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Griffiths S, Spencer E, Wilcock J, Bamford C, Wheatley A, Brunskill G, D'Andrea F, Walters KR, Lago N, O'Keeffe A, Hunter R, Tuijt R, Harrison Dening K, Banerjee S, Manthorpe J, Allan L, Robinson L, Rait G. Protocol for the feasibility and implementation study of a model of best practice in primary care led postdiagnostic dementia care: PriDem. BMJ Open 2023; 13:e070868. [PMID: 37597869 PMCID: PMC10441044 DOI: 10.1136/bmjopen-2022-070868] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/03/2023] [Indexed: 08/21/2023] Open
Abstract
INTRODUCTION Care is often inadequate and poorly integrated after a dementia diagnosis. Research and policy highlight the unaffordability and unsustainability of specialist-led support, and instead suggest a task-shared model, led by primary care. This study is part of the PriDem primary care led postdiagnostic dementia care research programme and will assess delivery of an evidence-informed, primary care based, person-centred intervention. The intervention involves Clinical Dementia Leads (CDLs) working in primary care to develop effective dementia care systems that build workforce capacity and support teams to deliver tailored support to people living with dementia and their carers. METHODS AND ANALYSIS This is a 15-month mixed-methods feasibility and implementation study, situated in four National Health Service (NHS) primary care networks in England. The primary outcome is adoption of personalised care planning by participating general practices, assessed through a patient records audit. Feasibility outcomes include recruitment and retention; appropriateness and acceptability of outcome measures; acceptability, feasibility and fidelity of intervention components. People living with dementia (n=80) and carers (n=66) will be recruited through participating general practices and will complete standardised measures of health and well-being. Participant service use data will be extracted from electronic medical records. A process evaluation will explore implementation barriers and facilitators through methods including semistructured interviews with people living with dementia, carers and professionals; observation of CDL engagement with practice staff; and a practice fidelity log. Process evaluation data will be analysed qualitatively using codebook thematic analysis, and quantitatively using descriptive statistics. Economic analysis will determine intervention cost-effectiveness. ETHICS AND DISSEMINATION The study has received favourable ethical opinion from Wales REC4. NHS Confidentiality Advisory Group support allows researchers preconsent access to patient data. Results will inform intervention adaptations and a future large-scale evaluation. Dissemination through peer-review journals, engagement with policy-makers and conferences will inform recommendations for dementia services commissioning. TRIAL REGISTRATION NUMBER ISRCTN11677384.
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Affiliation(s)
- Sarah Griffiths
- Research Department of Primary Care & Population Health, UCL, London, UK
| | - Emily Spencer
- Research Department of Primary Care & Population Health, UCL, London, UK
| | - Jane Wilcock
- Research Department of Primary Care & Population Health, UCL, London, UK
| | - Claire Bamford
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alison Wheatley
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Brunskill
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Federica D'Andrea
- Research Department of Primary Care & Population Health, UCL, London, UK
| | - Kate R Walters
- Research Department of Primary Care & Population Health, UCL, London, UK
| | | | - Aidan O'Keeffe
- Mathematical Sciences, University of Nottingham, Nottingham, UK
| | - Rachael Hunter
- Research Department of Primary Care & Population Health, UCL, London, UK
| | | | | | - Sube Banerjee
- Office of Vice Chancellor, University of Plymouth, Plymouth, UK
| | - Jill Manthorpe
- Health & Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Rait
- Research Department of Primary Care & Population Health, UCL, London, UK
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Bamford C, Wilcock J, Brunskill G, Wheatley A, Harrison Dening K, Manthorpe J, Allan L, Banerjee S, Booi L, Griffiths S, Rait G, Walters K, Robinson L. Improving primary care based post-diagnostic support for people living with dementia and carers: Developing a complex intervention using the Theory of Change. PLoS One 2023; 18:e0283818. [PMID: 37134099 PMCID: PMC10155958 DOI: 10.1371/journal.pone.0283818] [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: 03/09/2022] [Accepted: 03/17/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND The need to improve support following a diagnosis of dementia is widely recognised, but it is unclear how this can best be achieved within UK health and social care systems. A task-shared and task-shifted approach has been recommended, but there is limited guidance on how to achieve this in practice. As part of a programme of research, we developed an intervention to enhance the role of primary care in post-diagnostic care and support for people living with dementia and carers. METHODS We used the Theory of Change to develop a complex intervention informed by initial literature reviews and qualitative work. The intervention was developed through an iterative series of workshops, meetings and task groups with a range of stakeholders, including the multidisciplinary project team, people living with dementia and carers, service managers, frontline practitioners, and commissioners. RESULTS 142 participants contributed to intervention development through face-to-face or virtual meetings. The intervention comprises three complementary strands of work focusing on: developing systems, delivering tailored care and support, and building capacity and capability. Clinical dementia leads, based in primary care networks, will facilitate the intervention providing tailored expertise and support. CONCLUSION The Theory of Change proved useful in providing structure and engaging stakeholders. The process was challenging, took longer and was less participative than intended due to restrictions caused by the COVID-19 pandemic. We will next conduct a feasibility and implementation study to explore whether the intervention can be successfully delivered within primary care. If successful, the intervention offers practical strategies for delivering a task-shared and task-shifted approach to post-diagnostic support that could be adapted for similar health and social care contexts internationally.
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Affiliation(s)
- Claire Bamford
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jane Wilcock
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Greta Brunskill
- Voluntary Organisations Network North East, Newcastle, United Kingdom
| | - Alison Wheatley
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute at King's, King's College London, London, United Kingdom
| | - Louise Allan
- South Cloisters, University of Exeter, Exeter, United Kingdom
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Laura Booi
- Centre for Dementia Research, Leeds Beckett University, Leeds, United Kingdom
| | - Sarah Griffiths
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Greta Rait
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Kate Walters
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
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Bamford C, Wheatley A, Brunskill G, Booi L, Allan L, Banerjee S, Harrison Dening K, Manthorpe J, Robinson L. Key components of post-diagnostic support for people with dementia and their carers: A qualitative study. PLoS One 2021; 16:e0260506. [PMID: 34928972 PMCID: PMC8687564 DOI: 10.1371/journal.pone.0260506] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There has been a shift in focus of international dementia policies from improving diagnostic rates to enhancing the post-diagnostic support provided to people with dementia and their carers. There is, however, little agreement over what constitutes good post-diagnostic support. This study aimed to identify the components of post-diagnostic dementia support. METHODS We adopted a qualitative design using interviews, focus groups and observation to explore the perspectives of key stakeholders on the content of post-diagnostic dementia support. Purposive sampling was used to identify sites in England and Wales recognised as delivering good practice. Participants included 17 people with dementia, 31 carers, 68 service managers or funders, and 78 frontline staff. Interviews and focus groups were audio recorded and transcribed for analysis. Forty-eight sessions of observation were completed and recorded in fieldnotes. Components were identified through an inductive, thematic approach and cross-checked against national guidelines and existing frameworks; they were subsequently critically reviewed by a range of experts and our mixed stakeholder panel. RESULTS Twenty distinct components of post-diagnostic support were identified, related to five themes: timely identification and management of needs; understanding and managing dementia; emotional and psychological wellbeing; practical support; and integrating support. The first and last of these were cross-cutting themes facilitating the delivery of a unique constellation of components of post-diagnostic support to each individual living with dementia or dyad at a particular time. CONCLUSIONS Our work offers an empirically based framework to inform the development and delivery of holistic, integrated and continuous dementia care from diagnosis to end of life. It highlights the relevance of many components to both people living with dementia and their carers. Since the framework was developed in England and Wales, further research is needed to explore the relevance of our components to other sectors, countries and care systems.
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Affiliation(s)
- Claire Bamford
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alison Wheatley
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Greta Brunskill
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Laura Booi
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Louise Allan
- South Cloisters, University of Exeter, Exeter, United Kingdom
| | - Sube Banerjee
- Office of Vice Chancellor, University of Plymouth, Plymouth, United Kingdom
| | | | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute at King’s, King’s College London, London, United Kingdom
| | - Louise Robinson
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
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Walpert M, Mitchell S, Bamford C, Ivenso C, McKirdy S, Pattan V, Rodda J, Sikdar S, Barber R. Diagnosis of Alzheimer's disease before dementia: A study of UK psychiatrists. Alzheimers Dement 2021. [DOI: 10.1002/alz.051327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Claire Bamford
- Population and Health Sciences Institute, Newcastle University Newcastle upon Tyne United Kingdom
| | | | - Stuart McKirdy
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust Newcastle Upon Tyne United Kingdom
| | | | - Joanne Rodda
- North East London NHS Foundation Trust London United Kingdom
| | | | - Robert Barber
- Northumberland, Tyne and Wear NHS Foundation Trust Newcastle Upon Tyne United Kingdom
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Booi L, Wheatley A, Brunskill G, Banerjee S, Manthorpe J, Robinson L, Bamford C. Outcomes valued by people living with dementia and their carers: A qualitative systematic review with a qualitative synthesis. Alzheimers Dement 2021. [DOI: 10.1002/alz.053795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Laura Booi
- Population and Health Sciences Institute, Newcastle University Newcastle upon Tyne United Kingdom
| | - Alison Wheatley
- Population and Health Sciences Institute, Newcastle University Newcastle upon Tyne United Kingdom
| | - Greta Brunskill
- Population and Health Sciences Institute, Newcastle University Newcastle upon Tyne United Kingdom
| | | | | | - Louise Robinson
- Population and Health Sciences Institute, Newcastle University Newcastle upon Tyne United Kingdom
| | - Claire Bamford
- Population and Health Sciences Institute, Newcastle University Newcastle upon Tyne United Kingdom
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Wheatley A, Bamford C, Brunskill G, Booi L, Dening KH, Robinson L. Implementing post-diagnostic support for people living with dementia in England: a qualitative study of barriers and strategies used to address these in practice. Age Ageing 2021; 50:2230-2237. [PMID: 34240114 PMCID: PMC8675435 DOI: 10.1093/ageing/afab114] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND inequalities and gaps in post-diagnostic support (PDS) for people with dementia persist despite a policy focus on dementia in England and Wales. Understanding and overcoming the factors contributing to these inequalities is vital to improve care for people living with dementia (PLWD) and their families. OBJECTIVE to explore common barriers to the delivery of PDS in England and Wales and describe successful strategies to address them, drawing on examples from current practice. DESIGN qualitative semi-structured interviews, focus groups and observation. SETTINGS Phase 1: interviewees were drawn from multiple sectors across England and Wales, including NHS clinical commissioning groups and social care. Phase 2: six case study sites based in different sectors (primary care, secondary mental health and third sector) in England. PARTICIPANTS Phase 1: 61 professionals, including commissioners and service managers. Phase 2: 68 professionals, including frontline staff and those working in related services; 17 PLWD; 31 carers. RESULTS barriers to implementing PDS in dementia were an unsupportive infrastructure, limited proactive review and limited capacity and capability particularly in primary care. Strategies used successfully in practice to address these challenges included creating opportunities for service development, improving joint working, supporting non-specialists and developing ongoing, holistic review and care planning. CONCLUSION a range of practical strategies have been identified to address many of the common barriers to PDS in dementia. To achieve policy goals of a task-shifted and task-shared approach to PDS, widespread use of these strategies is recommended.
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Affiliation(s)
- Alison Wheatley
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Brunskill
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Booi
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Harrison Dening
- Health & Life Sciences, School of Nursing and Midwifery, De Montfort University, Leicester, UK
- Research & Publications, Dementia UK, London, UK
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Booi L, Wheatley A, Brunskill G, Banerjee S, Manthorpe J, Robinson L, Bamford C. Outcomes valued by people living with dementia and their care partners: protocol for a qualitative systematic review and synthesis. BMJ Open 2021; 11:e050909. [PMID: 34413109 PMCID: PMC8378359 DOI: 10.1136/bmjopen-2021-050909] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Growing numbers of interventions are being developed to support people and families living with dementia, but the extent to which they address the areas of most importance to the intended recipients is unclear. This qualitative review will synthesise outcomes identified as important from the perspectives of people living with dementia and their care partners, both for themselves and each other. METHODS AND ANALYSIS The review will employ thematic synthesis methodology. Studies from 1990 or later will be eligible if they include qualitative data on the views of people living with dementia or their care partners on valued outcomes or the lived experience of dementia. Databases to be searched include MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo and Social Sciences Premium Collection, in addition to systematically gathered grey literature. Rayyan QCRI software will be used to manage the screening processes, and NVivo software will be used to manage data extraction and analysis. The review will also critically evaluate the extent to which international recommendations address the areas of importance to people living with dementia and their families. The findings will be of relevance to researchers, policy makers and providers and commissioners of dementia services. The protocol is written in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. ETHICS AND DISSEMINATION As the methodology of this study consists of collecting data from publicly available articles, it does not require ethical approval. We will share the results through conference presentations and an open-access publication in a peer-reviewed journal. Our mixed stakeholder involvement group will advise on dissemination to non-academic audiences. PROSPERO REGISTRATION NUMBER CRD42020219274.
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Affiliation(s)
- Laura Booi
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Alison Wheatley
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Brunskill
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sube Banerjee
- Office of Vice Chancellor, University of Plymouth, Plymouth, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute at King's, King's College London, London, UK
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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O’Brien JT, Taylor JP, Thomas A, Bamford C, Vale L, Hill S, Allan L, Finch T, McNally R, Hayes L, Surendranathan A, Kane J, Chrysos AE, Bentley A, Barker S, Mason J, Burn D, McKeith I. Improving the diagnosis and management of Lewy body dementia: the DIAMOND-Lewy research programme including pilot cluster RCT. Programme Grants Appl Res 2021. [DOI: 10.3310/pgfar09070] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract
Background
Lewy body dementia, comprising both dementia with Lewy bodies and Parkinson’s disease dementia, is the second commonest cause of neurodegenerative dementia. Existing evidence suggests that it is underdiagnosed and without a consistent approach to management.
Objectives
To improve the diagnosis and management of Lewy body dementia by (1) understanding current diagnostic practice for dementia with Lewy bodies and Parkinson’s disease dementia; (2) identifying barriers to and facilitators of diagnosis and management; (3) developing evidence-based assessment toolkits to improve diagnosis of dementia with Lewy bodies and Parkinson’s disease dementia; (4) producing a management toolkit to facilitate management; and (5) undertaking a pilot cluster randomised clinical trial.
Design
Work package 1 assessed clinical diagnostic rates from case notes for dementia with Lewy bodies and Parkinson’s disease dementia before and after (work package 1 repeated) introduction of an assessment toolkit. In work package 2, we developed a management toolkit for Lewy body dementia. In work package 3, we developed assessment toolkits for dementia with Lewy bodies and Parkinson’s disease dementia and piloted these and the management toolkit in a clinical service. In work package 4, we undertook a pilot study of 23 services in nine NHS trusts that were cluster randomised to receiving and using the management toolkit or standard care. Work package 5 comprised a series of qualitative studies, examining barriers to and facilitators of diagnosis and management.
Setting
Secondary care memory assessment and movement disorder services in England.
Interventions
Assessment toolkits for Lewy body dementia consisted of questions for diagnostic symptoms, and management toolkits comprised 161 guidance statements grouped under five symptom domains.
Review methods
The systematic reviews of pharmacological and non-pharmacological management were based on published literature, with meta-analysis when possible, following a search of several electronic databases and the grey literature using terms related to Lewy body dementia, without restriction on time or language.
Participants
Participants aged ≥ 50 years diagnosed with dementia with Lewy bodies or Parkinson’s disease dementia and, for work package 1 and work package 1 repeated, non-dementia with Lewy bodies and non-Parkinson’s disease dementia controls. The qualitative studies included people with Lewy body dementia, carers and professionals.
Main outcome measures
For work packages 1 and 1 repeated, diagnostic rates for dementia with Lewy bodies and Parkinson’s disease dementia as a proportion of all dementia or Parkinson’s disease. For work packages 2 and 3, the production of diagnostic and management toolkits. For work package 4, feasibility of undertaking a cluster randomised trial of the toolkits, measured by number of participants recruited and use of the toolkits, assessed qualitatively.
Results
Work package 1 – 4.6% of dementia cases in secondary care received a dementia with Lewy bodies diagnosis (with significant differences in diagnostic rates between services) and 9.7% of those with Parkinson’s disease had a diagnosis of Parkinson’s disease dementia. There was evidence of delays in diagnosis for both dementia with Lewy bodies and Parkinson’s disease dementia compared with control patients, and the costs of dementia with Lewy bodies and Parkinson’s disease dementia were also greater than those for matched controls (p < 0.01 for both). Work package 2 – we produced 252 statements regarding Lewy body dementia management and, following a Delphi process, 161 statements were included in a management toolkit. Work package 3 – piloting indicated that separate assessment toolkits for use in memory clinic and movement disorder services were preferred, but a single toolkit for Lewy body dementia management was suitable. Work package 4 – we were able to recruit Lewy body dementia patients to target and recruited 131 patients within 6 months (target n = 120), of whom > 80% were retained in the study at 6 months. Work package 5 – barriers to diagnosis and management of Lewy body dementia were complex. Managing Lewy body dementia often requires input from a range of specialties and, therefore, care pathways may be fragmented. Positive attitudes to diagnosing Lewy body dementia, working with a team with expertise in Lewy body dementia and opportunities for cross-specialty discussion of patients with complex needs facilitated diagnosis and management. The toolkits were generally well received, particularly the management toolkit. Implementation, however, varied, reflecting differences in attitudes, skills, time and local leadership. Work package 1 repeated – following introduction of the assessment toolkit, we found that 9.7% of dementia cases had dementia with Lewy bodies (a significant increase from baseline; p = 0.0019), but Parkinson’s disease dementia rates were similar (8.2%) to baseline.
Limitations
We included only two geographical regions and evidence informing the management toolkit was limited. Work package 4 was a pilot study and, therefore, we did not set out to assess the extent to which use of the management toolkit altered outcomes at the individual patient level. We noted implementation of the toolkits was variable. The increase in diagnostic rates in dementia with Lewy bodies following introduction of the assessment toolkits cannot be necessarily causally attributed to them.
Conclusions
Dementia with Lewy bodies and Parkinson’s disease dementia were diagnosed in secondary care NHS services, with a lower frequency (around half) than that expected from known prevalence rates. The introduction of assessment toolkits for dementia with Lewy bodies and Parkinson’s disease dementia was associated with increased diagnostic rates of dementia with Lewy bodies, but not Parkinson’s disease dementia. Qualitative studies indicated inherent complexities of the disease itself, with treatment requiring input from different specialties and the potential for fragmented services, a workforce with variable training and confidence in Lewy body dementia, and negative attitudes towards diagnosis. The cluster randomised pilot trial demonstrated that patients could be successfully recruited, and provided preliminary evidence that the toolkits could be implemented in clinical services.
Future work
The evidence base informing the management of Lewy body dementia is limited, especially for non-pharmacological interventions. More well-designed randomised controlled trials for both cognitive and non-cognitive symptoms are needed.
Trial registration
Current Controlled Trials ISRCTN11083027.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- John T O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alan Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Hill
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Allan
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Richard McNally
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Hayes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Joseph Kane
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alexandros E Chrysos
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Allison Bentley
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - David Burn
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian McKeith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Surendranathan A, Kane J, Bentley A, Barker S, McNally R, Bamford C, Taylor JP, Thomas A, McKeith I, Burn D, O'Brien JT. Introduction of an assessment toolkit associated with increased rate of DLB diagnosis. Alzheimers Res Ther 2021; 13:50. [PMID: 33608039 PMCID: PMC7896389 DOI: 10.1186/s13195-021-00786-8] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/03/2021] [Indexed: 11/25/2022]
Abstract
Background Dementia with Lewy bodies (DLB) and dementia in Parkinson’s disease (PDD) are recognised to be under-recognised in clinical practice in the UK, with only one third to a half of expected cases diagnosed. We aimed to assess whether clinical diagnostic rates could be increased by the introduction of a structured assessment toolkit for clinicians. Methods We established baseline diagnostic rates for DLB and PDD in four memory clinics and three movement disorder/Parkinson’s disease (PD) clinics in two separate geographical regions in the UK. An assessment toolkit specifically developed to assist with the recognition and diagnosis of DLB and PDD was then introduced to the same clinical teams and diagnostic rates for DLB and PDD were reassessed. For assessing DLB diagnosis, a total of 3820 case notes were reviewed before the introduction of the toolkit, and 2061 case notes reviewed after its introduction. For PDD diagnosis, a total of 1797 case notes were reviewed before the introduction of the toolkit and 3405 case notes after it. Mean values and proportions were analysed using Student’s t test for independent samples and χ2 test, respectively. Results DLB was diagnosed in 4.6% of dementia cases prior to the introduction of the toolkit, and 6.2% of dementia cases afterwards, an absolute rise of 1.6%, equal to a 35% increase in the number of DLB cases diagnosed when using the toolkit (χ2 = 4.2, P = 0.041). The number of PD patients diagnosed with PDD was not found overall to be significantly different when using the toolkit: 9.6% of PD cases before and 8.2% of cases after its introduction (χ2 = 1.8, P = 0.18), though the ages of PD patients assessed after the toolkit’s introduction were lower (73.9 years vs 80.0 years, t = 19.2, p < 0.001). Conclusion Introduction of the assessment toolkit was associated with a significant increase in the rate of DLB diagnosis, suggesting that a structured means of assessing symptoms and clinical features associated with DLB can assist clinicians in recognising cases. The assessment toolkit did not alter the overall rate of PDD diagnosis, suggesting that alternate means may be required to improve the rate of diagnosis of dementia in Parkinson’s disease.
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Affiliation(s)
- A Surendranathan
- Department of Psychiatry, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Box 189, Cambridge, CB2 0QQ, UK.
| | - J Kane
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - A Bentley
- Department of Psychiatry, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Box 189, Cambridge, CB2 0QQ, UK
| | - S Barker
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - R McNally
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - C Bamford
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - J-P Taylor
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - A Thomas
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - I McKeith
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - D Burn
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - J T O'Brien
- Department of Psychiatry, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Box 189, Cambridge, CB2 0QQ, UK
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Allan LM, Wheatley A, Smith A, Flynn E, Homer T, Robalino S, Beyer FR, Fox C, Howel D, Barber R, Connolly JA, Robinson L, Parry SW, Rochester L, Corner L, Bamford C. An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study. Health Technol Assess 2020; 23:1-208. [PMID: 31661058 DOI: 10.3310/hta23590] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Fall-related injuries are a significant cause of morbidity and mortality in people with dementia. There is presently little evidence to guide the management of such injuries, and yet there are potentially substantial benefits to be gained if the outcomes of these injuries could be improved. This study aimed to design an appropriate new health-care intervention for people with dementia following a fall and to assess the feasibility of its delivery in the UK NHS. OBJECTIVES To determine whether or not it is possible to design an intervention to improve outcomes of falls in dementia, to investigate the feasibility and acceptability of the DIFRID (Developing an Intervention for Fall related Injuries in Dementia) intervention and to investigate the feasibility of a future randomised controlled trial and the data collection tools needed to evaluate both the effectiveness and the cost-effectiveness of the DIFRID intervention. DESIGN This was a mixed-methods feasibility study. A systematic review (using Cochrane methodology) and realist review [using Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) methodology] explored the existing evidence base and developed programme theories. Searches were carried out in November 2015 (updated in January 2018) for effectiveness studies and in August 2016 for economic studies. A prospective observational study identified service use via participant diary completion. Qualitative methods (semistructured interviews, focus groups and observation) were used to explore current practice, stakeholder perspectives of the health and social care needs of people with dementia following a fall, ideas for intervention and barriers to and facilitators of change. Each of the resulting data sets informed intervention development via Delphi consensus methods. Finally, a single-arm feasibility study with embedded process evaluation was conducted. SETTING This study was set in the community. PARTICIPANTS The participants were (1) people with dementia presenting with falls necessitating health-care attention in each setting (primary care, the community and secondary care) at three sites and their carers, (2) professionals delivering the intervention, who were responsible for training and supervision and who were members of the intervention team, (3) professionals responsible for approaching and recruiting participants and (4) carers of participants with dementia. INTERVENTIONS This was a complex multidisciplinary therapy intervention. Physiotherapists, occupational therapists and support workers delivered up to 22 sessions of tailored activities in the home or local area of the person with dementia over a period of 12 weeks. MAIN OUTCOME MEASURES (1) Assessment of feasibility of study procedures; (2) assessment of the acceptability, feasibility and fidelity of intervention components; and (3) assessment of the suitability and acceptability of outcome measures for people with dementia and their carers (number of falls, quality of life, fear of falling, activities of daily living, goal-setting, health-care utilisation and carer burden). RESULTS A multidisciplinary intervention delivered in the homes of people with dementia was designed based on qualitative work, realist review and recommendations of the consensus panel. The intervention was delivered to 11 people with dementia. The study suggested that the intervention is both feasible and acceptable to stakeholders. A number of modifications were recommended to address some of the issues arising during feasibility testing. The measurement of outcome measures was successful. CONCLUSIONS The study has highlighted the feasibility of delivering a creative, tailored, individual approach to intervention for people with dementia following a fall. Although the intervention required greater investment of time than usual practice, many staff valued the opportunity to work more closely with people with dementia and their carers. We conclude that further research is now needed to refine this intervention in the context of a pilot randomised controlled trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN41760734 and PROSPERO CRD42016029565. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 59. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Louise M Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Alison Wheatley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Amy Smith
- Department of Occupational Therapy, Tees, Esk and Wear Valleys NHS Foundation Trust, Stockton-on-Tees, UK
| | - Elizabeth Flynn
- Department of Physiotherapy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tara Homer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Shannon Robalino
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona R Beyer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Robert Barber
- Department of Old Age Psychiatry, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jim Anthony Connolly
- Department of Emergency Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Steve Wayne Parry
- Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Lynne Corner
- VOICE, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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11
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O'Brien JT, McKeith IG, Thomas AJ, Bamford C, Vale L, Hill S, Allan L, Finch T, McNally R, Hayes L, Surendranathan A, Kane JP, Dunn S, Bentley A, Barker S, Mason J, Burn D, Taylor J. Introduction of a Management Toolkit for Lewy Body Dementia: A Pilot Cluster‐Randomized Trial. Mov Disord 2020; 36:143-151. [DOI: 10.1002/mds.28282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/04/2020] [Accepted: 08/17/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- John T. O'Brien
- Department of Psychiatry University of Cambridge Cambridge UK
- Cambridgeshire and Peterborough National Health Service Foundation Trust Cambridge UK
| | - Ian G. McKeith
- Translational and Clinical Research Institute Newcastle University Newcastle UK
| | - Alan J. Thomas
- Translational and Clinical Research Institute Newcastle University Newcastle UK
| | - Claire Bamford
- Population Health Sciences Institute Newcastle University Newcastle UK
| | - Luke Vale
- Population Health Sciences Institute Newcastle University Newcastle UK
| | - Sarah Hill
- Population Health Sciences Institute Newcastle University Newcastle UK
| | - Louise Allan
- Institute of Health Research University of Exeter Exeter UK
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Faculty of Health & Life Sciences Northumbria University Newcastle UK
| | - Richard McNally
- Population Health Sciences Institute Newcastle University Newcastle UK
| | - Louise Hayes
- Population Health Sciences Institute Newcastle University Newcastle UK
| | | | | | - Sarah Dunn
- Newcastle Clinical Trials Unit Newcastle University Newcastle UK
| | - Allison Bentley
- Department of Psychiatry University of Cambridge Cambridge UK
- Cambridgeshire and Peterborough National Health Service Foundation Trust Cambridge UK
| | - Sally Barker
- Translational and Clinical Research Institute Newcastle University Newcastle UK
| | - James Mason
- Warwick Medical School University of Warwick Coventry UK
| | - David Burn
- Population Health Sciences Institute Newcastle University Newcastle UK
| | - John‐Paul Taylor
- Translational and Clinical Research Institute Newcastle University Newcastle UK
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Wheatley A, Bamford C, Brunskill G, Harrison Dening K, Allan L, Rait G, Robinson L. Task-shifted approaches to postdiagnostic dementia support: a qualitative study exploring professional views and experiences. BMJ Open 2020; 10:e040348. [PMID: 32958494 PMCID: PMC7507844 DOI: 10.1136/bmjopen-2020-040348] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES To explore the views of commissioners, service development leads, service managers and senior staff in selected dementia services on increasing the role of primary care in postdiagnostic support for people with dementia. DESIGN Qualitative semi-structured telephone interviews and a focus group. SETTING Participants were drawn from National Health Service (NHS) Clinical Commissioning Groups, social care commissioning and a range of dementia services across primary care, secondary mental healthcare, social care and the third sector. All participants were based in England or Wales. PARTICIPANTS 61 professionals, comprising 25 commissioners or service development leads; 25 service managers; and 11 team leads or senior staff. RESULTS Participants had varied views on whether a primary care-based approach for postdiagnostic support for people with dementia and their families was appropriate, achievable and/or desirable. Potential benefits of a task-shifted approach were continuity and a more holistic approach to care; familiarity for both patients and staff; and reduction of stigma. Key challenges included the capacity, ability and inclination of primary care to deliver postdiagnostic support for people with dementia and their families. We discovered a number of conceptual challenges to implementing a task-shifted and task-shared approach, including uncertainties around the nature of postdiagnostic support, the definition of primary care and identification of tasks that could be shifted to primary care. CONCLUSIONS Our data highlight the concerns of key professional staff around greater involvement of primary care in postdiagnostic support for dementia. Further research is needed to achieve a shared understanding and consensus over what postdiagnostic support means in the context of dementia. We will be undertaking such research in the next phase of our programme.
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Affiliation(s)
- Alison Wheatley
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Brunskill
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Harrison Dening
- Health & Life Sciences, School of Nursing and Midwifery, De Montfort University, Leicester, UK
- Research & Publications, Dementia UK, London, UK
| | - Louise Allan
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Robinson L, Poole M, McLellan E, Lee R, Amador S, Bhattarai N, Bryant A, Coe D, Corbett A, Exley C, Goodman C, Gotts Z, Harrison-Dening K, Hill S, Howel D, Hrisos S, Hughes J, Kernohan A, Macdonald A, Mason H, Massey C, Neves S, Paes P, Rennie K, Rice S, Robinson T, Sampson E, Tucker S, Tzelis D, Vale L, Bamford C. Supporting good quality, community-based end-of-life care for people living with dementia: the SEED research programme including feasibility RCT. Programme Grants Appl Res 2020. [DOI: 10.3310/pgfar08080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
In the UK, most people with dementia die in the community and they often receive poorer end-of-life care than people with cancer.
Objective
The overall aim of this programme was to support professionals to deliver good-quality, community-based care towards, and at, the end of life for people living with dementia and their families.
Design
The Supporting Excellence in End-of-life care in Dementia (SEED) programme comprised six interlinked workstreams. Workstream 1 examined existing guidance and outcome measures using systematic reviews, identified good practice through a national e-survey and explored outcomes of end-of-life care valued by people with dementia and family carers (n = 57) using a Q-sort study. Workstream 2 explored good-quality end-of-life care in dementia from the perspectives of a range of stakeholders using qualitative methods (119 interviews, 12 focus groups and 256 observation hours). Using data from workstreams 1 and 2, workstream 3 used co-design methods with key stakeholders to develop the SEED intervention. Worksteam 4 was a pilot study of the SEED intervention with an embedded process evaluation. Using a cluster design, we assessed the feasibility and acceptability of recruitment and retention, outcome measures and our intervention. Four general practices were recruited in North East England: two were allocated to the intervention and two provided usual care. Patient recruitment was via general practitioner dementia registers. Outcome data were collected at baseline, 4, 8 and 12 months. Workstream 5 involved economic modelling studies that assessed the potential value of the SEED intervention using a contingent valuation survey of the general public (n = 1002). These data informed an economic decision model to explore how the SEED intervention might influence care. Results of the model were presented in terms of the costs and consequences (e.g. hospitalisations) and, using the contingent valuation data, a cost–benefit analysis. Workstream 6 examined commissioning of end-of-life care in dementia through a narrative review of policy and practice literature, combined with indepth interviews with a national sample of service commissioners (n = 20).
Setting
The workstream 1 survey and workstream 2 included services throughout England. The workstream 1 Q-sort study and workstream 4 pilot trial took place in North East England. For workstream 4, four general practices were recruited; two received the intervention and two provided usual care.
Results
Currently, dementia care and end-of-life care are commissioned separately, with commissioners receiving little formal guidance and training. Examples of good practice rely on non-recurrent funding and leadership from an interested clinician. Seven key components are required for good end-of-life care in dementia: timely planning discussions, recognising end of life and providing supportive care, co-ordinating care, effective working with primary care, managing hospitalisation, continuing care after death, and valuing staff and ongoing learning. Using co-design methods and the theory of change, the seven components were operationalised as a primary care-based, dementia nurse specialist intervention, with a care resource kit to help the dementia nurse specialist improve the knowledge of family and professional carers. The SEED intervention proved feasible and acceptable to all stakeholders, and being located in the general practice was considered beneficial. None of the outcome measures was suitable as the primary outcome for a future trial. The contingent valuation showed that the SEED intervention was valued, with a wider package of care valued more than selected features in isolation. The SEED intervention is unlikely to reduce costs, but this may be offset by the value placed on the SEED intervention by the general public.
Limitations
The biggest challenge to the successful delivery and completion of this research programme was translating the ‘theoretical’ complex intervention into practice in an ever-changing policy and service landscape at national and local levels. A major limitation for a future trial is the lack of a valid and relevant primary outcome measure to evaluate the effectiveness of a complex intervention that influences outcomes for both individuals and systems.
Conclusions
Although the dementia nurse specialist intervention was acceptable, feasible and integrated well with existing care, it is unlikely to reduce costs of care; however, it was highly valued by all stakeholders (professionals, people with dementia and their families) and has the potential to influence outcomes at both an individual and a systems level.
Future work
There is no plan to progress to a full randomised controlled trial of the SEED intervention in its current form. In view of new National Institute for Health and Care Excellence dementia guidance, which now recommends a care co-ordinator for all people with dementia, the feasibility of providing the SEED intervention throughout the illness trajectory should be explored. Appropriate outcome measures to evaluate the effectiveness of such a complex intervention are needed urgently.
Trial registration
Current Controlled Trials ISRCTN21390601.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research, Vol. 8, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Marie Poole
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma McLellan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Lee
- Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Sarah Amador
- Division of Psychiatry, University College London, London, UK
| | - Nawaraj Bhattarai
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Bryant
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dorothy Coe
- North East and North Cumbria Local Clinical Research Network, Newcastle upon Tyne, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Goodman
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Zoe Gotts
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Sarah Hill
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Susan Hrisos
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Christopher Massey
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Paul Paes
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Faculty of Medical Sciences, Professional Services, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Rice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tomos Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elizabeth Sampson
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | | | - Dimitrios Tzelis
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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14
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Bhattarai N, Mason H, Kernohan A, Poole M, Bamford C, Robinson L, Vale L. The value of dementia care towards the end of life-A contingent valuation study. Int J Geriatr Psychiatry 2020; 35:489-497. [PMID: 31912572 PMCID: PMC7187265 DOI: 10.1002/gps.5259] [Citation(s) in RCA: 4] [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: 08/12/2019] [Accepted: 12/22/2019] [Indexed: 12/05/2022]
Abstract
OBJECTIVES A dementia nurse specialist (DNS) is expected to improve the quality of care and support to people with dementia nearing, and at, the end of life (EoL) by facilitating some key features of care. The aim of this study was to estimate willingness-to-pay (WTP) values from the general public perspective, for the different levels of support that the DNS can provide. METHODS Contingent valuation methods were used to elicit the maximum WTP for scenarios describing different types of support provided by the DNS for EoL care in dementia. In a general population online survey, 1002 participants aged 18 years or more sampled from the United Kingdom provided valuations. Five scenarios were valued with mean WTP value calculated for each scenario along with the relationship between mean WTP and participant characteristics. RESULTS The mean WTP varied across scenarios with higher values for the scenarios offering more features. Participants with some experience of dementia were willing to pay more compared with those with no experience. WTP values were higher for high-income groups compared with the lowest income level (P < .05). There was no evidence to suggest that respondent characteristics such as age, gender, family size, health utility or education status influenced the WTP values. CONCLUSION The general population values the anticipated improvement in dementia care provided by a DNS. This study will help inform judgements on interventions to improve the quality of EoL care.
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Affiliation(s)
- Nawaraj Bhattarai
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Helen Mason
- Yunus Centre for Social Business and HealthGlasgow Caledonian UniversityGlasgowUK
| | - Ashleigh Kernohan
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Marie Poole
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Claire Bamford
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Louise Robinson
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Luke Vale
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
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15
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Perovic O, Ismail H, Quan V, Bamford C, Nana T, Chibabhai V, Bhola P, Ramjathan P, Swe Swe-Han K, Wadula J, Whitelaw A, Smith M, Mbelle N, Singh-Moodley A. Carbapenem-resistant Enterobacteriaceae in patients with bacteraemia at tertiary hospitals in South Africa, 2015 to 2018. Eur J Clin Microbiol Infect Dis 2020; 39:1287-1294. [PMID: 32124106 DOI: 10.1007/s10096-020-03845-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 10/11/2019] [Accepted: 02/09/2020] [Indexed: 11/26/2022]
Abstract
Enhanced surveillance for CREs was established at national sentinel sites in South Africa. We aimed to apply an epidemiological and microbiological approach to characterise CREs and to assess trends in antimicrobial resistance from patients admitted to tertiary academic hospitals. A retrospective analysis was conducted on patients of all ages with CRE bacteraemia admitted at any one of 12 tertiary academic hospitals in four provinces (Gauteng, KwaZulu-Natal, Western Cape and Free State) in South Africa. The study period was from July 2015 to December 2018. A case of CRE bacteraemia was defined as a patient admitted to one of the selected tertiary hospitals where any of the Enterobacteriaceae was isolated from a blood culture, and was resistant to the carbapenems (ertapenem, meropenem, imipenem and/or doripenem) or had a positive result for the Modified Hodge Test (MHT) according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. A positive blood culture result obtained after 21 days of the last blood culture result was regarded as a new case. To distinguish hospital-acquired (HA) from the community-acquired (CA) bacteraemia, the following definitions were applied: the HA CRE bacteraemia was defined as a patient with CRE isolated from blood culture ≥ 72 h of hospital admission or with any prior healthcare contact, within 1 year prior to the current episode or referral from a healthcare facility where the patient was admitted before the current hospital. A case of the CA CRE bacteraemia was defined as a patient with CRE isolated from blood culture < 72 h of hospital admission and with no prior healthcare contact. The majority of carbapenem-resistant Enterobacteriaceae (CRE) (70%) were hospital-acquired (HA) with Klebsiella pneumoniae being the predominant species (78%). In-hospital mortality rate was 38%. The commonest carbapenemase genes were bla-OXA-48 (52%) and bla-NDM (34%). The high mortality rate related to bacteraemia with CRE and the fact that most were hospital-acquired infections highlights the need to control the spread of these drug-resistant bacteria. Replacement with OXA-48 is the striking finding from this surveillance analysis. Infection control and antibiotic stewardship play important roles in decreasing the spread of resistance.
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Affiliation(s)
- O Perovic
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses at National Institute for Communicable Diseases, Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa.
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - H Ismail
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses at National Institute for Communicable Diseases, Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - V Quan
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses at National Institute for Communicable Diseases, Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - C Bamford
- Department of Pathology, Groote Schuur Hospital Microbiology Laboratory, National Health Laboratory Service and Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - T Nana
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
- National Health Laboratory Service, Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - V Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
- National Health Laboratory Service, Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - P Bhola
- National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital Academic Complex, Durban, KwaZulu-Natal, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - P Ramjathan
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- National Health Laboratory Service, King Edward VIII Hospital, Durban, KwaZulu-Natal, South Africa
| | - K Swe Swe-Han
- National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital Academic Complex, Durban, KwaZulu-Natal, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - J Wadula
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
- National Health Laboratory Service, Microbiology Laboratory, Chris Hani Baragwanath Academic Hospital Laboratory, Johannesburg, South Africa
| | - A Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - M Smith
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses at National Institute for Communicable Diseases, Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Nontombi Mbelle
- Department of Medical Microbiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - A Singh-Moodley
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses at National Institute for Communicable Diseases, Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
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16
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Taylor JP, McKeith IG, Burn DJ, Boeve BF, Weintraub D, Bamford C, Allan LM, Thomas AJ, O'Brien JT. New evidence on the management of Lewy body dementia. Lancet Neurol 2020; 19:157-169. [PMID: 31519472 PMCID: PMC7017451 DOI: 10.1016/s1474-4422(19)30153-x] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 03/09/2019] [Accepted: 03/13/2019] [Indexed: 02/06/2023]
Abstract
Dementia with Lewy bodies and Parkinson's disease dementia, jointly known as Lewy body dementia, are common neurodegenerative conditions. Patients with Lewy body dementia present with a wide range of cognitive, neuropsychiatric, sleep, motor, and autonomic symptoms. Presentation varies between patients and can vary over time within an individual. Treatments can address one symptom but worsen another, which makes disease management difficult. Symptoms are often managed in isolation and by different specialists, which makes high-quality care difficult to accomplish. Clinical trials and meta-analyses now provide an evidence base for the treatment of cognitive, neuropsychiatric, and motor symptoms in patients with Lewy body dementia. Furthermore, consensus opinion from experts supports the application of treatments for related conditions, such as Parkinson's disease, for the management of common symptoms (eg, autonomic dysfunction) in patients with Lewy body dementia. However, evidence gaps remain and future clinical trials need to focus on the treatment of symptoms specific to patients with Lewy body dementia.
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Affiliation(s)
- John-Paul Taylor
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
| | - Ian G McKeith
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - David J Burn
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Brad F Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Daniel Weintraub
- Department of Psychiatry and Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; Parkinson's Disease and Mental Illness Research, Education and Clinical Centers, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Claire Bamford
- Institute of Health and Society, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Louise M Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Alan J Thomas
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
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Abstract
Objectives: People with dementia are more likely to fall and less likely to recover well after a fall than cognitively intact older people. Little is known about how best to deliver services to this patient group. This paper explores the importance of compensating for cognitive impairment when working with people with dementia. Methods: Qualitative methods - interviews, focus groups and observation - were used to explore the views and experiences of people with dementia, family carers and professionals providing services to people with dementia following an injurious fall. A thematic, iterative analysis was undertaken in which emerging themes were identified from each individual dataset, prior to an integrative analysis. Results: A key theme across all datasets was the need to deliver services in ways that compensate for cognitive impairment, such as negotiating meaningful activities that can be embedded into the routines of people with dementia. Professionals varied in their ability to adapt their practice to meet the needs of people with dementia. Negative attitudes towards dementia, a lack of knowledge and understanding of dementia limited the ability of some professionals to work in person-centred ways. Conclusion: Improving outcomes for people with dementia following a fall requires the principles of person-centred care to be enacted by professionals with a generic role, as well as specialist staff. This requires additional training and support by specialist staff to address the wide variability in current practice.
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Affiliation(s)
- Claire Bamford
- Institute of Health and Society, Newcastle University , Newcastle-upon-Tyne , UK
| | - Alison Wheatley
- Institute of Health and Society, Newcastle University , Newcastle-upon-Tyne , UK
| | - Caroline Shaw
- Institute of Health and Society, Newcastle University , Newcastle-upon-Tyne , UK
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Wheatley A, Bamford C, Shaw C, Boyles M, Fox C, Allan L. Service organisation for people with dementia after an injurious fall: challenges and opportunities. Age Ageing 2019; 48:454-458. [PMID: 30921459 PMCID: PMC6503936 DOI: 10.1093/ageing/afz010] [Citation(s) in RCA: 3] [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: 05/17/2018] [Revised: 12/19/2018] [Accepted: 01/29/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction people with dementia are more likely to fall and less likely to recover well after a fall than cognitively intact older people. Little is known about how best to deliver services to this patient group. This paper explored current service provision to help inform the development of a new intervention. Methods qualitative approaches were used to explore the views and experiences of people with dementia, family carers and professionals providing services to people with dementia following an injurious fall. These data were analysed using a thematic, iterative analysis. Findings while a wide range of services potentially relevant to people with dementia was identified, there were no dedicated services for people with dementia with fall-related injuries in our three geographical areas. Factors influencing service uptake included a lack of knowledge of local provision amongst professionals and underdeveloped information sharing systems. Some aspects of current service organisation were incompatible with the needs of people with dementia. These include an emphasis on time-limited interventions; lack of longer-term follow-up; and service delivery in environments that could be challenging for people with dementia. Conclusions care pathways for people with dementia who fall are fragmented and unclear. This is likely to preclude people with dementia from receiving all appropriate support and contribute to poor recovery following a fall. The findings highlight the need for new approaches to service organisation and delivery which address the specific needs of people with dementia who fall.
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Affiliation(s)
- Alison Wheatley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline Shaw
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Miriam Boyles
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norfolk, UK
| | - Louise Allan
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Institute of Health Research, University of Exeter, Exeter, UK
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Wheatley A, Bamford C, Shaw C, Flynn E, Smith A, Beyer F, Fox C, Barber R, Parry SW, Howel D, Homer T, Robinson L, Allan LM. Developing an Intervention for Fall-Related Injuries in Dementia (DIFRID): an integrated, mixed-methods approach. BMC Geriatr 2019; 19:57. [PMID: 30819097 PMCID: PMC6394022 DOI: 10.1186/s12877-019-1066-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/13/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Falls in people with dementia can result in a number of physical and psychosocial consequences. However, there is limited evidence to inform how best to deliver services to people with dementia following a fall. The aim of the DIFRID study was to determine the feasibility of developing and implementing a new intervention to improve outcomes for people with dementia with fall-related injuries; this encompasses both short-term recovery and reducing the likelihood of future falls. This paper details the development of the DIFRID intervention. METHODS The intervention was designed using an integrated, mixed-methods approach. This involved a realist synthesis of the literature and qualitative data gathered through interviews and focus groups with health and social care professionals (n = 81). An effectiveness review and further interviews and observation were also conducted and are reported elsewhere. A modified Delphi panel approach with 24 experts was then used to establish a consensus on how the findings should translate into a new intervention. After feedback from key stakeholders (n = 15) on the proposed model, the intervention was manualised and training developed. RESULTS We identified key components of a new intervention covering three broad areas: • Ensuring that the circumstances of rehabilitation are optimised for people with dementia • Compensating for the reduced ability of people with dementia to self-manage • Equipping the workforce with the necessary skills and information to care for this patient group Consensus was achieved on 54 of 69 statements over two rounds of the Delphi surveys. The statements were used to model the intervention and finalise the accompanying manual and protocol for a feasibility study. Stakeholder feedback was generally positive and the majority of suggested intervention components were approved. The proposed outcome was a 12-week complex multidisciplinary intervention primarily based at the patient's home. CONCLUSIONS A new intervention has been developed to improve outcomes for people with dementia following a fall requiring healthcare attention. The feasibility of this intervention is currently being tested. TRIAL REGISTRATION ISRCTN41760734 (16/11/2015).
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Affiliation(s)
- Alison Wheatley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England
| | - Claire Bamford
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England
| | - Caroline Shaw
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England
| | - Elizabeth Flynn
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England
| | - Amy Smith
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, England
| | - Fiona Beyer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England
| | - Chris Fox
- University of East Anglia, Norwich, England
| | - Robert Barber
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, England
| | | | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England
| | - Tara Homer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England
| | - Louise M. Allan
- Institute of Health Research, University of Exeter, South Cloisters, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU England
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Mactier M, Bamford C, Waas A, Logan J, Taylor R. 52IMPLEMENTING HOSPITAL ANTICIPATORY CARE PLANNING IN ACUTE ORTHOPAEDIC WARDS - A QUALITY IMPROVEMENT PROJECT. Age Ageing 2019. [DOI: 10.1093/ageing/afy211.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - A Waas
- University Hospital Wishaw
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21
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Bamford C, Lee R, McLellan E, Poole M, Harrison-Dening K, Hughes J, Robinson L, Exley C. What enables good end of life care for people with dementia? A multi-method qualitative study with key stakeholders. BMC Geriatr 2018; 18:302. [PMID: 30514221 PMCID: PMC6280541 DOI: 10.1186/s12877-018-0983-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 11/15/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND People with advanced dementia often experience suboptimal end of life care (EoLC) with inadequate pain control, increased hospitalisation, and fewer palliative care interventions compared to those with cancer. Existing policy, guidance and recommendations are based largely on expert opinion because of a shortage of high quality, empirical research. Previous studies have tended to consider the views and experience of particular groups. Whilst providing important evidence, they do not take into account the diversity of perspectives of different stakeholders. The Supporting Excellence in End of life care in Dementia (SEED) programme involved multiple stakeholder groups and an integrative analysis to identify key components of good EoLC for people with dementia and to inform a new intervention. METHODS The views of national experts, service managers, frontline staff, people with dementia and family carers were explored using a range of qualitative methods (semi-structured interviews, focus groups, discussions and observations of routine care). The large dataset comprises 116 interviews, 12 focus groups and 256 h of observation. Each dataset was initially analysed thematically prior to an integrative analysis, which drew out key themes across stakeholder groups. RESULTS Through the integrative analysis seven key factors required for the delivery of good EoLC for people with dementia were identified: timely planning discussions; recognition of end of life and provision of supportive care; co-ordination of care; effective working relationships with primary care; managing hospitalisation; continuing care after death; and valuing staff and ongoing learning. These factors span the entire illness trajectory from planning at a relatively early stage in the illness to continuing care after death. CONCLUSIONS This unique study has confirmed the relevance of much of the content of existing end of life frameworks to dementia. It has highlighted seven key areas that are particularly important in dementia care. The data are being used to develop an evidence-based intervention to support professionals to deliver better EoLC in dementia.
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Affiliation(s)
- Claire Bamford
- Institute of Health and Society, Newcastle University, 2nd Floor, Newcastle Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL UK
| | - Richard Lee
- Department of Social Work, Education and Community Wellbeing, Faculty of Health & Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - Emma McLellan
- Institute of Health and Society, Newcastle University, 2nd Floor, Newcastle Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL UK
| | - Marie Poole
- Institute of Health and Society, Newcastle University, 2nd Floor, Newcastle Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL UK
| | | | - Julian Hughes
- Bristol Medical School, Population and Health Sciences, University of Bristol, Bristol, BS8 2PS UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, 2nd Floor, Newcastle Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL UK
| | - Catherine Exley
- Health and Life Sciences, Northumbria University, Room NB266, Northumberland Building, College Street, Newcastle upon Tyne, NE1 8ST UK
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22
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Allan LM, Wheatley A, Flynn E, Smith A, Fox C, Howel D, Barber R, Homer TM, Robinson L, Parry SW, Corner L, Connolly JA, Rochester L, Bamford C. Is it feasible to deliver a complex intervention to improve the outcome of falls in people with dementia? A protocol for the DIFRID feasibility study. Pilot Feasibility Stud 2018; 4:170. [PMID: 30455976 PMCID: PMC6230281 DOI: 10.1186/s40814-018-0364-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/29/2018] [Indexed: 11/25/2022] Open
Abstract
Background People with dementia (PWD) experience ten times as many incident falls as people without dementia. Little is known about how best to deliver services to people with dementia following a fall. We used an integrated, mixed-methods approach to develop a new intervention which combines theory generated via a realist synthesis and data on current provision and pathways, gathered through a prospective observational study as well as qualitative interviews, focus groups and ethnographic observation. This intervention is to be tested in a feasibility study in the UK National Health Service. Methods People living with dementia in one of three geographical areas will be eligible for the study if they experience a fall requiring healthcare attention and have an informal carer. Potential participants will be identified by community services (primary care, paramedics, telecare), secondary care (ED, facilitated discharge services, rehabilitation outreach teams) and research case registers. Participants will receive a complex multidisciplinary intervention focused on their goals and interests for up to 12 weeks. The intervention will be delivered by occupational therapists, physiotherapists and rehabilitation support workers. Feasibility outcomes will include recruitment and retention, suitability and acceptability of outcome measures and acceptability, feasibility and fidelity of intervention components. PWD outcome measures will include number of falls, Montreal Cognitive Assessment (MOCA), European Quality of Life Instrument (EQ-5D-5L), Quality of Life–Alzheimer’s Disease Scale (QOL-AD), Modified Falls Efficacy Scale (MFES) and Goal Attainment Scaling (GAS). PWD outcome measures completed by an informal carer will include Disability Assessment for Dementia (DAD), EQ-5D-5L Proxy, QoL-AD Proxy and a Health Utilisation Questionnaire (HUQ). The carer outcome measure will be the Zarit Burden Interview (ZBI). An embedded process evaluation will explore barriers and facilitators to recruitment and intervention delivery. Discussion The study results will inform whether and how a larger multicentre RCT should be undertaken. A full RCT would have the potential to show how outcomes can be improved for people with dementia who have fallen. Ethics and dissemination The National Research Ethics Service Committee Newcastle and North Tyneside 2 approved the feasibility study. Trial registration International Standard Randomised Controlled Trial Registry. Registration number: ISRCTN41760734. Date of registration: 16/11/2015. Electronic supplementary material The online version of this article (10.1186/s40814-018-0364-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louise M Allan
- 1Institute of Health Research, University of Exeter, South Cloisters, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Alison Wheatley
- 2Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Elizabeth Flynn
- 3The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Amy Smith
- 4Tees, Esk and Wear Valleys NHS Foundation Trust, Stockton-on-Tees, UK
| | - Chris Fox
- 5University of East Anglia, Norwich, UK
| | - Denise Howel
- 2Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Robert Barber
- 6Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tara Marie Homer
- 2Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Robinson
- 2Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Jim Anthony Connolly
- 3The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lynn Rochester
- 8Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- 2Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Thomas AJ, Taylor JP, McKeith I, Bamford C, Burn D, Allan L, O'Brien J. Revision of assessment toolkits for improving the diagnosis of Lewy body dementia: The DIAMOND Lewy study. Int J Geriatr Psychiatry 2018; 33:1293-1304. [PMID: 30091150 PMCID: PMC6221009 DOI: 10.1002/gps.4948] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/13/2018] [Indexed: 11/23/2022]
Affiliation(s)
- Alan J. Thomas
- Institute of Neuroscience, Newcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK
| | - John Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK
| | - Ian McKeith
- Institute of Neuroscience, Newcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK
| | - Claire Bamford
- Institute of Neuroscience, Newcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK
| | - David Burn
- Institute of Neuroscience, Newcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK
| | - Louise Allan
- Institute of Neuroscience, Newcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK
| | - John O'Brien
- Department of PsychiatryUniversity of Cambridge School of Clinical MedicineCambridgeUK
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Connors MH, Quinto L, McKeith I, Brodaty H, Allan L, Bamford C, Thomas A, Taylor JP, O'Brien JT. Non-pharmacological interventions for Lewy body dementia: a systematic review. Psychol Med 2018; 48:1749-1758. [PMID: 29143692 PMCID: PMC6088773 DOI: 10.1017/s0033291717003257] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/05/2017] [Indexed: 01/15/2023]
Abstract
Lewy body dementia (consisting of dementia with Lewy bodies and Parkinson's disease dementia) is a common neurodegenerative disease characterised by visual hallucinations, fluctuating attention, motor disturbances, falls, and sensitivity to antipsychotics. This combination of features presents challenges for pharmacological management. Given this, we sought to review evidence for non-pharmacological interventions with patients with Lewy body dementia and their carers. Bibliographic databases were searched using a wide range of search terms and no restrictions were placed on study design, language, or clinical setting. Two reviewers independently assessed papers for inclusion, rated study quality, and extracted data. The search identified 21 studies including two randomised controlled trials with available subgroup data, seven case series, and 12 case studies. Most studies reported beneficial effects of the interventions used, though the only sizeable study was on dysphagia, showing a benefit of honey-thickened liquids. Given the heterogeneity of interventions and poor quality of the studies overall, no quantitative synthesis was possible. Overall, identified studies suggested possible benefits of non-pharmacological interventions in Lewy body dementia, but the small sample sizes and low quality of studies mean no definite recommendations can be offered. Our findings underscore the clear and urgent need for future research on this topic.
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Affiliation(s)
- Michael H. Connors
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Dementia Centre for Research Collaboration, UNSW Sydney, Sydney, NSW, Australia
- Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, NSW, Australia
| | - Lena Quinto
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Ian McKeith
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, UNSW Sydney, Sydney, NSW, Australia
- Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, NSW, Australia
| | - Louise Allan
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - Claire Bamford
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Alan Thomas
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - John T. O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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Allan LM, Wheatley A, Bamford C. P2‐019: IMPROVING CARE FOR FALLS IN DEMENTIA: DEVELOPMENT OF THE DIFRID INTERVENTION. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Louise M. Allan
- Newcastle UniversityNewcastle upon TyneUnited Kingdom
- Exeter UniversityExeterUnited Kingdom
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26
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Stocker R, Bamford C, Brittain K, Duncan R, Moffatt S, Robinson L, Hanratty B. Care home services at the vanguard: a qualitative study exploring stakeholder views on the development and evaluation of novel, integrated approaches to enhancing healthcare in care homes. BMJ Open 2018; 8:e017419. [PMID: 29581198 PMCID: PMC5875673 DOI: 10.1136/bmjopen-2017-017419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To explore stakeholders' understanding of novel integrated approaches to enhancing care in care homes (a care home 'vanguard') and identify priorities for evaluation. DESIGN A qualitative study, using semistructured interviews with commissioners and service providers to/within care homes, and third sector organisations with thematic analysis. SETTING A Clinical Commissioning Group (CCG) area in England. PARTICIPANTS Thirty interviewees from care homes, the National Health Service (NHS; England) and local authority, third sector (10 care home managers, 5 general practitioners, 4 CCG employees, 4 local authority employees, 1 national (NHS England) vanguard lead, 2 specialist nurses, 2 geriatricians, 1 third sector and 1 health manager). RESULTS Four higher level themes emerged from the data: understanding of proposed changes, communication, evaluation of outcome measures of success, and trust and complexity. The vision for the new programme was shared by stakeholders, with importance attached to equitable access to high-quality care. Support for the programme was described as being 'the right thing to do', inferring a moral imperative. However, the practical implications of key aspects, such as integrated working, were not clearly understood and the programme was perceived by some as being imposed, top down, from the health service. Barriers and facilitators to change were identified across themes of communication, outcomes, trust and complexity. Importance was attached to the measurement of intangible aspects of success, such as collaboration. Interviewees understood that outcome-based commissioning was one element of the new programme, but discussion of their aspirations and practices revealed values and beliefs more compatible with a system based on trust. CONCLUSIONS Innovation in service delivery requires organisations to adopt common priorities and share responsibility for success. The vanguard programme is working to ensure health and local authorities have this commitment, but engaging care homes that may feel isolated from the welfare system needs sustained dialogue over the longer term. Evaluation of the programme needs to measure what is important to stakeholders, and not focus too closely on resource consumption.
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Affiliation(s)
- Rachel Stocker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Katie Brittain
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
| | - Rachel Duncan
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Suzanne Moffatt
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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27
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Poole M, Bamford C, McLellan E, Lee RP, Exley C, Hughes JC, Harrison-Dening K, Robinson L. End-of-life care: A qualitative study comparing the views of people with dementia and family carers. Palliat Med 2018; 32:631-642. [PMID: 29020864 DOI: 10.1177/0269216317736033] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND In recent years, UK policy has increasingly recognised the importance of end-of-life care in dementia. While professional consensus on optimal palliative care in dementia has been reported, little is known about the perspectives of people with dementia and family carers. AIM To compare the views of people with dementia and family carers of people with dementia (current and recently bereaved) on optimal end-of-life care. DESIGN Qualitative interviews (32) and a focus group were conducted. Data were thematically analysed. SETTING/PARTICIPANTS Participants comprised people with early stage dementia, living at home in the north-east of England ( n = 11); and current and bereaved carers ( n = 25) from six services providing end-of-life care in England. FINDINGS Seven areas were identified as important to end-of-life care for people with dementia and/or family carers. People with dementia and carers expressed the need for receiving care in place, ensuring comfort and a skilled care team. However, they disagreed about the importance of planning for the future and the role of families in organising care and future decision-making. CONCLUSION Further comparison of our findings with expert consensus views highlighted key areas of divergence and agreement. Discordant views concerning perceptions of dementia as a palliative condition, responsibility for future decision-making and the practical co-ordination of end-of-life care may undermine the provision of optimal palliative care. Professionals must explore and recognise the individual perspectives of people with dementia and family carers.
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Affiliation(s)
- Marie Poole
- 1 Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- 1 Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Emma McLellan
- 1 Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Richard P Lee
- 1 Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Exley
- 2 Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Julian C Hughes
- 3 School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Louise Robinson
- 1 Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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Parry SW, Bamford C, Deary V, Finch TL, Gray J, MacDonald C, McMeekin P, Sabin NJ, Steen IN, Whitney SL, McColl EM. Cognitive-behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial - the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study. Health Technol Assess 2018; 20:1-206. [PMID: 27480813 DOI: 10.3310/hta20560] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Falls cause fear, anxiety and loss of confidence, resulting in activity avoidance, social isolation and increasing frailty. The umbrella term for these problems is 'fear of falling', seen in up to 85% of older adults who fall. Evidence of effectiveness of physical and psychological interventions is limited, with no previous studies examining the role of an individually delivered cognitive-behavioural therapy (CBT) approach. OBJECTIVES Primary objective To develop and then determine the effectiveness of a new CBT intervention (CBTi) delivered by health-care assistants (HCAs) plus usual care compared with usual care alone in reducing fear of falling. Secondary objectives To measure the impact of the intervention on falls, injuries, functional abilities, anxiety/depression, quality of life, social participation and loneliness; investigate the acceptability of the intervention for patients, family members and professionals and factors that promote or inhibit its implementation; and measure the costs and benefits of the intervention. DESIGN Phase I CBTi development. Phase II Parallel-group patient randomised controlled trial (RCT) of the new CBTi plus usual care compared with usual care alone. SETTING Multidisciplinary falls services. PARTICIPANTS Consecutive community-dwelling older adults, both sexes, aged ≥ 60 years, with excessive or undue fear of falling per Falls Efficacy Scale-International (FES-I) score of > 23. INTERVENTIONS Phase I Development of the CBTi. The CBTi was developed following patient interviews and taught to HCAs to maximise the potential for uptake and generalisability to a UK NHS setting. Phase II RCT. The CBTi was delivered by HCAs weekly for 8 weeks, with a 6-month booster session plus usual care. MAIN OUTCOME MEASURES These were assessed at baseline, 8 weeks, 6 months and 12 months. Primary outcome measure Fear of falling measured by change in FES-I scores at 12 months. Secondary outcome measures These comprised falls, injuries, anxiety/depression [Hospital Anxiety and Depression Scale (HADS)], quality of life, social participation, loneliness and measures of physical function. There were process and health-economic evaluations alongside the trial. RESULTS Four hundred and fifteen patients were recruited, with 210 patients randomised to CBTi group and 205 to the control group. There were significant reductions in mean FES-I [-4.02; 95% confidence interval (CI) -5.95 to -2.1], single-item numerical fear of falling scale (-1.42; 95% CI -1.87 to 1.07) and HADS (-1; 95% CI -1.6 to -0.3) scores at 12 months in the CBTi group compared with the usual care group. There were no differences in the other secondary outcome measures. Most patients found the CBTi acceptable. Factors affecting the delivery of the CBTi as part of routine practice were identified. There was no evidence that the intervention was cost-effective. CONCLUSIONS Our new CBTi delivered by HCAs significantly improved fear of falling and depression scores in older adults who were attending falls services. There was no impact on other measures. FURTHER WORK Further work should focus on a joint CBTi and physical training approach to fear of falling, more rational targeting of CBTi, the possibility of mixed group and individual CBTi, and the cost-effectiveness of provision of CBTi by non-specialists. TRIAL REGISTRATION Current Controlled Trials ISRCTN78396615. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 56. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Steve W Parry
- Institute of Cellular Medicine, Newcastle University, c/o Falls and Syncope Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Claire Bamford
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Vincent Deary
- Department of Health Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Tracy L Finch
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jo Gray
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Claire MacDonald
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Peter McMeekin
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Neil J Sabin
- Department of Clinical Psychology, Newcastle Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - I Nick Steen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Sue L Whitney
- Department of Otolaryngology, Pittsburgh University, Philadelphia, PA, USA
| | - Elaine M McColl
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
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Robinson L, Dickinson C, Magklara E, Newton L, Prato L, Bamford C. Proactive approaches to identifying dementia and dementia risk; a qualitative study of public attitudes and preferences. BMJ Open 2018; 8:e018677. [PMID: 29431130 PMCID: PMC5829774 DOI: 10.1136/bmjopen-2017-018677] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES The aim of this study was to critically explore the views of the public about the acceptability and feasibility of proactive approaches to earlier dementia diagnosis and also identification of people at high risk of dementia. DESIGN Qualitative study using task group methodology and thematic data analysis. SETTING Task groups were held either at the university (n=5) or at a carers' centre (n=1). PARTICIPANTS A convenience sample of 31 of 54 participants identified by local non-statutory agencies took part in a task group. All were aged between 40 years and 80 years, 21 were women and 10men participated. RESULTS Despite the use of task group methodology, participants expressed limited understandings of dementia and confusion between proactive approaches. Nevertheless, they highlighted a range of potential benefits and limitations of proactive approaches and the ethical issues raised. There was a preference to embed risk assessment within routine health checks, which focused on achieving a healthier lifestyle, rather than specifically on dementia. Participants emphasised the need to ensure informed consent prior to use of proactive approaches and to provide appropriate support. They also suggested alternative approaches that could potentially facilitate the early detection of dementia or reduce risk at a population level. CONCLUSIONS As international policy on dementia shifts towards a prevention agenda there is growing interest in identifying those at risk of developing dementia. This study provides useful insights into the acceptability of the use of such proactive approaches among the public. The introduction of proactive approaches to dementia identification raises complex practical and ethical issues, particularly in the context of low public understanding of dementia. The importance of better quality information about dementia (and the likelihood of developing dementia) and provision of psychological support for those undergoing risk assessment were highlighted.
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Affiliation(s)
- Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Dickinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eleni Magklara
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa Newton
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Prato
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Thomas AJ, Taylor JP, McKeith I, Bamford C, Burn D, Allan L, O'Brien J. Development of assessment toolkits for improving the diagnosis of the Lewy body dementias: feasibility study within the DIAMOND Lewy study. Int J Geriatr Psychiatry 2017; 32:1280-1304. [PMID: 27928840 PMCID: PMC5724510 DOI: 10.1002/gps.4609] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/30/2016] [Accepted: 09/26/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The Lewy body dementias (LBD, dementia with Lewy bodies and Parkinson's disease dementia) are the second most common cause of neurodegenerative dementia but remain under-recognised, with long delays from initial assessment to diagnosis. Whilst validated instruments have been developed for key symptoms, there is no brief instrument for overall diagnostic assessment suitable for routine practice. We here report the development of such assessment toolkits. METHODS We developed the LBD assessment toolkits in three stages. First, we conducted a systematic search for brief validated assessments for key symptoms and combined these into draft instruments. Second, we obtained feedback on acceptability and feasibility through two rounds of interviews with our patient and public involvement group. This led to modification of the toolkits. Finally, we piloted the toolkits in a feasibility study in routine dementia and Parkinson's disease services to produce final instruments suitable for routine clinical practice. RESULTS Eleven clinicians, working in both dementia/memory assessment and Parkinson's disease/movement disorder services, consented to pilot the assessment toolkits and provide feedback on their feasibility. Clinicians worked in routine health service (not academic) settings and piloted the draft toolkits by integrating them into their regular clinical assessments. Feedback obtained informally, by written comments and through qualitative interviews led to modifications and production of final acceptable versions. CONCLUSIONS We were able to address an important need, the under-diagnosis of LBD, by developing toolkits for improving the recognition and diagnosis of the LBD, which were acceptable to clinicians working in routine dementia and Parkinson's disease services. © 2016 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Alan J. Thomas
- Institute of Neuroscience and Newcastle University Institute for Ageing Newcastle UniversityNewcastle upon TyneUK
| | - John Paul Taylor
- Institute of Neuroscience and Newcastle University Institute for Ageing Newcastle UniversityNewcastle upon TyneUK
| | - Ian McKeith
- Institute of Neuroscience and Newcastle University Institute for Ageing Newcastle UniversityNewcastle upon TyneUK
| | - Claire Bamford
- Institute of Neuroscience and Newcastle University Institute for Ageing Newcastle UniversityNewcastle upon TyneUK
| | - David Burn
- Institute of Neuroscience and Newcastle University Institute for Ageing Newcastle UniversityNewcastle upon TyneUK
| | - Louise Allan
- Institute of Neuroscience and Newcastle University Institute for Ageing Newcastle UniversityNewcastle upon TyneUK
| | - John O'Brien
- Department of PsychiatryUniversity of CambridgeCambrigdeUK
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Lees J, Michalopoulou PG, Lewis SW, Preston S, Bamford C, Collier T, Kalpakidou A, Wykes T, Emsley R, Pandina G, Kapur S, Drake RJ. Modafinil and cognitive enhancement in schizophrenia and healthy volunteers: the effects of test battery in a randomised controlled trial. Psychol Med 2017; 47:2358-2368. [PMID: 28464963 DOI: 10.1017/s0033291717000885] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cognitive deficits in schizophrenia have major functional impacts. Modafinil is a cognitive enhancer whose effect in healthy volunteers is well-described, but whose effects on the cognitive deficits of schizophrenia appear to be inconsistent. Two possible reasons for this are that cognitive test batteries vary in their sensitivity, or that the phase of illness may be important, with patients early in their illness responding better. METHODS A double-blind, randomised, placebo-controlled single-dose crossover study of modafinil 200 mg examined this with two cognitive batteries [MATRICS Consensus Cognitive Battery (MCCB) and Cambridge Neuropsychological Test Automated Battery (CANTAB)] in 46 participants with under 3 years' duration of DSM-IV schizophrenia, on stable antipsychotic medication. In parallel, the same design was used in 28 age-, sex-, and education-matched healthy volunteers. Uncorrected p values were calculated using mixed effects models. RESULTS In patients, modafinil significantly improved CANTAB Paired Associate Learning, non-significantly improved efficiency and significantly slowed performance of the CANTAB Stockings of Cambridge spatial planning task. There was no significant effect on any MCCB domain. In healthy volunteers, modafinil significantly increased CANTAB Rapid Visual Processing, Intra-Extra Dimensional Set Shifting and verbal recall accuracy, and MCCB social cognition performance. The only significant differences between groups were in MCCB visual learning. CONCLUSIONS As in earlier chronic schizophrenia studies, modafinil failed to produce changes in cognition in early psychosis as measured by MCCB. CANTAB proved more sensitive to the effects of modafinil in participants with early schizophrenia and in healthy volunteers. This confirms the importance of selecting the appropriate test battery in treatment studies of cognition in schizophrenia.
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Affiliation(s)
- J Lees
- Division of Psychology & Mental Health,School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - P G Michalopoulou
- Institute of Psychiatry,Psychology and Neuroscience,King's Health Partners,London,UK
| | - S W Lewis
- Division of Psychology & Mental Health,School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - S Preston
- Division of Psychology & Mental Health,School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - C Bamford
- Division of Psychology & Mental Health,School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - T Collier
- Institute of Psychiatry,Psychology and Neuroscience,King's Health Partners,London,UK
| | - A Kalpakidou
- Institute of Psychiatry,Psychology and Neuroscience,King's Health Partners,London,UK
| | - T Wykes
- Institute of Psychiatry,Psychology and Neuroscience,King's Health Partners,London,UK
| | - R Emsley
- Division of Population Health,Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - G Pandina
- Janssen Research & Development, LLC,New Brunswick,New Jersey,USA
| | - S Kapur
- Institute of Psychiatry,Psychology and Neuroscience,King's Health Partners,London,UK
| | - R J Drake
- Division of Psychology & Mental Health,School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
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Bamford C, Boyles M, Finch T, Allan LM, Burn D, McKeith IG, Taylor J, Thomas A, O'Brien JT. [P2–312]: “WHAT DIFFERENCE DOES IT MAKE?” CLINICIAN VIEWS ON DIAGNOSING LEWY BODY DEMENTIA. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | | | | | - David Burn
- Newcastle UniversityNewcastle upon TyneUnited Kingdom
| | | | | | - Alan Thomas
- Newcastle UniversityNewcastle upon TyneUnited Kingdom
| | - John T. O'Brien
- Department of PsychiatryUniversity of CambridgeCambridgeUnited Kingdom
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Affiliation(s)
- C. Bamford
- Institute of Health and Society & Newcastle University Institute for Ageing, Newcastle University, Newcastle, United Kingdom
| | - M. Poole
- Institute of Health and Society & Newcastle University Institute for Ageing, Newcastle University, Newcastle, United Kingdom
| | - R. Lee
- Institute of Health and Society & Newcastle University Institute for Ageing, Newcastle University, Newcastle, United Kingdom
| | - E. McLellan
- Institute of Health and Society & Newcastle University Institute for Ageing, Newcastle University, Newcastle, United Kingdom
| | - C. Exley
- Institute of Health and Society & Newcastle University Institute for Ageing, Newcastle University, Newcastle, United Kingdom
| | - L. Robinson
- Institute of Health and Society & Newcastle University Institute for Ageing, Newcastle University, Newcastle, United Kingdom
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Wheatley A, Bamford C, Boyles M, Shaw C, Allan LM. [P3–512]: MAPPING EXISTING CARE PATHWAYS FOR PEOPLE WITH DEMENTIA WITH FALL‐RELATED INJURIES. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Caroline Shaw
- Newcastle UniversityNewcastle upon TyneUnited Kingdom
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Lee RP, Bamford C, Poole M, McLellan E, Exley C, Robinson L. End of life care for people with dementia: The views of health professionals, social care service managers and frontline staff on key requirements for good practice. PLoS One 2017. [PMID: 28622379 PMCID: PMC5473529 DOI: 10.1371/journal.pone.0179355] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Evidence consistently shows that people with advanced dementia experience suboptimal end of life care compared to those with cancer; with increased hospitalisation, inadequate pain control and fewer palliative care interventions. Understanding the views of those service managers and frontline staff who organise and provide care is crucial in order to develop better end of life care for people with dementia. Methods and findings Qualitative interviews and focus groups were conducted from 2013 to 2015 with 33 service managers and 54 staff involved in frontline care, including doctors, nurses, nursing and care home managers, service development leads, senior managers/directors, care assistants and senior care assistants/team leads. All were audio recorded and transcribed verbatim. Participants represented a diverse range of service types and occupation. Transcripts were subject to coding and thematic analysis in data meetings. Analysis of the data led to the development of seven key themes: Recognising end of life (EOL) and tools to support end of life care (EOLC), Communicating with families about EOL, Collaborative working, Continuity of care, Ensuring comfort at EOL, Supporting families, Developing and supporting staff. Each is discussed in detail and comprise individual and collective views on approaches to good end of life care for people with dementia. Conclusions The significant challenges of providing good end of life care for people with dementia requires that different forms of expertise should be recognised and used; including the skills and knowledge of care assistants. Successfully engaging with people with dementia and family members and helping them to recognise the dying trajectory requires a supportive integration of emotional and technical expertise. The study strengthens the existing evidence base in this area and will be used with a related set of studies (on the views of other stakeholders and observations and interviews conducted in four services) to develop an evidence-based intervention.
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Affiliation(s)
- Richard Philip Lee
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- * E-mail:
| | - Claire Bamford
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Marie Poole
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Emma McLellan
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Catherine Exley
- Faculty of Health & Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Louise Robinson
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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Smith A, Naicker P, Bamford C, Shuping L, McCarthy K, Sooka A, Smouse S, Tau N, Keddy K. Whole-genome sequencing analysis of Listeria monocytogenes isolated in South Africa. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.11.178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
Current government policy emphasises professional accountability, Best Value, evidence-based practice and outcomes for users and carers. In this context, being able to demonstrate the effectiveness of routine practice is increasingly important. This article considers the key issues in collecting information about the outcomes of equipment and adaptations. These include: the assessment of the full range of outcomes; the timing of data collection; the use of standardised and individualised measures; and linking outcomes to interventions. Three approaches to evaluating the outcomes of equipment and adaptations are distinguished: functional status measures; health status or quality of life measures; and indirect approaches. Examples of each approach are provided and their strengths and limitations discussed. Previous work on the outcomes of equipment and adaptations has neglected the perspectives of carers and the impact of service delivery (service process outcomes); further work on these areas is needed to ensure that all the outcomes of equipment and adaptations are fully evaluated.
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Spiliopoulou P, Millar J, Bamford C, Bisset L, Evans J. P-243 Undiagnosed chronic liver disease (CLD) in patients presenting with Hepatocellular Carcinoma (HCC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.235] [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: 11/12/2022] Open
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Iliffe S, Waugh A, Poole M, Bamford C, Brittain K, Chew-Graham C, Fox C, Katona C, Livingston G, Manthorpe J, Steen N, Stephens B, Hogan V, Robinson L. The effectiveness of collaborative care for people with memory problems in primary care: results of the CAREDEM case management modelling and feasibility study. Health Technol Assess 2016; 18:1-148. [PMID: 25138151 DOI: 10.3310/hta18520] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND People with dementia and their families need support in different forms, but currently services are often fragmented with variable quality of care. Case management offers a way of co-ordinating services along the care pathway and therefore could provide individualised support; however, evidence of the effectiveness of case management for dementia is inconclusive. OBJECTIVE To adapt the intervention used in a promising case management project in the USA and test its feasibility and acceptability in English general practice. DESIGN In work package 1, a design group of varied professionals, with a carer and staff from the voluntary sector, met six times over a year to identify the skills and personal characteristics required for case management; protocols from the US study were adapted for use in the UK. The feasibility of recruiting general practices and patient-carer dyads and of delivering case management were tested in a pilot study (work package 2). An embedded qualitative study explored stakeholder views on study procedures and case management. SETTING Four general practices, two in the north-east of England (Newcastle) one in London and one in Norfolk, took part in a feasibility pilot study of case management. PARTICIPANTS Community-dwelling people with dementia and their carers who were not already being case managed by other services. INTERVENTION A social worker shared by the two practices in the north-east and practice nurses in the other two practices were trained to deliver case management. We aimed to recruit 11 people with dementia from each practice who were not already being case managed. MAIN OUTCOME MEASURES Numbers of people with dementia and their carers recruited, numbers and content of contacts, needs identified and perceptions of case management among stakeholders. RESULTS Recruitment of practices and patients was slow and none of the practices achieved its recruitment target. It took more than 6 months to recruit a total of 28 people with dementia. Practice Quality and Outcome Framework registers for dementia contained only 60% of the expected number of people, most living in care homes. All stakeholders were positive about the potential of case management; however, only one of the four practices achieved a level of case management activity that might have influenced patient and carer outcomes. Case managers' activity levels were not related solely to time available for case management. Delivery of case management was hindered by limited clarity about the role, poor integration with existing services and a lack of embeddedness within primary care. There were discrepancies between case manager and researcher judgements about need, and evidence of a high threshold for acting on unmet need. The practice nurses experienced difficulties in ring-fencing case management time. CONCLUSIONS The model of case management developed and evaluated in this feasibility study is unlikely to be sustainable in general practice under current conditions and in our view it would not be appropriate to attempt a definitive trial of this model. This study could inform the development of a case management role with a greater likelihood of impact. Different approaches to recruiting and training case managers, and identifying people with dementia who might benefit from case management, are needed, as is exploration of the scale of need for this type of working. TRIAL REGISTRATION Current Controlled Trials ISRCTN74015152. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 52. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Amy Waugh
- Mental Health Sciences, University College London, London, UK
| | - Marie Poole
- Institute for Ageing, University of Newcastle, Newcastle upon Tyne, UK
| | - Claire Bamford
- Institute for Ageing, University of Newcastle, Newcastle upon Tyne, UK
| | - Katie Brittain
- Institute for Ageing, University of Newcastle, Newcastle upon Tyne, UK
| | | | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Gill Livingston
- Mental Health Sciences, University College London, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Nick Steen
- Clinical Trials Unit, Institute of Health and Society, University of Newcastle, Newcastle upon Tyne, UK
| | | | - Vanessa Hogan
- Clinical Trials Unit, Institute of Health and Society, University of Newcastle, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute for Ageing, University of Newcastle, Newcastle upon Tyne, UK
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Naicker P, Khonga M, Wojno J, Bamford C, Ntuli S, Oladokun R, Eley B, Ryan A, Gardiner S, Sooka A, Smith A, Keddy K. Five-year review of non-typhoidal salmonella meningitis in Cape Town, 2010 - 2015. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.736] [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: 11/29/2022] Open
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Abstract
Background Dementia, of all long term illnesses, accounts for the greatest chronic disease burden, and the number of people with age-related diseases like dementia is predicted to double by 2040. People with advanced dementia experience similar symptoms to those dying with cancer yet professional carers find prognostication difficult and struggle to meet palliative care needs, with physical symptoms undetected and untreated. While elements of good practice in this area have been identified in theory, the factors which enable such good practice to be implemented in real world practice need to be better understood. The aim of this study was to determine expert views on the key factors influencing good practice in end of life care for people with dementia. Methods Semi-structured telephone and face-to-face interviews with topic guide, verbatim transcription and thematic analysis. Interviews were conducted with experts in dementia care and/or palliative care in England (n = 30). Results Four key factors influencing good practice in end of life care for people with dementia were identified from the expert interviews: leadership and management of care, integrating clinical expertise, continuity of care, and use of guidelines. Conclusions The relationships between the four key factors are important. Leadership and management of care have implications for the successful implementation of guidelines, while the appropriate and timely use of clinical expertise could prevent hospitalisation and ensure continuity of care. A lack of integration across health and social care can undermine continuity of care. Further work is needed to understand how existing guidelines and tools contribute to good practice. Disclaimer This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (Grant Reference Number RP-PG-0611-20005). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
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Affiliation(s)
- Richard Philip Lee
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne, NE2 4AX, UK.
| | - Claire Bamford
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne, NE2 4AX, UK.
| | - Catherine Exley
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne, NE2 4AX, UK.
| | - Louise Robinson
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne, NE2 4AX, UK.
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Boyles T, Bamford C, Bateman K, Blumberg L, Dramowski A, Karstaedt A, Korsman S, le Roux D, Maartens G, Madhi S, Naidoo R, Nuttall J, Reubenson G, Taljaard J, Thomas J, van Zyl G, von Gottberg A, Whitelaw A, Mendelson M. Guidelines for the management of acute meningitis in children and adults in South Africa. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/10158782.2013.11441513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- T.H. Boyles
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - C. Bamford
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - K. Bateman
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - L. Blumberg
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - A. Dramowski
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - A. Karstaedt
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - S. Korsman
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - D.M. le Roux
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - G. Maartens
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - S. Madhi
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - R. Naidoo
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - J. Nuttall
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - G. Reubenson
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - J. Taljaard
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - J. Thomas
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - G. van Zyl
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - A. von Gottberg
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - A. Whitelaw
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
| | - M. Mendelson
- Federation of Infectious Diseases Societies of Southern Africa Working Group on Acute Meningitis in Children and Adults Infectious Diseases Society of Southern Africa
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Bamford C, Bonorchis K, Ryan A, Simpson J, Elliott E, Hoffmann R, Naicker P, Ismail N, Mbelle N, Nchabeleng M, Nana T, Sriruttan C, Seetharam S, Wadula J. Antimicrobial Susceptibility Patterns of Selected Bacteraemic Isolates from South African Public Sector Hospitals, 2010. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/10158782.2011.11441461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- C Bamford
- National Health Laboratory Service (NHLS), Groote Schuur and University of Cape Town
| | - K Bonorchis
- National Health Laboratory Service (NHLS), Green Point and University of Cape Town
| | - A Ryan
- National Health Laboratory Service (NHLS), Green Point and University of Cape Town
| | - J Simpson
- National Health Laboratory Service (NHLS), Green Point and University of Cape Town
| | - E Elliott
- National Health Laboratory Service (NHLS), Universitas and University of the Free State
| | - R Hoffmann
- National Health Laboratory Service (NHLS), Tygerberg and Stellenbosch University
| | - P Naicker
- National Health Laboratory Service (NHLS), Tygerberg and Stellenbosch University
| | - N Ismail
- National Health Laboratory Service (NHLS), Steve Biko Academic and University of Pretoria
| | - N Mbelle
- National Health Laboratory Service (NHLS), Dr George Mukhari and University of Limpopo
| | - M Nchabeleng
- National Health Laboratory Service (NHLS), Dr George Mukhari and University of Limpopo
| | - T Nana
- National Health Laboratory Service (NHLS), Charlotte Maxeke Johannesburg Academic and University of the Witwatersrand
| | - C Sriruttan
- National Health Laboratory Service (NHLS), Charlotte Maxeke Johannesburg Academic and University of the Witwatersrand
| | - S Seetharam
- National Health Laboratory Service (NHLS), Chris Hani Baragwanath and University of the Witwatersrand
| | - J Wadula
- National Health Laboratory Service (NHLS), Chris Hani Baragwanath and University of the Witwatersrand
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Bamford C, Poole M, Brittain K, Chew-Graham C, Fox C, Iliffe S, Manthorpe J, Robinson L. Understanding the challenges to implementing case management for people with dementia in primary care in England: a qualitative study using Normalization Process Theory. BMC Health Serv Res 2014; 14:549. [PMID: 25409598 PMCID: PMC4232624 DOI: 10.1186/s12913-014-0549-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 10/24/2014] [Indexed: 11/30/2022] Open
Abstract
Background Case management has been suggested as a way of improving the quality and cost-effectiveness of support for people with dementia. In this study we adapted and implemented a successful United States’ model of case management in primary care in England. The results are reported elsewhere, but a key finding was that little case management took place. This paper reports the findings of the process evaluation which used Normalization Process Theory to understand the barriers to implementation. Methods Ethnographic methods were used to explore the views and experiences of case management. Interviews with 49 stakeholders (patients, carers, case managers, health and social care professionals) were supplemented with observation of case managers during meetings and initial assessments with patients. Transcripts and field notes were analysed initially using the constant comparative approach and emerging themes were then mapped onto the framework of Normalization Process Theory. Results The primary focus during implementation was on the case managers as isolated individuals, with little attention being paid to the social or organizational context within which they worked. Barriers relating to each of the four main constructs of Normalization Process Theory were identified, with a lack of clarity over the scope and boundaries of the intervention (coherence); variable investment in the intervention (cognitive participation); a lack of resources, skills and training to deliver case management (collective action); and limited reflection and feedback on the case manager role (reflexive monitoring). Conclusions Despite the intuitive appeal of case management to all stakeholders, there were multiple barriers to implementation in primary care in England including: difficulties in embedding case managers within existing well-established community networks; the challenges of protecting time for case management; and case managers’ inability to identify, and act on, emerging patient and carer needs (an essential, but previously unrecognised, training need). In the light of these barriers it is unclear whether primary care is the most appropriate setting for case management in England. The process evaluation highlights key aspects of implementation and training to be addressed in future studies of case management for dementia.
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Affiliation(s)
- Claire Bamford
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle NE2 4AX, UK.
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O’Brien JT, Firbank MJ, Davison C, Barnett N, Bamford C, Donaldson C, Olsen K, Herholz K, Williams D, Lloyd J. 18F-FDG PET and Perfusion SPECT in the Diagnosis of Alzheimer and Lewy Body Dementias. J Nucl Med 2014; 55:1959-65. [DOI: 10.2967/jnumed.114.143347] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Iliffe S, Robinson L, Bamford C, Waugh A, Fox C, Livingston G, Manthorpe J, Brown P, Stephens B, Brittain K, Chew-Graham C, Katona C. Introducing case management for people with dementia in primary care: a mixed-methods study. Br J Gen Pract 2014; 64:e735-41. [PMID: 25348998 PMCID: PMC4220234 DOI: 10.3399/bjgp14x682333] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 04/04/2014] [Accepted: 06/20/2014] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Case management may be a feasible solution to the problem of service fragmentation for people with dementia. AIM To adapt a US model of primary care-based case management for people with dementia and test it in general practice. DESIGN AND SETTING Mixed-methodology case studies of case management implementation in four general practices: one rural, one inner-city, and two urban practices. Practice nurses undertook the case manager role in the rural and inner-city practices, and were allocated one session per week for case management by their practices. A seconded social worker worked full time for the two urban practices. METHOD Participants were community-dwelling patients with dementia who were living at home with a family carer, and who were not receiving specialist care coordination. Case study methods included analysis of case loads and interviews with patients, carers, local NHS and other stakeholders, and case managers. Measures included numbers of patients with dementia and their carers, number of unmet needs identified, and actions taken to meet needs. Case manager records were compared with findings from interviews with patients and carers, and with other stakeholders. RESULTS The number of eligible patients was smaller than expected. No practice achieved its recruitment target. Researchers identified more unmet needs than case managers. The practice nurse case managers reported lack of time and found research documentation burdensome. Patients and carers were positive about case management as a first point of contact with the practice, as a 'safety net', and for creating a one-to-one therapeutic relationship. CONCLUSION Further investigation is required before case management for people with dementia and their carers can be implemented in primary care.
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Affiliation(s)
- Steve Iliffe
- Department of Primary Care & Population Health, University College London, London
| | - Louise Robinson
- University of Newcastle Institute for Ageing, Newcastle upon Tyne
| | - Claire Bamford
- University of Newcastle Institute for Ageing, Newcastle upon Tyne
| | - Amy Waugh
- Mental Health Sciences Unit, University College London, London
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich
| | - Gill Livingston
- Mental Health Sciences Unit, University College London, London
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London
| | | | | | - Katie Brittain
- University of Newcastle Institute for Ageing, Newcastle upon Tyne
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Finch TL, Bamford C, Deary V, Sabin N, Parry SW. Making sense of a cognitive behavioural therapy intervention for fear of falling: qualitative study of intervention development. BMC Health Serv Res 2014; 14:436. [PMID: 25252807 PMCID: PMC4263069 DOI: 10.1186/1472-6963-14-436] [Citation(s) in RCA: 11] [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: 03/03/2014] [Accepted: 09/17/2014] [Indexed: 11/29/2022] Open
Abstract
Background Fear of Falling (FoF) is commonly reported among older adults (up to 50%) and can impact negatively on physical and social activities, mood and quality of life. This paper explores the development, acceptability and feasibility of a cognitive behavioural therapy intervention (CBTi) for FoF. Methods The process evaluation of the CBTi development phase of an RCT (conducted in the UK) reported here, used ethnographic methods. Data included: interviews with patients and carers (n = 16), clinic staff (n = 6) and the psychologists developing the CBTi (n = 3); observational field notes and transcripts of intervention development meetings (n = 9) and stakeholder engagement meetings (n = 2); and informal discussions with staff developing the CBTi (n = 8). Data collection and thematic analysis were guided by Normalisation Process Theory (NPT). Results The process evaluation showed two domains of work necessary to develop a CBTi that made sense to stakeholders, and that could be delivered as part of an RCT. For the psychologists developing the content of the CBTi, a growing understanding of the complexity of FoF highlighted the need for an individualised rather than a manualised intervention. For the research team, the work involved adapting the structures and processes of the RCT to address preliminary concerns over the acceptability and feasibility of the proposed CBTi. Conclusions Theory-based approaches to process evaluation can sensitise researchers to contested understandings about proposed interventions that could undermine implementation. Drawing on the coherence construct of NPT, this study emphasises the nature and extent of work required to ensure an intervention makes sufficient sense to key stakeholders in order to maximise chances of successful implementation. Electronic supplementary material The online version of this article (doi:10.1186/1472-6963-14-436) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tracy L Finch
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne NE2 4AX, UK.
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Parry SW, Deary V, Finch T, Bamford C, Sabin N, McMeekin P, O'Brien J, Caldwell A, Steen N, Whitney SL, Macdonald C, McColl E. The STRIDE (Strategies to Increase confidence, InDependence and Energy) study: cognitive behavioural therapy-based intervention to reduce fear of falling in older fallers living in the community - study protocol for a randomised controlled trial. Trials 2014; 15:210. [PMID: 24906406 PMCID: PMC4059076 DOI: 10.1186/1745-6215-15-210] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 02/07/2014] [Accepted: 05/08/2014] [Indexed: 11/17/2022] Open
Abstract
Background Around 30% to 62% of older individuals fall each year, with adverse consequences of falls being by no means limited to physical injury and escalating levels of dependence. Many older individuals suffer from a variety of adverse psychosocial difficulties related to falling including fear, anxiety, loss of confidence and subsequent increasing activity avoidance, social isolation and frailty. Such ‘fear of falling’ is common and disabling, but definitive studies examining the effective management of the syndrome are lacking. Cognitive behavioural therapy has been trialed with some success in a group setting, but there is no adequately powered randomised controlled study of an individually based cognitive behavioural therapy intervention, and none using non-mental health professionals to deliver the intervention. Methods/Design We are conducting a two-phase study examining the role of individual cognitive behavioural therapy delivered by healthcare assistants in improving fear of falling in older adults. In Phase I, the intervention was developed and taught to healthcare assistants, while Phase II is the pragmatic randomised controlled study examining the efficacy of the intervention in improving fear of falling in community-dwelling elders attending falls services. A qualitative process evaluation study informed by Normalization Process Theory is being conducted throughout to examine the potential promoters and inhibitors of introducing such an intervention into routine clinical practice, while a health economic sub-study running alongside the trial is examining the costs and benefits of such an approach to the wider health economy. Trial registration Current Controlled Trials ISRCTN78396615
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Affiliation(s)
- Steve W Parry
- Institute for Ageing and Health, Newcastle University, c/o Falls and Syncope Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK.
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Bamford C, Moodley C, Davidson A, Hendricks M, Eley B, Nuttall J, Rinquist C, Smith M. Emergence of vancomycin resistant Enterococci in a paediatric hospital in Cape Town. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Kift EV, Maartens G, Bamford C. Systematic review of the evidence for rational dosing of colistin. S Afr Med J 2014; 104:183-186. [PMID: 24897820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND There is an alarming global increase in the incidence of nosocomial infections with multidrug-resistant Gram-negative bacteria, which are often only susceptible to colistin. Colistin was developed prior to current methods of establishing dosing using pharmacokinetic-pharmacodynamic relationships. Dosing regimens differ in package inserts from different manufacturers and in different guidelines. It is imperative to avoid under-dosing with colistin in order to limit the development of resistance, as it is the last line of defence. METHODS We conducted a systematic review of the literature to develop guidelines for rational dosing of intravenous colistin, with a particular focus on critically ill patients. RESULTS Colistin is administered as the inactive pro-drug colistimethate sodium. Colistin demonstrates concentration-dependent bacterial killing, suggesting that higher doses should be administered less frequently to achieve higher peak concentrations. Dose-related nephrotoxicity occurs, making it impossible to safely achieve concentrations that prevent the selection of resistant mutants or the effective eradication of bacteria with higher minimum inhibitory concentrations. Theoretically, combination therapy should be used to reduce the risk of selection of resistant bacteria. In critically ill patients, a loading dose should be given to rapidly achieve therapeutic concentrations, followed by maintenance doses of 4.5 MU 12-hourly. Maintenance dose adjustment is necessary with renal impairment. CONCLUSION Easier access to colistin is needed in South Africa, where it is not a registered medicine. Further research is needed to better characterise colistin's pharmacokinetic-pharmacodynamic relationships in humans and to establish whether combinations of colistin with other antimicrobials result in improved clinical outcomes or a reduction in selection of resistant bacteria.
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