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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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Abstract
OBJECTIVES To explore the impact of COVID-19 on postdiagnostic dementia care and support provision in England and Wales. DESIGN Qualitative research using semistructured interviews, via video or telephone conferencing. SETTING Services providing postdiagnostic support across health, social care and the third sector. PARTICIPANTS 21 professionals previously recruited to an ongoing research programme on postdiagnostic dementia care (or colleagues, if unavailable). RESULTS Key themes identified from the data were: challenges caused by COVID-19; responses to those challenges, including a widespread shift to remote working; and effects of COVID-19 on future postdiagnostic support. Challenges included changing and sometimes conflicting guidelines; a lack of access to support; identifying and responding to emerging needs; emotional and physical impact of COVID-19; and balancing COVID-19 risk with other risks such as deterioration. Some dementia services closed, while others adapted and continued to provide support thus potentially widening existing inequalities. There were also some unintended positive outcomes, including improved cross-sector and multidisciplinary working between professionals. CONCLUSION Delivering postdiagnostic dementia support during COVID-19 required essential adaptations. While some changes were detrimental to service users, others were identified as potentially beneficial and highly likely to become the new 'norm', for example, use of blended approaches, combining virtual and face-to-face work, thus allowing more flexible, integrated care. Our data have implications for policy and practice to improve the response to the lingering effects of COVID-19 as well as creating service provision that is more resilient to future pandemics or other periods of disruption.
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Affiliation(s)
- Alison Wheatley
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Marie Poole
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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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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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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Affiliation(s)
- A. Wheatley
- McGill University Library, McGill University, Montréal, QC, Canada
| | - S. Armstrong
- University of New Brunswick Libraries, University of New Brunswick, Fredericton, NB, Canada
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Frost R, Rait G, Wheatley A, Wilcock J, Robinson L, Harrison Dening K, Allan L, Banerjee S, Manthorpe J, Walters K. What works in managing complex conditions in older people in primary and community care? A state-of-the-art review. Health Soc Care Community 2020; 28:1915-1927. [PMID: 32671922 DOI: 10.1111/hsc.13085] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
The number of older people living with complex health conditions is increasing, with the majority of these managed in primary and community settings. Many models of care have been developed to support them, however, there is mixed evidence on their value and they include multiple overlapping components. We aimed to synthesise the evidence to learn what works for managing complex conditions in older people in primary and community care. We carried out a state-of-the-art review of systematic reviews. We searched three databases (January 2009 to July 2019) for models of primary and community care for long-term conditions, frailty, multimorbidity and complex neurological conditions common to older people such as dementia. We narratively synthesised review findings to summarise the evidence for each model type and identify components which influenced effectiveness. Out of 2,129 unique titles and abstracts, 178 full texts were reviewed and 54 systematic reviews were included. We found that the models of care were more likely to improve depressive symptoms and mental health outcomes than physical health or service use outcomes. Interventions including self-management, patient education, assessment with follow-up care procedures, and structured care processes or pathways had greater evidence of effectiveness. The level of healthcare service integration appeared to be more important than inclusion of specific professional types within a team. However, more experienced and qualified nurses were associated with better outcomes. These conclusions are limited by the overlap between reviews, reliance on vote counting within some included reviews and the quality of study reports. In conclusion, primary and community care interventions for complex conditions in older people should include: (a) clear intervention targets; (b) explicit theoretical underpinnings; and (c) elements of self-management and patient education, structured collaboration between healthcare professionals and professional support. Further work needs to determine the optimal intensity, length, team composition and role of technology in interventions.
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Affiliation(s)
- Rachael Frost
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Alison Wheatley
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | - Jane Wilcock
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Louise Robinson
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | | | - Louise Allan
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jill Manthorpe
- NIHR Health and Social Care Workforce Research Unit, King's College London, London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, 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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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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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. 'One of the good guys': sperm donor masculinity and the falling Danish sperm count discourse. Cult Health Sex 2019; 21:495-509. [PMID: 30295157 DOI: 10.1080/13691058.2018.1491062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 06/17/2018] [Indexed: 06/08/2023]
Abstract
Sperm banks in Denmark produce and export donor semen worldwide. The role of the sperm bank is to provide high-quality, safe semen from desirable donors. However, over the last 20 years, global sperm counts are reported to be falling. Along with these discourses comes the implication that poor fertility is a personal failing, which implies a conflation of 'fertility' with 'potency'. This paper draws on qualitative research with Danish sperm donors to explore how donors construct their identities as donors and as the producers of 'good sperm'. Accounts of the drive to produce the best sperm possible and the resultant confidence boost are bound up in ideas about masculine potency and potential and bodily performance and set against a backdrop of a moral panic surrounding the apparently declining Danish sperm count.
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Affiliation(s)
- Alison Wheatley
- a Science, Technology & Innovation Studies , School of Social and Political Science, University of Edinburgh , Edinburgh , United Kingdom
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14
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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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15
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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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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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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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18
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Abstract
There has been a great deal of discussion about the ethical implications of donating sperm and of the ways in which donated tissue is presented, selected, and sold for use in assisted reproduction. Debates have emerged within the academic sphere, from donor offspring and recipients, and in broader popular culture, including questions about the commodification of human tissue and the eugenic potential of selecting donors from particular demographic categories. However, the voices of donors themselves on this subject have been largely silent. This paper draws on data from qualitative interviews with men who donated at a major Danish sperm bank between 2012 and 2013. It argues that many of them are indeed thinking through these complex issues. Donors' approaches to ethical issues fell into two broad 'types': a pragmatic, individualistic approach which focused on more immediate personal consequences, and an ethically-driven approach in which donors considered the impact of donation on offspring and on a wider societal level.
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Affiliation(s)
- Alison Wheatley
- Institute of Health & Society, Newcastle University, Floor 2, Newcastle Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
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19
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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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20
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Owrangi A, Wang J, Wheatley A, McCormack D, Cunningham I, Parraga G. SU-F-BRA-08: Development of Novel 1H Magnetic Resonance Imaging Methods to Map Lung Structure and Function. Med Phys 2011. [DOI: 10.1118/1.3612875] [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: 11/07/2022] Open
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21
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Kirby M, Heydarian M, Wheatley A, Etemad-Rezai R, McCormack DG, Parraga G. MO-F-211-08: Development and Application of Novel Hyperpolarized 3He Magnetic Resonance Imaging Segmentation to Measure Acute Treatment Effects in Pulmonary Disease. Med Phys 2011. [DOI: 10.1118/1.3613039] [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: 11/07/2022] Open
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22
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Mathew L, Gaede S, Wheatley A, Etemad-Rezai R, Rodrigues G, Parraga G. Sci-Thurs AM: YIS-09: Detection of Lung Remodeling Following Radiation Therapy Using Hyperpolarized 3He Magnetic Resonance Imaging. Med Phys 2009. [DOI: 10.1118/1.3244169] [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: 11/07/2022] Open
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23
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Kirby M, Mathew L, Wheatley A, McCormack DG, Parraga G. Sci-Thurs AM: YIS-06: Longitudinal Hyperpolarized 3He Magnetic Resonance Imaging of Chronic Obstructive Pulmonary Disease. Med Phys 2009. [DOI: 10.1118/1.3244166] [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: 11/07/2022] Open
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Affiliation(s)
- A Aslam
- School of Pharmacy, Centre for Biomolecular Sciences, University of Nottingham, Nottingham NG7 2RD, UK.
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25
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Blakey J, Halapi E, Bjornsdottir US, Wheatley A, Kristinsson S, Upmanyu R, Stefansson K, Hakonarson H, Hall IP. Contribution of ADAM33 polymorphisms to the population risk of asthma. Thorax 2005; 60:274-6. [PMID: 15790980 PMCID: PMC1747383 DOI: 10.1136/thx.2004.027227] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND ADAM 33 is the first gene identified as a candidate for asthma by positional cloning techniques, with association studies reaching impressive statistical significance. It has a postulated role in myogenesis, airway modelling, and signalling via protein shedding. Concerns over the methodology of the initial study have led to several attempts at replication, with inconsistent results. METHOD To clarify the role of ADAM33 in determining the risk of asthma in the general population, new transmission disequilibrium and case-control studies were undertaken followed by a meta-analysis of all existing data. RESULTS Studies in Icelandic and UK populations revealed no association when taken in isolation. The meta-analysis, however, showed that the F+1 and ST+7 variants were significantly associated with asthma in both types of study. CONCLUSIONS The additional risk imparted by this variation would account for 50,000 excess asthma cases in the UK alone. This study also demonstrates the size of study required to investigate such hypotheses adequately.
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Affiliation(s)
- J Blakey
- Division of Therapeutics and Molecular Medicine, University Hospital of Nottingham, Nottingham, UK
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26
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Simpson AB, Calvert PM, Sludden JA, Boddy AV, Griffin MJ, Schätzlein A, Wilson P, Fishwick K, Wheatley A, Ross GA, Calvert AH, Twelves CJ. Topotecan in combination with carboplatin: phase I trial evaluation of two treatment schedules. Ann Oncol 2002; 13:399-402. [PMID: 11996470 DOI: 10.1093/annonc/mdf041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Topotecan and cisplatin combinations have shown schedule-dependent toxicity, which may in part be due to cisplatin nephrotoxicity. As carboplatin is less nephrotoxic and increasingly replacing cisplatin in clinical practice, the aim of this study was to define the optimal sequence and dose for topotecan in combination with carboplatin. PATIENTS AND METHODS Two parallel phase I trials, with pharmacokinetic studies, were conducted administering carboplatin on day 1 with topotecan on days 1-5 (schedule A) or days 8-12 (schedule B). repeated every 3 weeks. RESULTS Twenty-one patients were treated over two dose levels, carboplatin AUC 4 [glomerular filtration rate (GFR) calculated from 51Cr-EDTA clearance] with topotecan 0.5 or 0.75 mg/m2. At the first dose level, six patients were evaluable for each schedule. With schedule A, from 34 cycles, there were two dose reductions and 10 treatment delays due to myelosuppression. With schedule B from 25 cycles, there was one reduction and 10 delays. At dose level 2, both patients in schedule A had dose-limiting neutropenia. In contrast, there was no dose-limiting toxicity with schedule B in six patients, although the majority of cycles were delayed. CONCLUSION The combination of topotecan and carboplatin using these 3-weekly schedules lead to significant myelotoxicity with attendant dose reductions and delays; the optimal scheduling of these agents remains to be defined.
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Affiliation(s)
- A B Simpson
- Cancer Research Campaign Department of Medical Oncology, Glasgow, UK
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Cho SH, Hall IP, Wheatley A, Dewar J, Abraha D, Del Mundo J, Lee H, Oh CK. Possible role of the 4G/5G polymorphism of the plasminogen activator inhibitor 1 gene in the development of asthma. J Allergy Clin Immunol 2001; 108:212-4. [PMID: 11496236 DOI: 10.1067/mai.2001.117260] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- S H Cho
- Division of Allergy and Immunology, the Department of Pediatrics, Harbor-UCLA Medical Center, School of Medicine, University of California, Los Angeles, Torrance 90509, USA
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Abstract
PURPOSE This phase I/II study was performed to evaluate the feasibility of administering the topoisomerase inhibitor topotecan in combination with carboplatin. PATIENTS AND METHODS Topotecan was given as a 30-minute infusion daily for 5 days, with carboplatin given immediately after topotecan on day 5. Treatment was repeated every 21 days. Carboplatin and then topotecan were escalated in sequential cohorts of three to six patients. Four dosage combinations of topotecan days 1 to 5 and carboplatin (day 5) were tested: 0.5 mg/m(2)/d and carboplatin area under the curve (AUC) of 4, topotecan 0.5 mg/m(2)/d and carboplatin AUC of 5, topotecan 0.75 mg/m(2)/d and carboplatin AUC of 5, and topotecan 1.0 mg/m(2)/d and carboplatin AUC of 5. RESULTS Grade 3 and 4 neutropenia was common at doses of 0.75 mg/m(2)/d and above, but dose-limiting hematologic toxicity occurred in only one patient. The most common reason for dose reduction or delay was failure of myelosuppression to resolve by day 21. Nonhematologic toxicity was generally mild. The maximum-tolerated dose as defined in the protocol was not reached, but topotecan dose escalation was stopped at 1.0 mg/m(2)/d, because delayed neutrophil recovery precluded re-treatment on a 21-day schedule. CONCLUSION Hematologic toxicity was common but rarely serious, and the combination of topotecan with carboplatin on this schedule was safe and well tolerated. Giving carboplatin to patients after topotecan on day 5, rather than on day 1, allowed dose escalation beyond the levels reported in other studies. The recommended doses for previously treated patients are topotecan 0.75 mg/m(2)/d, days 1 to 5, with carboplatin at an area under the curve (AUC) of 5 following topotecan on day 5. The combination of topotecan 1 mg/m(2)/d, days 1 to 5, followed on day 5 by carboplatin at an AUC of 5, merits further examination in untreated patients.
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Affiliation(s)
- A Bowman
- Imperial Cancer Research Fund Medical Oncology Unit, Western General Hospital, Edinburgh, United Kingdom
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29
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Abstract
Altered beta-adrenergic regulation has been reported in individuals with hypertension. The variability in vascular responsiveness to beta-agonists, such as isoproterenol, observed in humans may be explained partially by beta(2)-adrenoceptor polymorphism. Individuals with the Gln27 form of the receptor may show reduced vascular reactivity because of downregulation expression of the receptor in the vasculature. We screened 127 normotensive white subjects, 37 of whom were homozygous for these alleles. Thirty-two subjects (17 Gln27 and 15 Glu27) agreed to receive brachial artery infusions of isoproterenol at doses of 1 to 300 ng. min(-1); forearm blood flow was measured by using venous occlusion plethysmography. Of these subjects, 25 (12 Glu27 and 13 Gln27) received local doses of isoproterenol (0.3 to 30.0 ng. min(-1)) via a dorsal hand vein preconstricted with norepinephrine. Compared with subjects homozygous for the Glu27 allele, subjects with the Gln27 substitution had lower baseline blood flow and, in response to isoproterenol, had a significantly attenuated increase in forearm blood flow. This pattern was more marked in veins. We also studied the relationship between the position 16 polymorphism and vascular reactivity. Homozygotes for Arg16 had significantly lower basal blood flow and attenuated increases in forearm blood flow compared with the Gly16 homozygotes. This was significant in veins but not in arteries. Thus, beta(2)-adrenoceptor genotype determines vascular responses to isoproterenol in forearm resistance vessels and in capacitance vessels. Further studies are necessary to establish whether beta(2)-adrenoceptor polymorphisms are important in the genesis of hypertension.
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Affiliation(s)
- J R Cockcroft
- School of Medical and Surgical Sciences, Division of Therapeutics, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK.
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30
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Candy G, Samani N, Norton G, Woodiwiss A, Radevski I, Wheatley A, Cockcroft J, Hall IP. Association analysis of beta2 adrenoceptor polymorphisms with hypertension in a Black African population. J Hypertens 2000; 18:167-72. [PMID: 10694184 DOI: 10.1097/00004872-200018020-00006] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether or not beta2 adrenoceptor polymorphism is a risk factor for the development of hypertension in a Black South African population. BACKGROUND Attenuated vasodilator responses to endogenous catecholamines may contribute to the aetiology of hypertension. Downregulation of beta2 adrenoreceptors (beta2AR) following stimulation with agonists is determined in part by variation at the beta2AR gene locus. The Glu27 beta2AR genotype results in attenuated downregulation compared with the wild-type Gln27 receptor, whereas Gly16 exhibits enhanced down-regulation compared to Arg16. Possible racial differences in the prevalence of the beta2AR polymorphisms may be an explanation for the blunted responses to isoprenaline and the increased prevalence of hypertension in Black African populations. METHODS One hundred and ninety-two unrelated hypertensives and 123 normotensives of Black South African origin were studied. Hypertensives were recruited from hospital hypertension clinics in the province of Gauteng and if on treatment, had a 2-4 week washout period before 24-h ambulatory blood pressure assessment Normotensive controls were recruited from the same community. RESULTS There was no significant association between either the Arg-Gly16 polymorphism or the Gln-Glu27 polymorphism and hypertension status. Furthermore, in the hypertensives, no significant association was seen between beta2AR genotype at either site and clinical blood pressure, 24-h blood pressure or left ventricular mass. A significant association was seen between Arg16 homozygotes and lower body mass index in hypertensives (P = 0.007) although this was not a primary end point. Interestingly, the Glu27 polymorphism was much rarer in this population (allelic frequency 17%) compared to a Caucasian population. CONCLUSION These data suggest that beta2AR polymorphism is not a risk factor for hypertension per se in this defined population. The possibility that the decreased prevalence of Glu27 in black South African populations explains blunted vasodilator responses to isoprenaline requires further study.
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Affiliation(s)
- G Candy
- Department of Physiology and Medicine, University of the Witwatersrand, South Africa
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Abstract
We report that individuals carrying the CCR5 delta32 mutation, a naturally occurring variant of the C-C chemokine receptor 5 (CCR5), are at reduced risk of developing asthma. These data suggest a possible explanation for the high prevalence of this mutation in the general population.
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Lipworth BJ, Hall IP, Aziz I, Tan KS, Wheatley A. Beta2-adrenoceptor polymorphism and bronchoprotective sensitivity with regular short- and long-acting beta2-agonist therapy. Clin Sci (Lond) 1999; 96:253-9. [PMID: 10029561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The aim of the present study was to investigate bronchoprotective sensitivity in patients receiving regular treatment with short- and long-acting beta2-agonists and to evaluate any possible association with genetic polymorphism. Thirty-eight patients with stable mild to moderate asthma and receiving inhaled corticosteroids were randomized in a parallel group, double-blind, double-dummy fashion to receive 2 weeks of treatment with either formoterol (12 microg once daily, 6 microg twice daily or 24 microg twice daily) or terbutaline (500 microg four times daily). Bronchoprotection against methacholine challenge (as a provocative dose to produce a 20% fall in forced expiratory volume in 1.0 s: PD20) was measured at baseline (unprotected) after an initial 1 week run-in without beta2-agonist, and at 1 h after the first and last doses of each treatment. The PD20 values were log-transformed and calculated as change from baseline. Percentage desensitization of log PD20 for first- versus last-dose bronchoprotection was calculated and analysed according to effects of treatment and beta2-adrenoceptor polymorphism at codon 16 or 27. The mean degree of desensitization for bronchoprotection was comparable with all four treatments and there were no significant differences in absolute PD20 values after 2 weeks of chronic dosing. The PD20 values were (as microg of methacholine, geometric means+/-S. E.M.): formoterol, 12 microg once daily, 99+/-42 microg; formoterol, 6 microg twice daily, 107+/-44 microg; formoterol, 24 microg twice daily, 108+/-45 microg; terbutaline, 500 microg four times daily, 88+/-37 microg. All patients receiving formoterol, 24 microg twice daily, exhibited a loss of protection greater than 30% which was unrelated to polymorphism at codon 16 or 27. For codon 16, the use of lower doses of formoterol (12 microg once daily or 6 microg twice daily) showed wider variability in the propensity for protection loss in patients who were heterozygous, in contrast to a more uniform protection loss seen with homozygous glycine patients. The amount of protection loss was not significantly related to polymorphism at codon 16 or 27, expressed as values (mean+/-S.E.M.) for percentage desensitization according to each genotype (pooled treatments): Gly-16, 66+/-11%; Het-16, 53+/-8%; Arg-16, 69+/-18%; Glu-27, 68+/-12%; Het-27, 58+/-8%; Gln-27, 52+/-12%. The results of this preliminary study showed that bronchoprotective desensitization occurred readily in response to short- or long-acting beta2-agonist exposure irrespective of beta2-adrenoceptor polymorphism at codon 16 or 27. Further studies with larger patient numbers are required to further evaluate the effects of polymorphisms with lower doses of regular formoterol.
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Affiliation(s)
- B J Lipworth
- Department of Clinical Pharmacology and Therapeutics, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, Scotland, U.K
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Hopes E, McDougall C, Christie G, Dewar J, Wheatley A, Hall IP, Helms PJ. Association of glutamine 27 polymorphism of beta 2 adrenoceptor with reported childhood asthma: population based study. BMJ 1998; 316:664. [PMID: 9522789 PMCID: PMC28470 DOI: 10.1136/bmj.316.7132.664] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- E Hopes
- Department of Child Health, Medical School, University of Aberdeen
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Dewar JC, Wilkinson J, Wheatley A, Thomas NS, Doull I, Morton N, Lio P, Harvey JF, Liggett SB, Holgate ST, Hall IP. The glutamine 27 beta2-adrenoceptor polymorphism is associated with elevated IgE levels in asthmatic families. J Allergy Clin Immunol 1997; 100:261-5. [PMID: 9275150 DOI: 10.1016/s0091-6749(97)70234-3] [Citation(s) in RCA: 128] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The beta2-adrenoceptor polymorphisms occurring at amino acid positions 16 (arginine to glycine) and 27 (glutamine to glutamate) are known to be functionally relevant and also disease-modifying in subjects with asthma. However, the contribution of these polymorphisms to the development of the asthmatic phenotype or other markers for allergic disease remains to be established. OBJECTIVE This large family study examines the contributions of these polymorphisms in determining the heritable component of markers for allergic disease in asthmatic families. METHODS Three hundred twenty-four individuals from 60 families multiplex for asthma selected by means of an asthmatic proband were characterized for the following markers of allergic disease: asthma, atopy, and serum IgE. The polymerase chain reaction was used to generate a 234 base pair fragment spanning the region of interest, and the beta2-adrenoceptor polymorphism was then defined by allele-specific oligonucleotide hybridization. Segregation analysis was then performed. RESULTS We found a significant association (p = 0.009) between the glutamine 27 beta2-adrenoceptor polymorphism and elevated levels of IgE, which was supported by the observation of linkage between IgE and beta2-adrenoceptor polymorphisms at locus 27 (p = 0.037). However, there was no association between either the arginine-glycine 16 or the glutamine-glutamate 27 beta2-adrenoceptor polymorphism and an increased risk of asthma or atopy per se. CONCLUSION The glutamine 27 beta2-adrenoceptor polymorphism appears to contribute to IgE variability in families with asthma. However, it seems that although both amino acid 16 and 27 beta2-adrenoceptor polymorphisms are disease-modifying in subjects with asthma, they do not contribute markedly to the development of the asthmatic phenotype.
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Affiliation(s)
- J C Dewar
- Department of Therapeutics, University Hospital, Nottingham, United Kingdom
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Dewar J, Wheatley A, Wilkinson J, Holgate ST, Thomas NS, Lio P, Morton NE, Hall IP. Association of the Gln 27 beta 2-adrenoceptor polymorphism and IgE variability in asthmatic families. Chest 1997; 111:78S-79S. [PMID: 9184538 DOI: 10.1378/chest.111.6_supplement.78s] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- J Dewar
- Department of Therapeutics, University Hospital of Nottingham
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Hall IP, Wheatley A, Dewar J, Wilkinson J, Morrison J. Fc epsilon RI-beta polymorphisms unlikely to contribute substantially to genetic risk of allergic disease. BMJ 1996; 312:311. [PMID: 8611800 PMCID: PMC2349872 DOI: 10.1136/bmj.312.7026.311] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
Cells expressing the Glu 27 beta 2-adrenoceptor polymorphism show attenuated down-regulation of the receptor after long-term exposure to agonist. We studied beta 2-adrenoceptor genotype for the Gln/Glu 27 polymorphism and airway reactivity in 65 patients with mild to moderate asthma. Glu 27 homozygotes had a four-fold higher geometric mean methacholine PD20 (provocative dose) than individuals who were homozygous for the wild-type (Gln 27) form of the receptor; heterozygotes had an intermediate value (3.23, 0.86, 1.96 mumol, respectively). These data suggest that beta 2-adrenoceptor genotype is important in the establishment of the asthmatic phenotype.
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Affiliation(s)
- I P Hall
- Department of Medicine, University Hospital of Nottingham, UK
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