences, City University, London
| | | | - Martin Cartwright
- Health Services Research, School of Health Sciences, City University, London
| | - Michelle Beynon
- Health Services Research, School of Health Sciences, City University, London
| | - Helen Doll
- ICON Patient Reported Outcomes, Seacourt Tower, Westway, Oxford, UK
| | - Adam Steventon
- Data Analytics, The Health Foundation, 90 Long Acre, London
| | - Catherine Henderson
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton St, London, UK
| | - Stanton P Newman
- Health Services Research, School of Health Sciences, City University, London
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Wickwar S, McBain HB, Ezra DG, Hirani SP, Rose GE, Newman SP. Which factors are associated with quality of life in patients with Graves' orbitopathy presenting for orbital decompression surgery? Eye (Lond) 2015; 29:951-7. [PMID: 25998940 DOI: 10.1038/eye.2015.76] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/28/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Graves' orbitopathy (GO) is associated with changes in the appearance of the eyes and visual dysfunction. Patients report feeling socially isolated and unable to continue with day-to-day activities. This study aimed at investigating the demographic, clinical, and psychosocial factors associated with quality of life in patients presenting for orbital decompression surgery. METHODS One-hundred and twenty-three adults with GO due for orbital decompression at Moorfields Eye Hospital London were recruited prospectively. Clinical measures including treatment history, exophthalmos, optic neuropathy, and diplopia were taken by an ophthalmologist. Participants completed psychosocial questionnaires, including the Graves' Ophthalmopathy Quality of Life Scale (GO-QOL), the Hospital Anxiety and Depression Scale, and the Derriford Appearance Scale. Hierarchical multiple regression analyses were used to identify predictors of quality of life. RESULTS Higher levels of potential cases of clinical anxiety (37%) and depression (26%) were found in this study sample than in patients with other chronic diseases or facial disfigurements. A total of 55% of the variance in GO-QOL visual function scores was explained by the regression model; age, asymmetrical GO and depressed mood were significant unique contributors. In all, 75% of the variance in GO-QOL appearance scores was explained by the regression model; gender, appearance-related cognitions and depressed mood were significant unique contributors. CONCLUSION Appearance-related quality of life and mood were particularly affected in this sample. Predominantly psychosocial characteristics were associated with quality of life. It is important when planning surgery for patients that clinicians be aware of factors that could potentially influence outcomes.
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Affiliation(s)
- S Wickwar
- 1] Centre for Health Services Research, School of Community & Health Sciences, City University London, London, UK [2] Adnexal Department, Moorfields Eye Hospital, London, UK
| | - H B McBain
- 1] Centre for Health Services Research, School of Community & Health Sciences, City University London, London, UK [2] Community Health Newham, East London Foundation Trust, London, UK
| | - D G Ezra
- 1] Adnexal Department, Moorfields Eye Hospital, London, UK [2] UCL Institute of Ophthalmology, NIHR Biomedical Research Centre for Ophthalmology, London, UK
| | - S P Hirani
- Centre for Health Services Research, School of Community & Health Sciences, City University London, London, UK
| | - G E Rose
- 1] Adnexal Department, Moorfields Eye Hospital, London, UK [2] UCL Institute of Ophthalmology, NIHR Biomedical Research Centre for Ophthalmology, London, UK
| | - S P Newman
- Centre for Health Services Research, School of Community & Health Sciences, City University London, London, UK
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Henderson C, Knapp M, Fernández JL, Beecham J, Hirani SP, Beynon M, Cartwright M, Rixon L, Doll H, Bower P, Steventon A, Rogers A, Fitzpatrick R, Barlow J, Bardsley M, Newman SP. Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial. Age Ageing 2014; 43:794-800. [PMID: 24950690 PMCID: PMC4204660 DOI: 10.1093/ageing/afu067] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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] [Indexed: 11/15/2022] Open
Abstract
Purpose of the study: to examine the costs and cost-effectiveness of ‘second-generation’ telecare, in addition to standard support and care that could include ‘first-generation’ forms of telecare, compared with standard support and care that could include ‘first-generation’ forms of telecare. Design and methods: a pragmatic cluster-randomised controlled trial with nested economic evaluation. A total of 2,600 people with social care needs participated in a trial of community-based telecare in three English local authority areas. In the Whole Systems Demonstrator Telecare Questionnaire Study, 550 participants were randomised to intervention and 639 to control. Participants who were offered the telecare intervention received a package of equipment and monitoring services for 12 months, additional to their standard health and social care services. The control group received usual health and social care. Primary outcome measure: incremental cost per quality-adjusted life year (QALY) gained. The analyses took a health and social care perspective. Results: cost per additional QALY was £297,000. Cost-effectiveness acceptability curves indicated that the probability of cost-effectiveness at a willingness-to-pay of £30,000 per QALY gained was only 16%. Sensitivity analyses combining variations in equipment price and support cost parameters yielded a cost-effectiveness ratio of £161,000 per QALY. Implications: while QALY gain in the intervention group was similar to that for controls, social and health services costs were higher. Second-generation telecare did not appear to be a cost-effective addition to usual care, assuming a commonly accepted willingness to pay for QALYs. Trial registration number: ISRCTN 43002091.
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Affiliation(s)
- Catherine Henderson
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton St, London, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton St, London, UK
- King's College, London, UK
| | - José-Luis Fernández
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton St, London, UK
| | - Jennifer Beecham
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton St, London, UK
| | | | | | | | | | | | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Abstract
BACKGROUND Thyroid eye disease (TED) causes a number of esthetic and visual problems, and its treatment requires close clinical assessment, often for several years. There is evidence to suggest that clinical factors are poor indicators of patient-reported outcomes after treatments that aim to improve appearance, vision, or both. Psychosocial factors can impact on both adjustment to living with TED and also patients' perceptions of their improvements after treatment. There has been growing recognition that it is essential to evaluate treatment efficacy in terms of psychosocial outcomes, but, to date, there has been no review that has systematically evaluated psychosocial outcomes following a variety of treatments for TED. SUMMARY Fifteen studies were included in the review, and six were randomized controlled trials. The studies varied greatly in methodological rigor; whilst major treatments such as surgery do improve quality of life outcomes, other noninvasive treatments such as intravenous steroids can have a similar impact and show long-term benefits. Only three studies reviewed orbital decompressive surgery, which showed better psychosocial outcomes than other types of surgery. CONCLUSIONS The effect of some treatments remains unclear due to poor methodology and poor reporting of results. Clinicians need to be aware when planning rehabilitative treatments such as surgery of the influence of psychosocial factors on quality of life outcomes and the lack of a relationship with clinical factors such as disease severity.
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Affiliation(s)
- Sadie Wickwar
- 1 City University London , School of Health Sciences, London, United Kingdom
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Abstract
OBJECTIVES To (1) assess food intake; (2) establish the prevalence of dietary supplement usage and its associated cost (oral nutritional supplements (ONS); vitamin and mineral supplements (VMS)) and; (3) identify the characteristics of nutritional supplement users among patients admitted to a spinal cord injury (SCI) center. STUDY DESIGN A single center survey. METHODS Standardized questionnaires were used to collect demographic information, food consumption over a 24-hour period, and the use of nutritional supplements. Multivariate logistic regression was used to determine the characteristics of dietary supplement usage and those using them. RESULTS Seventy-three patients with SCI completed and returned the questionnaires (69.5% response rate). From 67 questionnaires with food intake data, 21 patients (31.3%) consumed three full meals a day. Nine of the full 73 patients (12.3%) received artificial nutritional support, 14 of 73 (19.1%) received ONS, 34 of 73 (46.5%) received VMS, and 31 of 73 (42.4%) required assistance in order to eat. The three supplements most often prescribed were multivitamins (19.1%), vitamins B (17.8%), and vitamin D (13.6%). VMS use was associated with age (years: >60 vs. ≤ 60: 62.1 vs. 34.1%, P = 0.019), nutrition risk (Spinal Nutrition Screening Tool (≥ 11 vs. <11: 65.7 vs. 28.9%, P = 0.001), and serum albumin concentration (<35 vs. ≥ 35 g/l: 59.6 vs. 16%, P < 0.01). Patients at nutrition risk were found to consume more ONS than the lower risk group (28.5 vs. 10.5%, P = 0.05). The expenditures on ONS and VMS were higher in the group at greater nutritional risk (£1878.3 vs. £914.3, P = 0.005). CONCLUSION The use of nutritional supplements is common in patients with SCI, particularly in older adults and patients with poor nutritional state. However, the present study identified only small numbers of patients consuming all of their hospital meals, which may well contribute to undernutrition risk. Given that a high proportion of patients with SCI require assistance to eat, we suggest that further efforts focus on the feasibility of providing feeding assistants, and on reviewing the nature of the hospital menu.
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Affiliation(s)
- Samford Wong
- Department of Nutrition and Dietetics, National Spinal Injuries Centre, Stoke Mandeville Hospital, Bucks, England, UK; School of Health Sciences, City University, London, England, UK; and Centre for Gastroenterology and Clinical Nutrition, University College London Hospital, London, England, UK,Correspondence to: Samford Wong, Department of Nutrition and Dietetics, National Spinal Injuries Centre, Stoke Mandeville Hospital, Bucks, England, HP21 8AL, UK.
| | - Allison Graham
- Department of Nutrition and Dietetics, National Spinal Injuries Centre, Stoke Mandeville Hospital, Bucks, England, UK
| | - Debbie Green
- Department of Nutrition and Dietetics, National Spinal Injuries Centre, Stoke Mandeville Hospital, Bucks, England, UK
| | | | - Alastair Forbes
- Centre for Gastroenterology and Clinical Nutrition, University College London Hospital, London, England, UK
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Henderson C, Knapp M, Fernández JL, Beecham J, Hirani SP, Cartwright M, Rixon L, Beynon M, Rogers A, Bower P, Doll H, Fitzpatrick R, Steventon A, Bardsley M, Hendy J, Newman SP. Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial. BMJ 2013; 346:f1035. [PMID: 23520339 DOI: 10.1136/bmj.f1035] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the costs and cost effectiveness of telehealth in addition to standard support and treatment, compared with standard support and treatment. DESIGN Economic evaluation nested in a pragmatic, cluster randomised controlled trial. SETTING Community based telehealth intervention in three local authority areas in England. PARTICIPANTS 3230 people with a long term condition (heart failure, chronic obstructive pulmonary disease, or diabetes) were recruited into the Whole Systems Demonstrator telehealth trial between May 2008 and December 2009. Of participants taking part in the Whole Systems Demonstrator telehealth questionnaire study examining acceptability, effectiveness, and cost effectiveness, 845 were randomised to telehealth and 728 to usual care. INTERVENTIONS Intervention participants received a package of telehealth equipment and monitoring services for 12 months, in addition to the standard health and social care services available in their area. Controls received usual health and social care. MAIN OUTCOME MEASURE Primary outcome for the cost effectiveness analysis was incremental cost per quality adjusted life year (QALY) gained. RESULTS We undertook net benefit analyses of costs and outcomes for 965 patients (534 receiving telehealth; 431 usual care). The adjusted mean difference in QALY gain between groups at 12 months was 0.012. Total health and social care costs (including direct costs of the intervention) for the three months before 12 month interview were £1390 (€1610; $2150) and £1596 for the usual care and telehealth groups, respectively. Cost effectiveness acceptability curves were generated to examine decision uncertainty in the analysis surrounding the value of the cost effectiveness threshold. The incremental cost per QALY of telehealth when added to usual care was £92 000. With this amount, the probability of cost effectiveness was low (11% at willingness to pay threshold of £30 000; >50% only if the threshold exceeded about £90 000). In sensitivity analyses, telehealth costs remained slightly (non-significantly) higher than usual care costs, even after assuming that equipment prices fell by 80% or telehealth services operated at maximum capacity. However, the most optimistic scenario (combining reduced equipment prices with maximum operating capacity) eliminated this group difference (cost effectiveness ratio £12 000 per QALY). CONCLUSIONS The QALY gain by patients using telehealth in addition to usual care was similar to that by patients receiving usual care only, and total costs associated with the telehealth intervention were higher. Telehealth does not seem to be a cost effective addition to standard support and treatment. TRIAL REGISTRATION ISRCTN43002091.
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Wilson MH, Davagnanam I, Holland G, Dattani RS, Tamm A, Hirani SP, Kolfschoten N, Strycharczuk L, Green C, Thornton JS, Wright A, Edsell M, Kitchen ND, Sharp DJ, Ham TE, Murray A, Holloway CJ, Clarke K, Grocott MP, Montgomery H, Imray C. Cerebral venous system and anatomical predisposition to high-altitude headache. Ann Neurol 2013; 73:381-9. [DOI: 10.1002/ana.23796] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 09/12/2012] [Accepted: 10/29/2012] [Indexed: 01/03/2023]
Affiliation(s)
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology; National Hospital for Neurology and Neurosurgery; London
| | - Graeme Holland
- Centre for Altitude, Space, and Extreme Environment Medicine; University College London; London
| | - Raj S. Dattani
- Centre for Altitude, Space, and Extreme Environment Medicine; University College London; London
| | - Alexander Tamm
- Centre for Altitude, Space, and Extreme Environment Medicine; University College London; London
| | | | - Nicky Kolfschoten
- Centre for Altitude, Space, and Extreme Environment Medicine; University College London; London
| | - Lisa Strycharczuk
- Lysholm Department of Neuroradiology; National Hospital for Neurology and Neurosurgery; London
| | - Cathy Green
- Lysholm Department of Neuroradiology; National Hospital for Neurology and Neurosurgery; London
| | - John S. Thornton
- Lysholm Department of Neuroradiology; National Hospital for Neurology and Neurosurgery; London
| | | | | | - Neil D. Kitchen
- Department of Neurosurgery; National Hospital for Neurology and Neurosurgery; London
| | - David J. Sharp
- The Traumatic Brain Injury Centre; St Mary's Hospital; Imperial College; London; W1 2NY
| | - Timothy E. Ham
- The Traumatic Brain Injury Centre; St Mary's Hospital; Imperial College; London; W1 2NY
| | - Andrew Murray
- Department of Physiology, Development, and Neuroscience; University of Cambridge; Cambridge
| | | | - Kieran Clarke
- Department of Physiology; University of Oxford; Oxford
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Cartwright M, Hirani SP, Rixon L, Beynon M, Doll H, Bower P, Bardsley M, Steventon A, Knapp M, Henderson C, Rogers A, Sanders C, Fitzpatrick R, Barlow J, Newman SP. Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial. BMJ 2013; 346:f653. [PMID: 23444424 PMCID: PMC3582704 DOI: 10.1136/bmj.f653] [Citation(s) in RCA: 175] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the effect of second generation, home based telehealth on health related quality of life, anxiety, and depressive symptoms over 12 months in patients with long term conditions. DESIGN A study of patient reported outcomes (the Whole Systems Demonstrator telehealth questionnaire study; baseline n=1573) was nested in a pragmatic, cluster randomised trial of telehealth (the Whole Systems Demonstrator telehealth trial, n=3230). General practice was the unit of randomisation, and telehealth was compared with usual care. Data were collected at baseline, four months (short term), and 12 months (long term). Primary intention to treat analyses tested treatment effectiveness; multilevel models controlled for clustering by general practice and a range of covariates. Analyses were conducted for 759 participants who completed questionnaire measures at all three time points (complete case cohort) and 1201 who completed the baseline assessment plus at least one other assessment (available case cohort). Secondary per protocol analyses tested treatment efficacy and included 633 and 1108 participants in the complete case and available case cohorts, respectively. SETTING Provision of primary and secondary care via general practices, specialist nurses, and hospital clinics in three diverse regions of England (Cornwall, Kent, and Newham), with established integrated health and social care systems. PARTICIPANTS Patients with chronic obstructive pulmonary disease (COPD), diabetes, or heart failure recruited between May 2008 and December 2009. MAIN OUTCOME MEASURES Generic, health related quality of life (assessed by physical and mental health component scores of the SF-12, and the EQ-5D), anxiety (assessed by the six item Brief State-Trait Anxiety Inventory), and depressive symptoms (assessed by the 10 item Centre for Epidemiological Studies Depression Scale). RESULTS In the intention to treat analyses, differences between treatment groups were small and non-significant for all outcomes in the complete case (0.480 ≤ P ≤ 0.904) or available case (0.181 ≤ P ≤ 0.905) cohorts. The magnitude of differences between trial arms did not reach the trial defined, minimal clinically important difference (0.3 standardised mean difference) for any outcome in either cohort at four or 12 months. Per protocol analyses replicated the primary analyses; the main effect of trial arm (telehealth v usual care) was non-significant for any outcome (complete case cohort 0.273 ≤ P ≤ 0.761; available case cohort 0.145 ≤ P ≤ 0.696). CONCLUSIONS Second generation, home based telehealth as implemented in the Whole Systems Demonstrator Evaluation was not effective or efficacious compared with usual care only. Telehealth did not improve quality of life or psychological outcomes for patients with chronic obstructive pulmonary disease, diabetes, or heart failure over 12 months. The findings suggest that concerns about potentially deleterious effect of telehealth are unfounded for most patients. TRIAL REGISTRATION ISRCTN43002091.
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Affiliation(s)
- Martin Cartwright
- School of Health Sciences, City University London, London EC1A 7QN, UK
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Wong S, Graham A, Hirani SP, Grimble G, Forbes A. Validation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) in patients with spinal cord injuries (SCIs). Spinal Cord 2013; 51:424-9. [DOI: 10.1038/sc.2012.166] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Rixon L, Hirani SP, Cartwright M, Beynon M, Doll H, Newman SP. A pragmatic cluster randomised controlled trial of telehealth on disease specific quality of life in patients’ with chronic obstructive pulmonary disease and their health-related quality of life and psychological distress over 1 year in the Whole System Demonstrator programme. Int J Integr Care 2012. [PMCID: PMC3571149] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction There is limited evidence for the effectiveness of TH on quality of life (QoL) in patients with COPD. A systematic review in the area inclusive of all respiratory conditions indicated that there were no UK based studies, or randomised controlled trials (RCTs) evaluating the effectiveness of TH for COPD (Janna et al. 2009). A more recent systematic review found 6 studies, only two of which measured QoL as an outcome (Bolton et al. 2010). One of these studies was a RCT and found improvements in QoL at 3 months (Koff 2009), while the other was a non-controlled before and after study which found no difference in quality of life scores at 6 months (Trappenburg, 2008). Research in this area is plagued by small sample sizes, absence of longer-term follow-ups, insufficient descriptions of the intervention, poor internal validity of whether using the device in the context of a complex healthcare intervention leads to improved outcomes for the patient, and few attempts to measure quality of life in patients with COPD following the introduction of these devices. Aims and objectives The current investigation is part of the Whole System Demonstrator (WSD) programme that aims to evaluate the effectiveness of telehealth (TH) for patient reported outcomes with Chronic Obstructive Pulmonary Disease (COPD). The primary objective was to evaluate the effectiveness of telehealth for COPD specific QoL and to examine whether there were improvements in HRQoL and psychological distress at short-term and long-term follow-up in this cohort of patients with COPD. Methods WSD is one of the largest pragmatic cluster randomised controlled trials evaluating TH in the UK. Patients with COPD from three regions in England (Cornwall, Kent and Newham) were recruited from 179 GP practices randomised balancing for region, practice size, deprivation index, non-white proportion and prevalence of COPD. Over 570 patients with COPD completed a comprehensive battery of questionnaires assessing a range of patient reported outcomes. Measures of generic Health-Related Quality of Life (HRQoL) (Short Form-12), disease specific QoL including perceived control over COPD, fatigue caused by the disease and the emotional impact of the disease (Chronic Respiratory Questionnaire). Psychological distress was measured by depression (CESD-10) and anxiety (STAI). Results Multi-level modelling was utilised to evaluate the effect of trial arm on HRQoL and COPD specific QoL. Results for intention-to-treat analysis, participants that received the intervention as per the research protocol, complete case analysis for cases with all baseline, short-term and longer-term follow-ups completed and an available case analysis of patients with either a short or long-term follow-up available. The results will be discussed and have important clinical implications for COPD management. Conclusions Results and conclusions are censored until any findings are published in peer-reviewed journals.
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Wong S, Derry F, Jamous A, Hirani SP, Grimble G, Forbes A. Validation of the spinal nutrition screening tool (SNST) in patients with spinal cord injuries (SCI): result from a multicentre study. Eur J Clin Nutr 2011; 66:382-7. [PMID: 22166898 DOI: 10.1038/ejcn.2011.209] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVES A disease-specific nutrition screening tool (NST): the spinal nutrition screening tool (SNST) has been developed for use in patients with spinal cord injury (SCI) but its reliability and agreement with other published tools requires investigation. The aims of this study were to assess the prevalence of malnutrition risk in SCI patients and to confirm the diagnostic accuracy of the SNST. SUBJECTS/METHODS Patients' baseline clinical data, anthropometric measurements and NST scores were assessed. The validity of the SNST was assessed by (i) comparing with a full dietetic assessment (criterion validity); (ii) comparison with a generic NST: malnutrition universal screening tool (MUST) (concurrent validity); and (iii) completion of an additional SNST to assess inter- and intra-rater reliability. Agreement was assessed using Cohen's κ-statistics. RESULTS Using the SNST, the prevalence of malnutrition risk ranged from 22 to 64% on admission to four SCI centres. The SNST had substantial agreement with MUST (κ: 0.723, 95% confidence interval (CI): 0.607-0.839) and dietitian assessment (κ: 0.567, 95% CI: 0.434-0.699). The SNST had a moderate to substantial reliability (inter-rater reliability: κ: 0.5, 95% CI: 0.2-0.8; intra-rater reliability: κ: 0.64, 95% CI: 0.486-0.802). When compared with dietetic assessment, the SNST had a numerically lower specificity (76.1% vs 80.4%) and similar agreement to MUST (κ: 0.57 vs 0.58) but SNST showed a numerically higher sensitivity (85.7% vs 80.4%) and a numerically higher negative predictive value (92% vs 89.2%) than MUST. CONCLUSIONS This study shows that malnutrition is common in SCI patients. The SNST is an acceptable (valid and reliable) NST and may be a useful alternative to MUST in identifying SCI patients at risk of malnutrition.
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Affiliation(s)
- S Wong
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK.
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Wilson MH, Edsell MEG, Davagnanam I, Hirani SP, Martin DS, Levett DZH, Thornton JS, Golay X, Strycharczuk L, Newman SP, Montgomery HE, Grocott MPW, Imray CHE. Cerebral artery dilatation maintains cerebral oxygenation at extreme altitude and in acute hypoxia--an ultrasound and MRI study. J Cereb Blood Flow Metab 2011; 31:2019-29. [PMID: 21654697 PMCID: PMC3208157 DOI: 10.1038/jcbfm.2011.81] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [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] [Indexed: 12/31/2022]
Abstract
Transcranial Doppler is a widely used noninvasive technique for assessing cerebral artery blood flow. All previous high altitude studies assessing cerebral blood flow (CBF) in the field that have used Doppler to measure arterial blood velocity have assumed vessel diameter to not alter. Here, we report two studies that demonstrate this is not the case. First, we report the highest recorded study of CBF (7,950 m on Everest) and demonstrate that above 5,300 m, middle cerebral artery (MCA) diameter increases (n=24 at 5,300 m, 14 at 6,400 m, and 5 at 7,950 m). Mean MCA diameter at sea level was 5.30 mm, at 5,300 m was 5.23 mm, at 6,400 m was 6.66 mm, and at 7,950 m was 9.34 mm (P<0.001 for change between 5,300 and 7,950 m). The dilatation at 7,950 m reversed with oxygen. Second, we confirm this dilatation by demonstrating the same effect (and correlating it with ultrasound) during hypoxia (FiO(2)=12% for 3 hours) in a 3-T magnetic resonance imaging study at sea level (n=7). From these results, we conclude that it cannot be assumed that cerebral artery diameter is constant, especially during alterations of inspired oxygen partial pressure, and that transcranial 2D ultrasound is a technique that can be used at the bedside or in the remote setting to assess MCA caliber.
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Affiliation(s)
- Mark H Wilson
- Centre for Altitude, Space and Extreme Environment Medicine, Institute of Human Health and Performance, Charterhouse Building, UCL Archway Campus, University College London, London, UK.
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Bower P, Cartwright M, Hirani SP, Barlow J, Hendy J, Knapp M, Henderson C, Rogers A, Sanders C, Bardsley M, Steventon A, Fitzpatrick R, Doll H, Newman S. A comprehensive evaluation of the impact of telemonitoring in patients with long-term conditions and social care needs: protocol for the whole systems demonstrator cluster randomised trial. BMC Health Serv Res 2011; 11:184. [PMID: 21819569 PMCID: PMC3169462 DOI: 10.1186/1472-6963-11-184] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 08/05/2011] [Indexed: 11/10/2022] Open
Abstract
Background It is expected that increased demands on services will result from expanding numbers of older people with long-term conditions and social care needs. There is significant interest in the potential for technology to reduce utilisation of health services in these patient populations, including telecare (the remote, automatic and passive monitoring of changes in an individual's condition or lifestyle) and telehealth (the remote exchange of data between a patient and health care professional). The potential of telehealth and telecare technology to improve care and reduce costs is limited by a lack of rigorous evidence of actual impact. Methods/Design We are conducting a large scale, multi-site study of the implementation, impact and acceptability of these new technologies. A major part of the evaluation is a cluster-randomised controlled trial of telehealth and telecare versus usual care in patients with long-term conditions or social care needs. The trial involves a number of outcomes, including health care utilisation and quality of life. We describe the broad evaluation and the methods of the cluster randomised trial Discussion If telehealth and telecare technology proves effective, it will provide additional options for health services worldwide to deliver care for populations with high levels of need. Trial Registration Current Controlled Trials ISRCTN43002091
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Affiliation(s)
- Peter Bower
- Health Sciences Research Group, University of Manchester, Manchester, UK
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Oliveira G, Hirani SP, Epstein R, Yazigi L, Behlau M. Coping strategies in voice disorders of a Brazilian population. J Voice 2011; 26:205-13. [PMID: 21550778 DOI: 10.1016/j.jvoice.2010.10.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 10/27/2010] [Indexed: 11/16/2022]
Abstract
The purpose of this research is to explore coping strategies of individuals with and without vocal complaint and to examine relationships between the type of coping and vocal complaint; vocal symptoms; vocal self-assessment; perceptual analysis and states of depression, anxiety, and aspects related to self-esteem; and locus of control. One hundred seventy-eight subjects with (n=87) and without vocal (n=91) complaint completed the following analysis: identification and characterization questionnaire, vocal self-assessment, perceptual analysis, Voice Disability Coping Questionnaire (VDCQ)-Brazilian Version, Beck Depression Inventory, Rosenberg Self-esteem Scale, Spielberger State-Trait Anxiety Inventory, and Health Locus of Control Scale. Age (P=0.219) and sex (P=0.132) were similar for both groups. The groups were statistically different for the following vocal characterization: number of symptoms, voice complaint, vocal self-assessment, and perceptual analysis. Conversely, the groups did not differ on states of depression, anxiety, and aspects related to self-esteem; and locus of control. Mean coping scores for the group with vocal complaint was 51.86 and for the group without vocal complaint was 23.18. Furthermore, men and women did not differ on the coping strategies reported (P=0.750); however, individuals with vocal complaint reported statistically more strategies than the individuals without vocal complaint (P<0.001). Problem-focused strategies were more frequently reported by individuals with vocal complaint (46.7%). Coping results correlated (Spearman's r) positively with vocal perceptual analysis (P=0.036), depression (P=0.006), and anxiety (P=0.022), and correlated negatively with locus of control (P=0.001). No correlation was found between coping and the other variables studied. These findings indicate that people with vocal complaint use a variety of coping strategies, problem focused in particular, to deal with their voice problems. Coping results appear to be associated with perceptual characteristics of voice and some traits, such as depression, anxiety, and locus of control.
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Affiliation(s)
- Gisele Oliveira
- Department of Human Communication Disorders, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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Abstract
Coping is a key concept in psychological medicine and refers to the way in which people deal with the stress of illness. Voice disorders may have pervasive effects upon the individual's life beyond the vocal impairment, yet there is little reference in the current literature as to how people cope with voice problems. The purpose of this article is to provide a brief review of coping and its evaluation and to explore cultural differences and coping styles in individuals with voice disorders. The implications for voice therapy also are discussed.
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Affiliation(s)
- Ruth Epstein
- Royal National Throat Nose & Ear Hospital and Ear Institute, University College London, UK
| | - Shashivadan P. Hirani
- Health Services Research, School of Community and Health sciences, City University London, UK
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