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Soori BIP, Regmi K, Pappas Y. Factors Influencing the Integration of Traditional Medicine and Mainstream Medicine in Mental Health Services in West Africa: A Systematic Review Using Narrative Synthesis. Community Ment Health J 2024:10.1007/s10597-024-01263-w. [PMID: 38619699 DOI: 10.1007/s10597-024-01263-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/27/2024] [Indexed: 04/16/2024]
Abstract
This study explored the enablers and obstacles to the integration of traditional medicine and mainstream medicine in mental health services in West Africa. This study is a systematic review conducted in accordance with the relevant parts of the Preferred Reporting Items for Systematic reviews and Meta-analyses. Keywords searches were done in databases, and other reference lists were also searched. The Rainbow model of integrated care and a thematic analysis framework were used to account for the factors influencing the integration of traditional medicine and mainstream medicine in mental health services in West Africa. A total of 12 studies met the eligibility criteria after the evaluation of 6413 articles from databases and reference lists. The themes of: policy and implementation; different conceptualisation of mental health/referrals; trust issues, and education and training, were enablers or obstacles of integration depending on how they worked to facilitate or hinder integration. There was an indication of little integration of TM and MM at the macro, meso and micro levels in mental health services in West Africa. Though the study does cover all the West African states evenly, it is recommended that policy-makers and stakeholders interested in integration should ensure integration activities, especially policies, cut across all the levels of the rainbow model of integrated care and are planned and aligned at the macro, meso and micro levels instead of using ad hoc measures, informal initiatives or placing TM services in MM mental health services, which do not amount to integration.
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Affiliation(s)
- Batuuroh I P Soori
- Faculty of Health and Social Sciences, Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK.
| | - Krishna Regmi
- Faculty of Health and Social Sciences, Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK
| | - Yannis Pappas
- Faculty of Health and Social Sciences, Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK
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Horne J, Donald L, Gracia R, Kentzer N, Pappas Y, Trott M, Vseteckova J. Supporting adult unpaid carers via an online dancing intervention: A feasibility/acceptability study. PLOS Glob Public Health 2024; 4:e0002798. [PMID: 38241209 PMCID: PMC10798499 DOI: 10.1371/journal.pgph.0002798] [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] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/15/2023] [Indexed: 01/21/2024]
Abstract
Unpaid carers often experience poor mental and physical health linked to their caring role. Engagement in physical activity has been shown to alleviate these negative health outcomes, but it is harder for carers to find the time, energy and space to exercise. This qualitative study, based in the UK, explored the feasibility of an online, dance-based physical activity intervention with six female unpaid carers. Five themes resulted from the thematic analysis of the pre- and post-intervention interviews: Perceived physical health benefits of the intervention; Perceived mental health benefits of the intervention; Satisfactoriness of the dance classes; Impact of caring responsibilities on participation; and Suggestions for future classes. Further research is required to measure the effectiveness of the dance intervention in improving mental and physical wellbeing with larger samples including a wider mix of carers in terms of gender, age and health conditions of the care recipients, as well as international samples. Future research should also consider the barriers that some carers may face when accessing an online intervention, and alternative forms of exercise that may appeal to other groups of carers (e.g., male carers, older adult carers).
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Affiliation(s)
- Joanna Horne
- School of Psychology and Counselling, The Open University, Milton Keynes, Buckinghamshire, United Kingdom
| | - Louisa Donald
- School of Psychology, University of Bedfordshire, Luton, Bedfordshire, United Kingdom
| | - Rosaria Gracia
- School of Social Sciences and Global Studies, The Open University, Milton Keynes, Buckinghamshire, United Kingdom
| | - Nichola Kentzer
- School of Education, Childhood, Youth and Sport, The Open University, Milton Keynes, Buckinghamshire, United Kingdom
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, United Kingdom
| | - Mike Trott
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Jitka Vseteckova
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, Buckinghamshire, United Kingdom
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3
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Eltaybani S, Igarashi A, Cal A, Lai CKY, Carrasco C, Sari DW, Cho E, Haugan G, Bravo JD, Abouzeid NA, Wachholz PA, Isaramalai SA, Dawood SS, Pappas Y, Abd El Moneam AAEG, Rodríguez AB, Alqahtani BA, Pereira CLN, Jenssen CRS, Yu DSF, Ahmed FR, Mendes FRP, Randhawa G, Ahmed HAESH, Suzuki H, Prambudi H, Avci IA, Waluyo I, Nurbaeti I, Vseteckova J, Horne JK, Liu JY, Ingstad K, Kashiwabara K, Grant L, Abd El Moniem MM, Sakka M, Abdelgawad ME, Subu MA, Kentzer N, Almadani NA, Tomas-Carus P, Rodrigues Garcia RCM, Indarwati R, Maneerat S, Chien WT, Amamiya Y, Cavalcanti YW, Yamamoto-Mitani N. Long-term care facilities' response to the COVID-19 pandemic: An international, cross-sectional survey. J Adv Nurs 2024; 80:350-365. [PMID: 37452500 DOI: 10.1111/jan.15785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/01/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023]
Abstract
AIMS To (i) assess the adherence of long-term care (LTC) facilities to the COVID-19 prevention and control recommendations, (ii) identify predictors of this adherence and (iii) examine the association between the adherence level and the impact of the pandemic on selected unfavourable conditions. DESIGN Cross-sectional survey. METHODS Managers (n = 212) and staff (n = 2143) of LTC facilities (n = 223) in 13 countries/regions (Brazil, Egypt, England, Hong Kong, Indonesia, Japan, Norway, Portugal, Saudi Arabia, South Korea, Spain, Thailand and Turkey) evaluated the adherence of LTC facilities to COVID-19 prevention and control recommendations and the impact of the pandemic on unfavourable conditions related to staff, residents and residents' families. The characteristics of participants and LTC facilities were also gathered. Data were collected from April to October 2021. The study was reported following the STROBE guidelines. RESULTS The adherence was significantly higher among facilities with more pre-pandemic in-service education on infection control and easier access to information early in the pandemic. Residents' feelings of loneliness and feeling down were the most affected conditions by the pandemic. More psychological support to residents was associated with fewer residents' aggressive behaviours, and more psychological support to staff was associated with less work-life imbalance. CONCLUSIONS Pre-pandemic preparedness significantly shaped LTC facilities' response to the pandemic. Adequate psychological support to residents and staff might help mitigate the negative impacts of infection outbreaks. IMPACT This is the first study to comprehensively examine the adherence of LTC facilities to COVID-19 prevention and control recommendations. The results demonstrated that the adherence level was significantly related to pre-pandemic preparedness and that adequate psychological support to staff and residents was significantly associated with less negative impacts of the pandemic on LTC facilities' staff and residents. The results would help LTC facilities prepare for and respond to future infection outbreaks. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Sameh Eltaybani
- Global Nursing Research Center, The University of Tokyo, Tokyo, Japan
| | - Ayumi Igarashi
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Ayse Cal
- Department of Nursing, School of Health Sciences, Ankara Medipol University, Ankara, Turkey
| | - Claudia K Y Lai
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, Hong Kong SAR
| | - Cristina Carrasco
- Neuroimmunophysiology and Chrononutrition Research Group, Department of Physiology, Faculty of Sciences, University of Extremadura, Badajoz, Spain
| | | | - Eunhee Cho
- Mo-Im Kim Nursing Research Institute, Yonsei University, College of Nursing, Seoul, South Korea
| | - Gørill Haugan
- Norwegian University of Science and Technology, Department of Public Health Nursing, Trondheim, Norway
- Nord University, Faculty of Nursing and Health Science, Levanger, Norway
| | - Jorge D Bravo
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Évora, Portugal
- Comprehensive Health Research Centre(CHRC), Universidade de Évora, Évora, Portugal
| | - Nesreen A Abouzeid
- Department of Medical Surgical Nursing, College of Nursing, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- Department of Medical Surgical Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | | | | | - Shaimaa Samir Dawood
- Gerontological nursing department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, luton, UK
| | | | - Ana Beatriz Rodríguez
- Neuroimmunophysiology and Chrononutrition Research Group, Department of Physiology, Faculty of Sciences, University of Extremadura, Badajoz, Spain
| | | | - Catarina Lino Neto Pereira
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Évora, Portugal
| | | | - Doris S F Yu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Fatma Refaat Ahmed
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Felismina Rosa P Mendes
- Departamento de Enfermagem, Escola Superior de Enfermagem São João de Deus, Universidade de Évora, Évora, Portugal
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, luton, UK
| | | | - Haruno Suzuki
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Hery Prambudi
- An Nasher Institute of Healh Sciences, Cirebon, Cirebon West Java, Indonesia
| | - Ilknur Aydin Avci
- Department of Public Health Nursing, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey
| | - Imam Waluyo
- Padma Kumara Foundation and Consultant International, Collaboration Physiotherapy School YAB, Jakarta, Indonesia
| | - Irma Nurbaeti
- Faculty of Health Sciences, Universitas Islam Negeri Syarif Hidayatullah, Jakarta, Indonesia
| | - Jitka Vseteckova
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
| | | | - Justina Yw Liu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, Hong Kong SAR
| | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | | | - Louise Grant
- Faculty of Health and Social Sciences, University of Bedfordshire, Luton, UK
| | | | - Mariko Sakka
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Muhammad Arsyad Subu
- University of Sharjah, Sharjah, United Arab Emirates
- Universitas Binawan, Jakarta, Indonesia
| | - Nichola Kentzer
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
| | - Noura A Almadani
- Community health nursing department, College of Nursing, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Pablo Tomas-Carus
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Évora, Portugal
| | | | - Retno Indarwati
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Sonthaya Maneerat
- Prapokklao Nursing College, Faculty of Nursing, Praboromarajchanok Institute, Chantaburi, Thailand
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Yuko Amamiya
- Department of Nursing, Faculty of Healthcare Sciences, Chiba Prefectural University of Health Sciences, Chiba, Japan
| | | | - Noriko Yamamoto-Mitani
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
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Sithole BR, Pappas Y, Randhawa G. eHealth in obesity care. Clin Med (Lond) 2023; 23:347-352. [PMID: 38614648 PMCID: PMC10541052 DOI: 10.7861/clinmed.2023-0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Obesity in adults is a growing health concern. Although effective, current treatment options have not been able to overcome the various factors that contribute toward rising obesity rates. eHealth might hold the capacity to improve the effectiveness, delivery and flexibility of some of these treatments. Here, we show that eHealth lifestyle change interventions delivered through smartphones (mHealth) can facilitate significant weight loss, making mHealth an attractive adjunct to clinical obesity care. However, evidence is currently limited to short-term effects, and is also lacking with regards to effectiveness based on socioeconomic status and ethnic group. This raises concerns around the potential and inadvertent widening of obesity prevalence disparities between groups as mHealth lifestyle change interventions are increasingly used in obesity care. Thus, we also describe opportunities to address these concerns and gaps in evidence.
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Affiliation(s)
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, UK
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Liapi F, Chater AM, Kenny T, Anderson J, Randhawa G, Pappas Y. Evaluating step-down, intermediate care programme in Buckinghamshire, UK: a mixed methods study. BMC Public Health 2023; 23:1087. [PMID: 37280556 DOI: 10.1186/s12889-023-15868-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/10/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Intermediate care (IC) services are models of care that aim to bridge the gap between hospital and home, enabling continuity of care and the transition to the community. The purpose of this study was to explore patient experience with a step-down, intermediate care unit in Buckinghamshire, UK. METHODS A mixed-methods study design was used. Twenty-eight responses to a patient feedback questionnaire were analysed and seven qualitative semi-structured interviews were conducted. The eligible participants were patients who had been admitted to the step-down IC unit. Interview transcripts were analysed using thematic analysis. FINDINGS Our interview data generated five core themes: (1) "Being uninformed", (2) "Caring relationships with health practitioners", (3) "Experiencing good intermediate care", (4) "Rehabilitation" and (5) "Discussing the care plan". When comparing the quantitative to the qualitative data, these themes are consistent. CONCLUSIONS Overall, the patients reported that the admission to the step-down care facility was positive. Patients highlighted the supportive relationship they formed with healthcare professionals in the IC and that the rehabilitation that was offered in the IC service was important in increasing mobility and regaining their independence. In addition, patients reported that they were largely unaware about their transfer to the IC unit before this occurred and they were also unaware of their discharge package of care. These findings will inform the evolving patient-centred journey for service development within intermediate care.
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Affiliation(s)
- Fani Liapi
- Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK.
| | - Angel Marie Chater
- Institute for Sport and Physical Activity Research, University of Bedfordshire, MK41 9EA, Bedford, UK
- University College London, Centre for Behaviour Change, WC1E 7HB, London, UK
| | - Tina Kenny
- Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | - Juliet Anderson
- Buckinghamshire Health and Social Care Academy, Aylesbury, HP21 7Q, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK
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Ibrahim MS, Pang D, Randhawa G, Pappas Y. Development and Validation of a Simple Risk Model for Predicting Metabolic Syndrome (MetS) in Midlife: A Cohort Study. Diabetes Metab Syndr Obes 2022; 15:1051-1075. [PMID: 35418767 PMCID: PMC8995775 DOI: 10.2147/dmso.s336384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/15/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To develop and validate a simple risk model for predicting metabolic syndrome in midlife using a prospective cohort data. Design Prospective cohort study. Participants A total of 7626 members of the 1958 British birth cohort (individuals born in the first week of March 1958) participated in the biomedical survey at age 45 and have completed information on metabolic syndrome. Methods Variables utilised were obtained prospectively at birth, 7, 16, 23 and 45 years. Multivariable logistic regression was used to develop a total of ten (10) MetS risk prediction models taking the life course approach. Measures of discrimination and calibration were used to evaluate the performance of the models. A pragmatic criteria developed was used to select one model with the most potential to be useful. The internal validity (overfitting) of the selected model was assessed using bootstrap technique of Stata. Main Outcome Measure Metabolic syndrome was defined based on the NCEP-ATP III clinical criteria. Results There is high prevalence of MetS among the cohort members (19.6%), with males having higher risk as compared to females (22.8% vs 16.4%, P < 0.001). Individuals with MetS are more likely to have higher levels of HbA1c and low HDL-cholesterol. Similarly, regarding the individual components of MetS, male cohort members are more likely to have higher levels of glycaemia (HbA1c), BP and serum triglycerides. In contrast, female cohort members have lower levels of HDL-cholesterol and higher levels of waist circumference. Furthermore, a total of ten (10) MetS risk prediction models were developed taking the life course approach. Of these, one model with the most potential to be applied in practical setting was selected. The model has good accuracy (AUROC 0.91 (0.90, 0.92)), is well calibrated (Hosmer-Lemeshow 6.47 (0.595)) and has good internal validity. Conclusion Early life factors could be included in a risk model to predict MetS in midlife. The developed model has been shown to be accurate and has good internal validity. Therefore, interventions targeting socioeconomic inequality could help in the wider prevention of MetS. However, the validity of the developed model needs to be further established in an external population.
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Affiliation(s)
- Musa S Ibrahim
- Institute for Health Research, University of Bedfordshire, Putteridge Bury Luton, Bedfordshire, LU2 8LE, England
| | - Dong Pang
- Institute for Health Research, University of Bedfordshire, Putteridge Bury Luton, Bedfordshire, LU2 8LE, England
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Putteridge Bury Luton, Bedfordshire, LU2 8LE, England
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Putteridge Bury Luton, Bedfordshire, LU2 8LE, England
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Liapi F, Chater AM, Pescheny JV, Randhawa G, Pappas Y. Understanding the Experience of Service Users in an Integrated Care Programme for Obesity and Mental Health: A Qualitative Investigation of Total Wellbeing Luton. Int J Environ Res Public Health 2022; 19:817. [PMID: 35055637 PMCID: PMC8775803 DOI: 10.3390/ijerph19020817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/19/2021] [Accepted: 12/24/2021] [Indexed: 02/04/2023]
Abstract
Obesity is a complex public health issue with multiple contributing factors. The emphasis on joined care has led to the development and implementation of a number of integrated care interventions targeting obesity and mental health. The purpose of this study was to examine user experience in an integrated care programme for obesity and mental health in Luton, UK. Semi-structured interviews were conducted with a purposeful sample of service users (N = 14). Interview transcripts were analysed using thematic analysis. Analysis of the interviews identified six main themes for understanding service users' experiences of integrated care: (1) 'A user-centered system', (2) 'Supports behaviour change', (3) 'Valued social support', (4) 'Communication is key', (5) 'Flexible referral process', and (6) 'Positive impact on life'. These themes describe how the service is operated, evidence perceived value service users place on social support in behavior change intervention, and address which service areas work well and which require improvement. The findings of these interviews have offered a significant contribution to understanding what service users value the most in an integrated healthcare setting. Service users value ongoing support and being listened to by healthcare professionals, as well as the camaraderie and knowledge acquisition to support their own behaviour change and promote self-regulation following their participation in the programme.
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Affiliation(s)
- Fani Liapi
- Faculty of Health and Social Science, Institute for Health Research, University of Bedfordshire, Luton LU2 8LE, UK; (G.R.); (Y.P.)
| | - Angel Marie Chater
- Faculty of Education and Sport, Institute for Sport and Physical Activity Research, University of Bedfordshire, Bedford MK41 9EA, UK;
| | | | - Gurch Randhawa
- Faculty of Health and Social Science, Institute for Health Research, University of Bedfordshire, Luton LU2 8LE, UK; (G.R.); (Y.P.)
| | - Yannis Pappas
- Faculty of Health and Social Science, Institute for Health Research, University of Bedfordshire, Luton LU2 8LE, UK; (G.R.); (Y.P.)
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Bature F, Pappas Y, Pang D, Guinn BA. Can non-invasive biomarkers lead to an earlier diagnosis of Alzheimer's Disease? Curr Alzheimer Res 2021; 18:908-913. [PMID: 34875991 DOI: 10.2174/1567205018666211207094630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/14/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Fidelia Bature
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire, Luton, LU2 8LE. United Kingdom
| | - Yannis Pappas
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire, Luton, LU2 8LE. United Kingdom
| | - Dong Pang
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire, Luton, LU2 8LE. United Kingdom
| | - Barbara-Ann Guinn
- Department of Biomedical Sciences, University of Hull, HU6 7RX. United Kingdom
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Liapi F, Chater A, Randhawa G, Pappas Y. Factors that facilitate or hinder whole system integrated care for obesity and mental health: a scoping review protocol. BMJ Open 2021; 11:e050527. [PMID: 34376452 PMCID: PMC8356181 DOI: 10.1136/bmjopen-2021-050527] [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: 11/30/2022] Open
Abstract
INTRODUCTION Integrated care aims to improve population health. Obesity and mental health are major health issues worldwide. The complexity of the multifactorial drivers of these public health problems has led to the adoption of a whole system approach. This review aims to highlight factors that influence the planning, implementation and evaluation of whole system integrated care for these conditions. METHODS AND ANALYSIS Using the framework of Arksey and O' Malley, we will perform a comprehensive search in the following databases: MEDLINE, CINAHL, PsychINFO, PubMed, British Nursing Database, Web of Science, Health Systems Evidence, Cochrane Library and University of York Centre for Reviews and Dissemination. Further hand-search of reference lists and the grey literature will be conducted. The search will be restricted to articles published from 2000 to 2020. The review is expected to be completed by August 2021. Full texts of the potential studies will be screened for the inclusion criteria. Quality of studies will be appraised. Narrative synthesis will be completed using data extracted from the included studies. ETHICS AND DISSEMINATION A favourable ethics opinion for this study was obtained from the Institute for Health Research Ethics Committee of the University of Bedfordshire (IHREC937). This review expects to identify information relating to factors that facilitate or hinder whole system integrated care for obesity and mental health. The finding from this review will be widely disseminated to stakeholders to inform implementation of whole system integrated care initiatives.
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Affiliation(s)
- Fani Liapi
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Angel Chater
- Department of Sport Science and Physical, University of Bedfordshire, Luton, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, UK
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Pescheny JV, Gunn LH, Pappas Y, Randhawa G. The impact of the Luton social prescribing programme on mental well-being: a quantitative before-and-after study. J Public Health (Oxf) 2021; 43:e69-e76. [PMID: 31883018 DOI: 10.1093/pubmed/fdz155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Social prescribing programmes expand the range of options available to primary care health professionals to address patients' psychosocial needs, impacting on their health and well-being. The objective of this study was to assess the change in the mental well-being of service users after participation in the Luton social prescribing programme. METHODS Skew-normal (SN) regression was applied to analyse the change in mental well-being post-intervention (N = 63). The short Warwick-Edinburgh mental well-being scale was used as the outcome measure. RESULTS The SN regression found a statistically significant change (P < 0.0001) in the average difference score between baseline and post-intervention measures. However, the observed change does not appear to be of clinical relevance. No significant associations in mental well-being scores by gender, age or working status were found. CONCLUSION Findings of this study indicate that social prescribing may have the potential to improve the mental well-being of service users. The study findings contribute to the sparse evidence base on social prescribing outcomes by socio-demographic characteristics of participants and highlight the importance of considering subgroup analysis in future research.
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Affiliation(s)
- Julia V Pescheny
- Institute of Health Research, University of Bedfordshire, Luton LU1 3JU, UK
| | - Laura H Gunn
- Department of Public Health Sciences, University of North Carolina (UNC), Charlotte 28223, NC, USA.,School of Public Health, Imperial College London, London SW7 2AZ, UK
| | - Yannis Pappas
- Institute of Health Research, University of Bedfordshire, Luton LU1 3JU, UK
| | - Gurch Randhawa
- Institute of Health Research, University of Bedfordshire, Luton LU1 3JU, UK
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Bailey DP, Edwardson CL, Pappas Y, Dong F, Hewson DJ, Biddle SJH, Brierley ML, Chater AM. A randomised-controlled feasibility study of the REgulate your SItting Time (RESIT) intervention for reducing sitting time in individuals with type 2 diabetes: study protocol. Pilot Feasibility Stud 2021; 7:76. [PMID: 33741077 PMCID: PMC7977248 DOI: 10.1186/s40814-021-00816-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/01/2020] [Accepted: 03/09/2021] [Indexed: 12/14/2022] Open
Abstract
Background People with type 2 diabetes mellitus (T2DM) generally spend a large amount of time sitting. This increases their risk of cardiovascular disease, premature mortality, diabetes-related complications and mental health problems. There is a paucity of research that has evaluated interventions aimed at reducing and breaking up sitting in people with T2DM. The primary aim of this study is to assess the feasibility of delivering and evaluating a tailored intervention to reduce and break up sitting in ambulatory adults with T2DM. Methods This is a mixed-methods randomised controlled feasibility trial. Participants (n=70) with T2DM aged 18-85 years who sit ≥7 h/day and are able to ambulate independently will be randomly allocated to receive the REgulate your SItting Time (RESIT) intervention or usual care (control group) for 24 weeks. RESIT is a person-focused intervention that delivers a standardised set of behaviour change techniques to the participants, but the mode through which they are delivered can vary depending on the tools selected by each participant. The intervention includes an online education programme, health coach support, and a range of self-selected tools (smartphone apps, computer-prompt software, and wearable devices) that deliver behaviour change techniques such as self-monitoring of sitting and providing prompts to break up sitting. Measures will be taken at baseline, 12 and 24 weeks. Eligibility, recruitment, retention and data completion rates will be used to assess trial feasibility. Sitting, standing and stepping will be measured using a thigh-worn activity monitor. Cardiometabolic health, physical function, psychological well-being, sleep and musculoskeletal symptoms will also be assessed. A process evaluation will be conducted including evaluation of intervention acceptability and fidelity. Discussion This study will identify the feasibility of delivering a tailored intervention to reduce and break up sitting in ambulatory adults with T2DM and evaluating it through a randomised controlled trial (RCT) design. The findings will inform a fully powered RCT to evaluate the effectiveness of the intervention. Trial registration ISRCTN, ISRCTN14832389; Registered 6 August 2020.
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Affiliation(s)
- Daniel P Bailey
- Sedentary Behaviour, Health and Disease Research Group, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, UK. .,Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, UK.
| | - Charlotte L Edwardson
- Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.,NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, LU1 3JU, UK
| | - Feng Dong
- Department of Computer and Information Sciences, University of Strathclyde, G1 1XH, Glasgow, UK
| | - David J Hewson
- Institute for Health Research, University of Bedfordshire, Luton, LU1 3JU, UK
| | - Stuart J H Biddle
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, 4300, Australia
| | - Marsha L Brierley
- Sedentary Behaviour, Health and Disease Research Group, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, UK.,Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, UK
| | - Angel M Chater
- Institute for Sport and Physical Activity Research, Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Polhill Avenue, Bedford, MK41 9EA, UK
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12
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Pescheny JV, Randhawa G, Pappas Y. The impact of social prescribing services on service users: a systematic review of the evidence. Eur J Public Health 2020; 30:664-673. [PMID: 31199436 DOI: 10.1093/eurpub/ckz078] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Social prescribing initiatives are widely implemented in the UK National Health Service to integrate health and social care. Social prescribing is a service in primary care that links patients with non-medical needs to sources of support provided by the community and voluntary sector to help improve their health and wellbeing. Such programmes usually include navigators, who work with referred patients and issue onward referrals to sources of non-medical support. This systematic review aimed to assess the evidence of service user outcomes of social prescribing programmes based on primary care and involving navigators. METHODS We searched 11 databases, the grey literature, and the reference lists of relevant studies to identify the available evidence on the impact of social prescribing on service users. Searches were limited to literature written in English. No date restrictions were applied, and searches were conducted to June 2018. Findings were synthesized narratively, employing thematic analysis. The Mixed Methods Appraisal Tool Version 2011 was used to evaluate the methodological quality of included studies. RESULTS Sixteen studies met the inclusion criteria. The evidence base is mixed, some studies found improvements in health and wellbeing, health-related behaviours, self-concepts, feelings, social contacts and day-to-day functioning post-social prescribing, whereas others have not. The review also shows that the evaluation methodologies utilized were variable in quality. CONCLUSION In order to assess the success of social prescribing services, more high quality and comparable evaluations need to be conducted in the future.International Prospective Register of Systematic Reviews number: CRD42017079664.
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Affiliation(s)
- Julia V Pescheny
- Institute of Health Research, University of Bedfordshire, Luton, UK
| | - Gurch Randhawa
- Institute of Health Research, University of Bedfordshire, Luton, UK
| | - Yannis Pappas
- Institute of Health Research, University of Bedfordshire, Luton, UK
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13
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Vseteckova J, Dadova K, Gracia R, Ryan G, Borgstrom E, Abington J, Gopinath M, Pappas Y. Barriers and facilitators to adherence to walking group exercise in older people living with dementia in the community: a systematic review. Eur Rev Aging Phys Act 2020; 17:15. [PMID: 32973961 PMCID: PMC7507295 DOI: 10.1186/s11556-020-00246-6] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/06/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND & AIMS Evidence suggests that targeted exercise is important for people living with dementia. The aim of this review was to collect and synthesize evidence on the known barriers and facilitators to adherence to walking group exercise of older people living with dementia in the community. METHODS We have searched appropriate electronic databases between January 1990 until September 2019, in any language. Additionally, we searched trial registries (clinicaltrial.gov and WHO ICTRP) for ongoing studies. We included all study designs. Studies were excluded when participants were either healthy older people or people suffering from dementia but living in residential care. Narrative synthesis was used. FINDINGS 10 papers met the inclusion criteria. The narrative analysis focused on barriers, facilitators, and adherence. All studies reported on barriers and facilitators. Barriers included: bio-medical reasons (including mental wellbeing and physical ability); relationship dynamics; and socio-economic reasons and environmental issues. Facilitators included: bio-medical benefits & benefits related to physical ability; staff, group relationship dynamics and social aspect of walking group; environmental issues and individual tailoring; and participants perceptions about the walks & the program. Most studies did not provide data about adherence or attendance; where reported, adherence ranged from 47 to 89%. CONCLUSIONS This systematic review of literature has highlighted known barriers and facilitators to adherence to walking groups type of exercise for people living with dementia in community. Carers' willingness to engage, their circumstances, perspectives and previous experiences of exercise seem to play a key role in facilitating adherence but there is little research that explores these. Also, the design, location and organisation of walking groups facilitate adherence. This reflects the need for such activities to be part of a wider 'program of care', tailored to the needs of the individual, flexible and convenient. Knowledgeable and well-trained instructors or healthcare professionals are recommended as group exercise leaders.
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Affiliation(s)
- J. Vseteckova
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - K. Dadova
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - R. Gracia
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - G. Ryan
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - E. Borgstrom
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - J. Abington
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - M. Gopinath
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - Y. Pappas
- Institute for Health Research, University of Bedfordshire, Bedford, UK
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Iwundu C, Pang D, Pappas Y. Childhood Maternal School Leaving Age (Level of Education) and Risk Markers of Metabolic Syndrome in Mid-Adulthood: Results from the 1958 British Birth Cohort. Diabetes Metab Syndr Obes 2020; 13:3761-3771. [PMID: 33116725 PMCID: PMC7573814 DOI: 10.2147/dmso.s263332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study is to investigate the relationship between childhood maternal level of education (CMLE) and changes in anthropometric and laboratory risk markers of metabolic syndrome (MetS) in mid-adulthood using results from the 1958 British Birth Cohort Study. DESIGN Cohort study. PARTICIPANTS A total of 9376 study samples consisting of subjects that participated in the biomedical survey of the national child development study (NCDS) carried out between 2002 and 2004 were used for the analysis. MAIN OUTCOME MEASURES Five risk markers of MetS: (i) HDL-cholesterol (ii) triglyceride (iii) blood pressure (BP) including systolic (SBP) and diastolic (DBP) (iv) waist circumference (WC) and (v) glycated haemoglobin (HbA1c). METHODS The NCDS or the 1958 British birth cohort data deposited in the UK data service by the centre for longitudinal studies were used for analyses. Ordinary least squares regression was used to determine unit changes in the outcome variables given CMLE. RESULTS The estimates for unadjusted regression analysis of individual risk markers indicated a significant relationship between CMLE and alterations in the five risk markers of MetS (HDL-cholesterol, triglyceride, WC, HbA1c, and BP) in midlife. After adjustment for birth and lifestyle characteristics/health behaviours, the relationship between CMLE and the risk markers was attenuated for HDL-cholesterol, triglycerides, and HbA1c but remained significant for WC 0.70 (95% confidence interval (CI) 0.065-1.30, p<0.001) and SBP 1.48 (95% CI 0.48-2.47 p<0.001). CONCLUSION There was a positive association between lower CMLE and the risk of MetS using the NCDS data. Lifestyle characteristics may be influential determinants of MetS risk in mid-adulthood.
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Affiliation(s)
- Chukwuma Iwundu
- Institute for Health Research, University of Bedfordshire, Luton, UK
- Correspondence: Chukwuma Iwundu Institute for Health Research, University of Bedfordshire, Luton, BedfordshireLU2 8LE, UKTel +44 1582 743797Fax +44 1582 743918 Email
| | - Dong Pang
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, UK
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Abstract
Purpose
Individuals with intellectual disability(ies) are living longer contributing to an overall increase in the average age of caregivers. The purpose of this paper is to review the literature on the physical, social and psychological needs of ageing carers of individuals with intellectual disability(ies) in the UK.
Design/methodology/approach
A scoping review framework was used to identify literature from eleven databases, the grey literature and the references lists of relevant studies. Only primary research studies that discussed the needs of non-professional carers, aged 65+ years old, of individuals with intellectual disability(ies) in the UK were included. No date restrictions were applied. Thematic analysis was used to narratively synthesise findings.
Findings
Six studies were included. Five key themes were identified: Living with fear, lack of information, rebuilding trust, proactive professional involvement and being ignored. Housing and support information is not communicated well to carers. Professionals require more training on carer needs and trust must be rebuilt between carers and professionals. Proactive approaches would help identify carer needs, reduce marginalisation, help carers feel heard and reduce the risk of care crisis. Greater recognition of mutual caring relationships is needed.
Originality/value
This review highlighted the needs of older caregivers for individuals with intellectual disability(ies) as well as the need for more high-quality research in this field. The information presented in this review may be considered by primary care providers and funding bodies when planning future support for this growing population of carers.
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Abstract
INTRODUCTION Metabolic syndrome 'a clustering of risk factors which includes hypertension central obesity, impaired glucose metabolism with insulin resistance and dyslipidaemia' affects approximately 20%-25% of the global adult population. Individuals with metabolic syndrome have two to threefold risk of developing cardiovascular disease and a fivefold risk of developing developing diabetes and death from all causes. Although there is rapid proliferation of risk scores for predicting the risk of developing metabolic syndrome later in life, yet, these are seldom used in the practice. Therefore, the purpose of this review is to determine the performance of risk models and scores for predicting the metabolic syndrome. METHODS AND ANALYSIS Articles will be sought for from electronic databases (MEDLINE, CINAHL, PubMed and Web of Science) as well as the Cochrane Library. Further manual search of reference lists and grey literatures will be conducted. The search will cover from the start of indexing to 3 October 2018. Identified studies will be included if they fulfil the study selection criteria. Quality of studies will be appraised using suitable criteria for the risk models. The risk scores in the final sample of the review will be ranked/prioritised based on previous quality criteria for prognostic risk models. Lastly, the impact of the models will be ascertained by tracking citations on Google Scholar. ETHICS AND DISSEMINATION This study does not require formal ethical approval as primary data will not be collected. The results will be disseminated through a peer-reviewed publication and relevant conference presentations. PROSPERO REGISTRATION NUMBER CRD42019139326.
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Affiliation(s)
- Musa Saulawa Ibrahim
- Institute for Health Research, Faculty of Health and Social Sciences, University of Bedfordshire, Luton, UK
| | - Dong Pang
- Institute for Health Research, Faculty of Health and Social Sciences, University of Bedfordshire, Luton, UK
| | - Gurch Randhawa
- Institute for Health Research, Faculty of Health and Social Sciences, University of Bedfordshire, Luton, UK
| | - Yannis Pappas
- Institute for Health Research, Faculty of Health and Social Sciences, University of Bedfordshire, Luton, UK
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Bature F, Pang D, Robinson A, Polson N, Pappas Y, Guinn B. Identifying Patterns in Signs and Symptoms Preceding the Clinical Diagnosis of Alzheimer's Disease: Retrospective Medical Record Review Study and a Nested Case-control Design. Curr Alzheimer Res 2019; 15:723-730. [PMID: 29623839 DOI: 10.2174/1567205015666180404155358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/09/2018] [Accepted: 03/28/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Evidence suggests that individuals with Alzheimer's disease (AD) are often diagnosed in the later stages of their disease with a poor prognosis. This study is aimed to identify patterns in signs and symptoms preceding the clinical diagnosis of AD to suggest a predictive model for earlier diagnosis of the disease in the primary care. DESIGN A retrospective medical record review; nested case control design. PARTICIPANTS Participants included one hundred and nine patients from three general practice (GP) surgeries in Milton Keynes and Luton Clinical Commissioning Groups (CCG) (37 cases with AD and 72 controls without AD). MAIN OUTCOME MEASURE A retrospective analysis using the logistic regression of the presence of signs and symptoms before the diagnosis of AD was attained. Identification of the timing and sequence of appearance of these presentations as first reported before the clinical diagnosis was measured. RESULT Episodic memory with an odds ratio of 1.85 was the most frequent presentation, documented in 1.38% of the controls and 75.6% in cases. Auditory disturbance with an odds ratio of 3.03, which has not previously been noted except in the form of auditory hallucination, could have a diagnostic value. CONCLUSION Auditory disturbance, which occurred mostly in the Caucasian females, could discriminate individuals with AD from those without the disease. The symptom, which presented up to 14.5 (mean time) years prior to clinical diagnosis, was identified in Caucasians and mixed race individuals only. Strengths The study demonstrates that auditory disturbance could allow an earlier diagnosis of AD in Caucasian females. Episodic memory was confirmed as being frequently noted in AD patients prior to a clinical diagnosis as per previous publications. This study supports the development of a scoring system for the earlier diagnosis of AD. The data used was free from the confounding effects of misinformation, as this was written at the point of collection, thereby benefitting from the use of GP data that is diversified, reliable and valid. LIMITATIONS Limited sample size that will not allow for generalization of less frequent observations due to their low prevalence in case notes. Randomisation was not achieved; however, the best available nonrandomisation which is consecutive sampling was used. Patterns identified were in LOAD, the baseline could vary with other geographical areas.
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Affiliation(s)
- Fidelia Bature
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire Ringgold Standard Institution, Vicarage St., Luton LU2 8LE, United Kingdom
| | - Dong Pang
- Moakes Medical Centre, The Moakes, Marsh Farm Luton, LU3 3SR, United Kingdom
| | - Anthea Robinson
- Fishermead Medical Centre Ringgold Standard Institution, Milton Keynes, Buckinghamshire, United Kingdom
| | - Norma Polson
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire Ringgold Standard Institution, Vicarage St., Luton LU2 8LE, United Kingdom
| | - Yannis Pappas
- School of Life Science, University of Hull, Biomedical Science, Hull, United Kingdom
| | - Barbara Guinn
- School of Life Science, University of Hull, Biomedical Science, Hull, United Kingdom
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Pescheny JV, Gunn LH, Randhawa G, Pappas Y. The impact of the Luton social prescribing programme on energy expenditure: a quantitative before-and-after study. BMJ Open 2019; 9:e026862. [PMID: 31209089 PMCID: PMC6588998 DOI: 10.1136/bmjopen-2018-026862] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 03/04/2019] [Accepted: 04/08/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES The objective of this study was to assess the change in energy expenditure levels of service users after participation in the Luton social prescribing programme. DESIGN Uncontrolled before-and-after study. SETTING This study was set in the East of England (Luton). PARTICIPANTS Service users with complete covariate information and baseline measurements (n=146) were included in the analysis. INTERVENTION Social prescribing, which is an initiative that aims to link patients in primary care with sources of support within the community sector to improve their health, well-being and care experience. Service users were referred to 12 sessions (free of charge), usually provided by third sector organisations. PRIMARY OUTCOME MEASURE Energy expenditure measured as metabolic equivalent (MET) minutes per week. RESULTS Using a Bayesian zero-inflated negative binomial model to account for a large number of observed zeros in the data, 95% posterior intervals show that energy expenditure from all levels of physical activities increased post intervention (walking 41.7% (40.31%, 43.11%); moderate 5.0% (2.94%, 7.09%); vigorous 107.3% (98.19%, 116.20%) and total 56.3% (54.77%, 57.69%)). The probability of engaging in physical activity post intervention increased, in three of four MET physical activity levels, for those individuals who were inactive at the start of the programme. Age has a negative effect on energy expenditure from any physical activity level. Similarly, working status has a negative effect on energy expenditure in all but one MET physical activity level. No consistent pattern was observed across physical activity levels in the association between gender and energy expenditure. CONCLUSION This study shows that social prescribing may have the potential to increase the physical activity levels of service users and promote the uptake of physical activity in inactive patient groups. Results of this study can inform future research in the field, which could be of use for commissioners and policy makers.
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Affiliation(s)
| | - Laura H Gunn
- Department of Public Health Sciences, University of North Carolina (UNC) at Charlotte, Charlotte, NC, USA
- School of Public Health, Imperial College London, London, UK
| | - Gurch Randhawa
- Institute of Health Research, University of Bedfordshire, Luton, UK
| | - Yannis Pappas
- Institute of Health Research, University of Bedfordshire, Luton, UK
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Bature F, Guinn B, Pang D, Pappas Y. Perspectives of General Practitioners on the Issues Surrounding the Late Diagnosis of Alzheimer's Disease. J Alzheimers Dis Rep 2018; 2:207-212. [PMID: 30560245 PMCID: PMC6294576 DOI: 10.3233/adr-180064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2018] [Indexed: 11/15/2022] Open
Abstract
We set out to investigate the insights general practitioners (GPs) have into the early signs and symptoms of Alzheimer's disease (AD), factors that may be responsible for the late diagnosis, as well as their recommendations for early diagnosis of AD. This was a semi-structured, qualitative and audio-recorded interview of seven GPs, from five GP surgeries in Milton Keynes and Luton, using the framework analysis. GPs reported challenges with the current patient's consultation time, a lack of continuity of care, inadequate training, limited support for patients after diagnosis, and poor treatment of the UK's aging population. The study highlights important changes that would facilitate the earlier diagnosis of AD.
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Affiliation(s)
- Fidelia Bature
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire, Luton, LU2 8LE, UK
| | - Barbara Guinn
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire, Luton, LU2 8LE, UK
- Faculty of Health Sciences – Biomedical Sciences, University of Hull, HU6 7RX, UK
| | - Dong Pang
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire, Luton, LU2 8LE, UK
| | - The Luton, Dunstable, Milton Keynes General Practise consortium
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire, Luton, LU2 8LE, UK
- Faculty of Health Sciences – Biomedical Sciences, University of Hull, HU6 7RX, UK
| | - Yannis Pappas
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire, Luton, LU2 8LE, UK
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Vseteckova J, Deepak-Gopinath M, Borgstrom E, Holland C, Draper J, Pappas Y, McKeown E, Dadova K, Gray S. Barriers and facilitators to adherence to group exercise in institutionalized older people living with dementia: a systematic review. Eur Rev Aging Phys Act 2018; 15:11. [PMID: 30455778 PMCID: PMC6225693 DOI: 10.1186/s11556-018-0200-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 04/21/2018] [Accepted: 09/27/2018] [Indexed: 11/10/2022] Open
Abstract
Objectives Research suggests targeted exercise is important for people living with dementia, especially those living in residential care. The aim of this review was to collect and synthesize evidence on the known barriers and facilitators to adherence to group exercise of institutionalized older people living with dementia. Methods We searched all available electronic databases. Additionally, we searched trial registries (clinicaltrial.gov, and WHO ICTRP) for ongoing studies. We searched for and included papers from January 1990 until September 2017 in any language. We included randomized, non-randomized trials. Studies were not eligible if participants were either healthy older people or people suffering from dementia but not living in an institution. Studies were also excluded if they were not focused on barriers and facilitators to adherence to group exercise. Results Using narrative analysis, we identified the following themes for barriers: bio-medical reasons and mental wellbeing and physical ability, relationships dynamics, and socioeconomic reasons. The facilitators were grouped under the following thematic frames: bio-medical benefits and benefits related to physical ability, feelings and emotions and confidence improvements, therapist and group relationships dynamics and activity related reasons. Conclusions We conclude that institutionalized older people living with dementia, even those who are physically frail, incontinent and/or have mild dementia can demonstrate certain level of exercise adherence, and therefore can respond positively to exercise programs. Tailored, individually-adjusted and supported physical activity, led by a knowledgeable, engaging and well communicating therapist/facilitator improves the adherence to group exercise interventions of institutionalized older people living with dementia.
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Affiliation(s)
- Jitka Vseteckova
- 1School of Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - Manik Deepak-Gopinath
- 1School of Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - Erica Borgstrom
- 1School of Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - Caroline Holland
- 1School of Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - Jan Draper
- 1School of Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - Yannis Pappas
- 2Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Eamonn McKeown
- 3Health Services Research & Management Division in the School of Health Sciences at City, University of London, London, UK
| | - Klara Dadova
- 4Department of Adapted Physical Activity and Sports Medicine, Faculty of Physical education and Sport, Charles University, Prague, Czech Republic
| | - Steve Gray
- 1School of Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
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Balal S, Udoh A, Pappas Y, Cook E, Barton G, Hassan A, Hayden K, Bourne RRA, Ahmad S, Pardhan S, Harrison M, Sharma B, Wasil M, Sharma A. The feasibility of finger prick autologous blood (FAB) as a novel treatment for severe dry eye disease (DED): protocol for a randomised controlled trial. BMJ Open 2018; 8:e026770. [PMID: 30385451 PMCID: PMC6252631 DOI: 10.1136/bmjopen-2018-026770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Patients with severe dry eye disease (DED) often have limited treatment options with standard non-surgical management focused on the use of artificial tears for lubrication and anti-inflammatory drugs. However, artificial tears do not address the extraordinary complexity of human tears. Crudely, human tears with its vast constituents is essentially filtered blood. Blood and several blood-derived products including autologous serum, have been studied as tear substitutes. This study proposes to test the use of whole, fresh, autologous blood obtained from a finger prick for treatment of severe DED. METHODS AND ANALYSIS The research team at the two participating sites will approach patients with severe DED for this study. Recruitment will take place over 12 months and we expect to recruit 60 patients in total. The primary outcome of this feasibility study is to estimate the proportion of eligible patients approached who consent to and comply with study procedures including treatment regimen and completion of required questionnaires. The secondary outcome measures, although not powered for in this feasibility, include corneal inflammation (assessed by the Oxford corneal staining guide), patient pain and symptoms scores (assessed by the Ocular Surface Disease Index Score), and objective signs of DED as indicated by visual acuity (assessed by Schirmer's test, tear break-up time, lower and/or upper tear meniscus height measurement). Other secondary outcomes include patients' quality of life (assessed using the validated EQ-5D-5L Questionnaire), cost to the National Health Service (NHS) and patient (assessed via use of NHS services and privately purchased over-the-counter treatment related to DED) and safety measure of pressure within the eye (assessed by the Intraocular Pressure (IOP) Score). ETHICS AND DISSEMINATION This protocol and any subsequent amendments, along with any accompanying material provided to the participant in addition to any advertising material used in this trial have been approved by the East of England - Cambridgeshire and Hertfordshire Research Ethics Committee (REC reference: 17/EE/0508). Written approval from the committee was obtained and subsequently submitted to the respective Trust's Research and Development (R&D) office with final NHS R&D approval obtained. Data obtained from this study will be published in a suitable peer-review journal and will also presented at international ophthalmic conferences including the American Academy of Ophthalmology, the Royal College of Ophthalmology Annual Congress, the Association for Research and Vision and Ophthalmology, and the European Society of Cataract and Refractive Surgery. Information will be provided to patient groups and charities such as the Sjogren's Society and the Royal National Institute of Blind People. This will also be shared with the study participants as well as with relevant patient groups and charities. TRIAL REGISTRATION NUMBER NCT03395431; Pre-results.
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Affiliation(s)
- Shafi Balal
- Bedford Hospital NHS Trust, Bedford, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Arit Udoh
- Clinical Trial Unit, School of Medicine, Anglia Ruskin University, Chelmsford, UK
| | - Yannis Pappas
- The Research Centre for Health Organisation and Delivery, Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Erica Cook
- The Research Centre for Health Organisation and Delivery, Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Garry Barton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ali Hassan
- Bedford Hospital NHS Trust, Bedford, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Karen Hayden
- Clinical Trial Unit, School of Medicine, Anglia Ruskin University, Chelmsford, UK
| | - Rupert Richard Alexander Bourne
- Vision and Eye Research Unit (VERU), School of Medicine, Anglia Ruskin University, Cambridge, UK
- Ophthalmology, Cambridge University Hospitals, Cambridge, UK
| | - Sajjad Ahmad
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Shahina Pardhan
- Vision and Eye Research Unit (VERU), School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Michael Harrison
- Clinical Trial Unit, School of Medicine, Anglia Ruskin University, Chelmsford, UK
| | | | | | - Anant Sharma
- Bedford Hospital NHS Trust, Bedford, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Abstract
This article provides an analysis of the skills that health professionals and patients employ in reaching diagnosis and decision-making in telemedicine consultations. As governmental priorities continue to emphasize patient involvement in the management of their disease, there is an increasing need to accurately capture the provider–patient interactions in clinical encounters. Drawing on conversation analysis of 10 video-mediated consultations in 3 National Health Service settings in England, this study examines the interaction between patients, General Practitioner (GPs), nurses, and consultants during diagnosis and decision-making, with the aim to identify the range of skills that participants use in the process and capture the interprofessional communication and patient involvement in the diagnosis and decision-making phases of telemedicine consultations. The analysis shows that teleconsultations enhance collaborative working among professionals and enable GPs and nurses to develop their skills and actively participate in diagnosis and decision-making by contributing primary care–specific knowledge to the consultation. However, interprofessional interaction may result in limited patient involvement in decision-making. The findings of this study can be used to inform training programs in telemedicine that focus on the development of effective skills for professionals and the provision of information to patients.
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Affiliation(s)
- Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, United Kingdom
| | - Jitka Vseteckova
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, United Kingdom
| | - Nikolas Mastellos
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Geva Greenfield
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, United Kingdom
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Lee PA, Greenfield G, Pappas Y. Patients' perception of using telehealth for type 2 diabetes management: a phenomenological study. BMC Health Serv Res 2018; 18:549. [PMID: 30005696 PMCID: PMC6045870 DOI: 10.1186/s12913-018-3353-x] [Citation(s) in RCA: 14] [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: 09/01/2017] [Accepted: 07/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is a growing body of evidence that supports the uses of telehealth to monitor and manage people with diabetes at a distance. Despite this, the uptake of telehealth has been low. The objective of this study is to explore patients’ perceptions of using telehealth for type 2 diabetes management. Methods Semi-structured interviews were undertaken with 10 patients from the NHS Newham area in London, UK. Data were collected using recorded semi-structured interviews. The interviews were transcribed verbatim and the analysis was guided by the phenomenological analysis approach. Results We identified three main themes for facilitating positive patient experience or acceptance of telehealth and these included: technology consideration, service perceptions and empowerment. All patients asserted that they were pleased with the technology and many also proclaimed that they could not see themselves being without it. Moreover, very few negative views were reported with respect to the use of telehealth. Conclusion The patients’ perceived telehealth as a potential to enhance their quality of life, allow them to live independently at home as well as help them take and be in more control over their own health state. The findings of this study therefore supports the use of telehealth for the routine care of people with type 2 diabetes. However, one must interpret the results with caution due to limitations identified in the sample.
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Affiliation(s)
- Puikwan A Lee
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
| | - Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, UK
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Lee PA, Greenfield G, Pappas Y. The impact of telehealth remote patient monitoring on glycemic control in type 2 diabetes: a systematic review and meta-analysis of systematic reviews of randomised controlled trials. BMC Health Serv Res 2018; 18:495. [PMID: 29940936 PMCID: PMC6019730 DOI: 10.1186/s12913-018-3274-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 06/04/2018] [Indexed: 02/03/2023] Open
Abstract
Background There is a growing body of evidence to support the use of telehealth in monitoring HbA1c levels in people living with type 2 diabetes. However, the overall magnitude of effect is yet unclear due to variable results reported in existing systematic reviews. The objective of this study is to conduct a systematic review and meta-analysis of systematic reviews of randomised controlled trials to create an evidence-base for the effectiveness of telehealth interventions on glycemic control in adults with type 2 diabetes. Methods Electronic databases including The Cochrane Library, MEDLINE, EMBASE, HMIC, and PsychINFO were searched to identify relevant systematic reviews published between 1990 and April 2016, supplemented by references search from the relevant reviews. Two independent reviewers selected and reviewed the eligible studies. Of the 3279 references retrieved, 4 systematic reviews reporting in total 29 unique studies relevant to our review were included. Both conventional pairwise meta-analyses and network meta-analyses were performed. Results Evidence from pooling four systematic reviews found that telehealth interventions produced a small but significant improvement in HbA1c levels compared with usual care (MD: -0.55, 95% CI: -0.73 to − 0.36). The greatest effect was seen in telephone-delivered interventions, followed by Internet blood glucose monitoring system interventions and lastly interventions involving automatic transmission of SMBG using a mobile phone or a telehealth unit. Conclusion Current evidence suggests that telehealth is effective in controlling HbA1c levels in people living with type 2 diabetes. However there is need for better quality primary studies as well as systematic reviews of RCTs in order to confidently conclude on the impact of telehealth on glycemic control in type 2 diabetes. Electronic supplementary material The online version of this article (10.1186/s12913-018-3274-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Puikwan A Lee
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
| | - Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, UK
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Major PB, Puthussery S, Pappas Y. Attitudes and perceptions of pregnant women towards the use of Anti-Retroviral Therapy in Nigeria. Women Birth 2018; 32:e189-e196. [PMID: 29954689 DOI: 10.1016/j.wombi.2018.06.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/28/2018] [Accepted: 06/05/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mother-to-child transmission of Human Immunodeficiency Virus continues to be a major problem in Nigeria. Despite several initiatives, the number of infected pregnant women receiving Anti-Retroviral Therapy to prevent mother-to-child transmission of the virus remains low in Nigeria. Evidence suggests that attitudes and perceptions of the pregnant women influence their use of Anti-Retroviral Therapy. AIM To understand the attitudes and perceptions of Human Immunodeficiency Virus infected pregnant women towards the use of Anti-Retroviral Therapy for prevention of mother-to-child transmission in Nigeria. METHOD Twenty four Human Immunodeficiency Virus infected pregnant women were purposively selected from antenatal clinics. Women's attitudes and perceptions towards the use of Anti-Retroviral Therapy were explored using semi-structured in-depth interviews conducted in May/June 2016. All interviews were recorded, transcribed and analysed using thematic approach. FINDINGS Overall, participants reflected a positive attitude about using Anti-Retroviral Therapy to prevent mother-to-child transmission and perceived the treatment as beneficial. The main themes identified included: perceived benefits of Anti-Retroviral Therapy; barriers to using Anti-Retroviral Therapy; threat from the susceptibility to the illness and the severity; perceived roles in treatment; and the negative behaviours of healthcare providers. CONCLUSION The findings provide useful insights to inform Nigeria's health policies on Anti-Retroviral Therapy. There is a need to educate the women on the benefits of the treatment as well as how they can cope with side effects and the daily regimen of the therapy during pregnancy. The findings also indicate the need for training healthcare providers on facilitative patient-provider relationship.
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Affiliation(s)
- Puremeluan B Major
- Institute for Health Research, University of Bedfordshire, United Kingdom
| | - Shuby Puthussery
- Institute for Health Research, University of Bedfordshire, United Kingdom.
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, United Kingdom
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Pappas Y, Všetečková J, Poduval S, Tseng PC, Car J. Computer-Assisted versus Oral-and-Written History Taking for the Prevention and Management of Cardiovascular Disease: a Systematic Review of the Literature. Acta Medica (Hradec Kralove) 2018; 60:97-107. [PMID: 29439755 DOI: 10.14712/18059694.2018.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVES CVD is an important global healthcare issue; it is the leading cause of global mortality, with an increasing incidence identified in both developed and developing countries. It is also an extremely costly disease for healthcare systems unless managed effectively. In this review we aimed to: - Assess the effect of computer-assisted versus oral-and-written history taking on the quality of collected information for the prevention and management of CVD. - Assess the effect of computer-assisted versus oral-and-written history taking on the prevention and management of CVD. METHODS A systematic review of randomised controlled trials that included participants of 16 years or older at the beginning of the study, who were at risk of CVD (prevention) or were either previously diagnosed with CVD (management). We searched all major databases. We assessed risk of bias using the Cochrane Collaboration tool. RESULTS Two studies met the inclusion criteria. One comparing the two methods of history-taking for the prevention of cardiovascular disease n = 75. The study shows that generally the patients in the experimental group underwent more laboratory procedures, had more biomarker readings recorded and/or were given (or had reviewed), more dietary changes than the control group. The other study compares the two methods of history-taking for the management of cardiovascular disease (n = 479). The study showed that the computerized decision aid appears to increase the proportion of patients who responded to invitations to discuss CVD prevention with their doctor. The Computer- Assisted History Taking Systems (CAHTS) increased the proportion of patients who discussed CHD risk reduction with their doctor from 24% to 40% and increased the proportion who had a specific plan to reduce their risk from 24% to 37%. DISCUSSION With only one study meeting the inclusion criteria, for prevention of CVD and one study for management of CVD we did not gather sufficient evidence to address all of the objectives of the review. We were unable to report on most of the secondary patient outcomes in our protocol. CONCLUSIONS We tentatively conclude that CAHTS can provide individually-tailored information about CVD prevention. However, further primary studies are needed to confirm these findings. We cannot draw any conclusions in relation to any other clinical outcomes at this stage. There is a need to develop an evidence base to support the effective development and use of CAHTS in this area of practice. In the absence of evidence on effectiveness, the implementation of computer-assisted history taking may only rely on the clinicians' tacit knowledge, published monographs and viewpoint articles.
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Affiliation(s)
- Yannis Pappas
- Institute for Health Research, University of Bedfordshire, United Kingdom
| | - Jitka Všetečková
- School of Well Being, Education and Language Studies, Open University, United Kingdom.
| | - Shoba Poduval
- School of Health Sciences, City University London, London, United Kingdom
| | - Pei Ching Tseng
- Institute for Health Research, University of Bedfordshire, United Kingdom
| | - Josip Car
- Lee Kong Chian School of Medicine, Imperial College and Nanyang Technological University, Singapore
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Pescheny JV, Pappas Y, Randhawa G. Facilitators and barriers of implementing and delivering social prescribing services: a systematic review. BMC Health Serv Res 2018; 18:86. [PMID: 29415720 PMCID: PMC5803993 DOI: 10.1186/s12913-018-2893-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [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] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 01/25/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Social Prescribing is a service in primary care that involves the referral of patients with non-clinical needs to local services and activities provided by the third sector (community, voluntary, and social enterprise sector). Social Prescribing aims to promote partnership working between the health and the social sector to address the wider determinants of health. To date, there is a weak evidence base for Social Prescribing services. The objective of the review was to identify factors that facilitate and hinder the implementation and delivery of SP services based in general practice involving a navigator. METHODS We searched eleven databases, the grey literature, and the reference lists of relevant studies to identify the barriers and facilitators to the implementation and delivery of Social Prescribing services in June and July 2016. Searches were limited to literature written in English. No date restrictions were applied. Findings were synthesised narratively, employing thematic analysis. The Mixed Methods Appraisal Tool Version 2011 was used to evaluate the methodological quality of included studies. RESULTS Eight studies were included in the review. The synthesis identified a range of factors that facilitate and hinder the implementation and delivery of SP services. Facilitators and barriers were related to: the implementation approach, legal agreements, leadership, management and organisation, staff turnover, staff engagement, relationships and communication between partners and stakeholders, characteristics of general practices, and the local infrastructure. The quality of most included studies was poor and the review identified a lack of published literature on factors that facilitate and hinder the implementation and delivery of Social Prescribing services. CONCLUSION The review identified a range of factors that facilitate and hinder the implementation and delivery of Social Prescribing services. Findings of this review provide an insight for commissioners, managers, and providers to guide the implementation and delivery of future Social Prescribing services. More high quality research and transparent reporting of findings is needed in this field.
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Affiliation(s)
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, UK
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Milligan F, Wareing M, Preston-Shoot M, Pappas Y, Randhawa G, Bhandol J. "Supporting nursing, midwifery and allied health professional students to raise concerns with the quality of care: A review of the research literature". Nurse Educ Today 2017; 57:29-39. [PMID: 28711721 DOI: 10.1016/j.nedt.2017.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 06/09/2016] [Revised: 05/11/2017] [Accepted: 06/18/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND This article reports aspects of a systematic literature review commissioned by the UK Council of Deans of Health. The review collated and analysed UK and international literature on pre-registration healthcare students raising concerns with poor quality care. The research found in that review is summarised here. OBJECTIVE To review research on healthcare students raising concerns with regard to the quality of practice published from 2009 to the present. DATA SOURCES In addition to grey literature and Google Scholar a search was completed of the CINAHL, Medline, ERIC, BEI, ASSIA, PsychInfo, British Nursing Index, Education Research Complete databases. REVIEW METHOD Sandelowski and Barroso's (2007) method of metasynthesis was used to screen and analyse the research literature. The review covered students from nursing, midwifery, health visiting, paramedic science, operating department practice, physiotherapy, chiropody, podiatry, speech and language therapy, orthoptist, occupational therapy, orthotist, prosthetist, radiography, dietitian, and music and art therapy. RESULTS Twenty three research studies were analysed. Most of the research relates to nursing students with physiotherapy being the next most studied group. Students often express a desire to report concerns, but factors such as the potential negative impact on assessment of their practice hinders reporting. There was a lack of evidence on how, when and to whom students should report. The most commonly used research approach found utilised vignettes asking students to anticipate how they would report. CONCLUSIONS Raising a concern with the quality of practice carries an emotional burden for the student as it may lead to sanctions from staff. Further research is required into the experiences of students to further understand the mechanisms that would enhance reporting and support them in the reporting process.
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Affiliation(s)
- Frank Milligan
- Patient Safety, University of Bedfordshire, United Kingdom.
| | - Mark Wareing
- Practice Learning, University of Bedfordshire, United Kingdom
| | | | - Yannis Pappas
- Health Services Research, University of Bedfordshire, United Kingdom
| | - Gurch Randhawa
- Diversity and Public Health, Institute of Health Research, University of Bedfordshire, United Kingdom
| | - Janine Bhandol
- Learning Resources, University of Bedfordshire, United Kingdom
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Ramasamy Venkatasalu M, Sirala Jagadeesh N, Elavally S, Pappas Y, Mhlanga F, Pallipalayam Varatharajan R. Public, patient and carers’ views on palliative and end-of-life care in India. Int Nurs Rev 2017; 65:292-301. [DOI: 10.1111/inr.12403] [Citation(s) in RCA: 7] [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] [Indexed: 11/28/2022]
Affiliation(s)
- M. Ramasamy Venkatasalu
- Cancer and Palliative Care; PAP Rashidah Sa'adatul Bolkiah Institute of Health Sciences; Universiti Brunei Darussalam; Gadong Brunei Darussalam
| | | | - S. Elavally
- Government College of Nursing; Alappuza India
| | - Y. Pappas
- Institute for Health Research; University of Bedfordshire; Bedfordshire UK
| | - F. Mhlanga
- Mental Health Nursing; Department of Healthcare Practice; Faculty of Health and Social Sciences; University of Bedfordshire; Bedfordshire UK
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Abstract
OBJECTIVE Late diagnosis of Alzheimer's disease (AD) may be due to diagnostic uncertainties. We aimed to determine the sequence and timing of the appearance of established early signs and symptoms in people who are subsequently diagnosed with AD. METHODS We used systematic review methodology to investigate the existing literature. Articles were reviewed in May 2016, using the following databases: MEDLINE, PsycINFO, CINAHL, British Nursing Index, PubMed central and the Cochrane library, with no language restriction. Data from the included articles were extracted independently by two authors and quality assessment was undertaken with the quality assessment and diagnostic accuracy tool-2 (QUADAS tool-2 quality assessment tool). RESULTS We found that depression and cognitive impairment were the first symptoms to appear in 98.5% and 99.1% of individuals in a study with late-onset AD (LOAD) and 9% and 80%, respectively, in early-onset AD (EOAD). Memory loss presented early and was experienced 12 years before the clinically defined AD dementia in the LOAD. However, the rapidly progressive late-onset AD presented predominantly with 35 non-established focal symptoms and signs including myoclonus (75%), disturbed gait (66%) and rigidity. These were misdiagnosed as symptoms of Creutzfeldt-Jacob disease (CJD) in all the cases. The participant with the lowest mini-mental state examination score of 25 remained stable for 2 years, which is consistent with the score of the healthy family members. CONCLUSIONS The findings of this review suggest that neurological and depressive behaviours are an early occurrence in EOAD with depressive and cognitive symptoms in the measure of semantic memory and conceptual formation in LOAD. Misdiagnosis of rapidly progressive AD as CJD and the familial memory score can be confounding factors while establishing a diagnosis. However, the study was limited by the fact that each one of the findings was based on a single study.
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Affiliation(s)
- Fidelia Bature
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire, Putteridgebury, Luton, UK
| | - Barbara-ann Guinn
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire, Putteridgebury, Luton, UK
- School of Life Sciences, The University of Hull, Hull, UK
| | - Dong Pang
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire, Putteridgebury, Luton, UK
| | - Yannis Pappas
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire, Putteridgebury, Luton, UK
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Abstract
BACKGROUND Since 1879, the year of the first documented medical telephone consultation, the ability to consult by telephone has become an integral part of modern patient-centred healthcare systems. Nowadays, upwards of a quarter of all care consultations are conducted by telephone. Studies have quantified the impact of medical telephone consultation on clinicians' workload and detected the need for quality improvement. While doctors routinely receive training in communication and consultation skills, this does not necessarily include the specificities of telephone communication and consultation. Several studies assessed the short-term effect of interventions aimed at improving clinicians' telephone consultation skills, but there is no systematic review reporting patient-oriented outcomes or outcomes of interest to clinicians. OBJECTIVES To assess the effects of training interventions for clinicians' telephone consultation skills and patient outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, five other electronic databases and two trial registers up to 19 May 2016, and we handsearched references, checked citations and contacted study authors to identify additional studies and data. SELECTION CRITERIA We considered randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted time series studies evaluating training interventions compared with any control intervention, including no intervention, for improving clinicians' telephone consultation skills with patients and their impact on patient outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data and assessed the risk of bias of eligible studies using standard Cochrane and EPOC guidance and the certainty of evidence using GRADE. We contacted study authors where additional information was needed. We used standard methodological procedures expected by Cochrane for data analysis. MAIN RESULTS We identified one very small controlled before-after study performed in 1989: this study used a validated tool to assess the effects of a training intervention on paediatric residents' history-taking and case management skills. It reported no difference compared to no intervention, but authors did not report any quantitative analyses and could not supply additional data. We rated this study as being at high risk of bias. Based on GRADE, we assessed the certainty of the evidence as very low, and consequently it is uncertain whether this intervention improves clinicians' telephone skills.We did not find any study assessing the effect of training interventions for improving clinicians' telephone communication skills on patient primary outcomes (health outcomes measured by validated tools or biomedical markers or patient behaviours, patient morbidity or mortality, patient satisfaction, urgency assessment accuracy or adverse events). AUTHORS' CONCLUSIONS Telephone consultation skills are part of a wider set of remote consulting skills whose importance is growing as more and more medical care is delivered from a distance with the support of information technology. Nevertheless, no evidence specifically coming from telephone consultation studies is available, and the training of clinicians at the moment has to be guided by studies and models based on face-to-face communication, which do not consider the differences between these two communicative dimensions. There is an urgent need for more research assessing the effect of different training interventions on clinicians' telephone consultation skills and their effect on patient outcomes.
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Affiliation(s)
- Alberto Vaona
- Azienda ULSS 20 ‐ VeronaPrimary CareOspedale di MarzanaPiazzale Ruggero Lambranzi 1VeronaItaly37142
| | - Yannis Pappas
- University of BedfordshireInstitute for Health ResearchPark SquareLutonBedfordUKLU1 3JU
| | - Rumant S Grewal
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthThe Reynolds Building, Charing Cross CampusSt Dunstans RoadLondonLondonUKW6 8RP
| | - Mubasshir Ajaz
- University of BedfordshireInstitute for Health ResearchPark SquareLutonBedfordUKLU1 3JU
| | - Azeem Majeed
- Imperial College LondonDepartment of Primary Care and Public HealthThe Reynolds Building, Charing Cross CampusSt Dunstan's RoadLondonUKW6 8RP
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)3 Fusionopolis Link, #03‐08Nexus@one‐northSingaporeSingapore138543
- University of LjubljanaDepartment of Family Medicine, Faculty of MedicineLjubljanaSlovenia
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Posadzki P, Mastellos N, Ryan R, Gunn LH, Felix LM, Pappas Y, Gagnon M, Julious SA, Xiang L, Oldenburg B, Car J. Automated telephone communication systems for preventive healthcare and management of long-term conditions. Cochrane Database Syst Rev 2016; 12:CD009921. [PMID: 27960229 PMCID: PMC6463821 DOI: 10.1002/14651858.cd009921.pub2] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Automated telephone communication systems (ATCS) can deliver voice messages and collect health-related information from patients using either their telephone's touch-tone keypad or voice recognition software. ATCS can supplement or replace telephone contact between health professionals and patients. There are four different types of ATCS: unidirectional (one-way, non-interactive voice communication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request advice (ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention. OBJECTIVES To assess the effects of ATCS for preventing disease and managing long-term conditions on behavioural change, clinical, process, cognitive, patient-centred and adverse outcomes. SEARCH METHODS We searched 10 electronic databases (the Cochrane Central Register of Controlled Trials; MEDLINE; Embase; PsycINFO; CINAHL; Global Health; WHOLIS; LILACS; Web of Science; and ASSIA); three grey literature sources (Dissertation Abstracts, Index to Theses, Australasian Digital Theses); and two trial registries (www.controlled-trials.com; www.clinicaltrials.gov) for papers published between 1980 and June 2015. SELECTION CRITERIA Randomised, cluster- and quasi-randomised trials, interrupted time series and controlled before-and-after studies comparing ATCS interventions, with any control or another ATCS type were eligible for inclusion. Studies in all settings, for all consumers/carers, in any preventive healthcare or long term condition management role were eligible. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods to select and extract data and to appraise eligible studies. MAIN RESULTS We included 132 trials (N = 4,669,689). Studies spanned across several clinical areas, assessing many comparisons based on evaluation of different ATCS types and variable comparison groups. Forty-one studies evaluated ATCS for delivering preventive healthcare, 84 for managing long-term conditions, and seven studies for appointment reminders. We downgraded our certainty in the evidence primarily because of the risk of bias for many outcomes. We judged the risk of bias arising from allocation processes to be low for just over half the studies and unclear for the remainder. We considered most studies to be at unclear risk of performance or detection bias due to blinding, while only 16% of studies were at low risk. We generally judged the risk of bias due to missing data and selective outcome reporting to be unclear.For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). The effects of ATCS in adults are unclear (RR 2.18, 95% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty).For screening, multimodal ATCS increase uptake of screening for breast cancer (RR 2.17, 95% CI 1.55 to 3.04; 2 studies, N = 462; high certainty) and colorectal cancer (CRC) (RR 2.19, 95% CI 1.88 to 2.55; 3 studies, N = 1013; high certainty) versus usual care. It may also increase osteoporosis screening. ATCS Plus interventions probably slightly increase cervical cancer screening (moderate certainty), but effects on osteoporosis screening are uncertain. IVR systems probably increase CRC screening at 6 months (RR 1.36, 95% CI 1.25 to 1.48; 2 studies, N = 16,915; moderate certainty) but not at 9 to 12 months, with probably little or no effect of IVR (RR 1.05, 95% CI 0.99, 1.11; 2 studies, 2599 participants; moderate certainty) or unidirectional ATCS on breast cancer screening.Appointment reminders delivered through IVR or unidirectional ATCS may improve attendance rates compared with no calls (low certainty). For long-term management, medication or laboratory test adherence provided the most general evidence across conditions (25 studies, data not combined). Multimodal ATCS versus usual care showed conflicting effects (positive and uncertain) on medication adherence. ATCS Plus probably slightly (versus control; moderate certainty) or probably (versus usual care; moderate certainty) improves medication adherence but may have little effect on adherence to tests (versus control). IVR probably slightly improves medication adherence versus control (moderate certainty). Compared with usual care, IVR probably improves test adherence and slightly increases medication adherence up to six months but has little or no effect at longer time points (moderate certainty). Unidirectional ATCS, compared with control, may have little effect or slightly improve medication adherence (low certainty). The evidence suggested little or no consistent effect of any ATCS type on clinical outcomes (blood pressure control, blood lipids, asthma control, therapeutic coverage) related to adherence, but only a small number of studies contributed clinical outcome data.The above results focus on areas with the most general findings across conditions. In condition-specific areas, the effects of ATCS varied, including by the type of ATCS intervention in use.Multimodal ATCS probably decrease both cancer pain and chronic pain as well as depression (moderate certainty), but other ATCS types were less effective. Depending on the type of intervention, ATCS may have small effects on outcomes for physical activity, weight management, alcohol consumption, and diabetes mellitus. ATCS have little or no effect on outcomes related to heart failure, hypertension, mental health or smoking cessation, and there is insufficient evidence to determine their effects for preventing alcohol/substance misuse or managing illicit drug addiction, asthma, chronic obstructive pulmonary disease, HIV/AIDS, hypercholesterolaemia, obstructive sleep apnoea, spinal cord dysfunction or psychological stress in carers.Only four trials (3%) reported adverse events, and it was unclear whether these were related to the interventions. AUTHORS' CONCLUSIONS ATCS interventions can change patients' health behaviours, improve clinical outcomes and increase healthcare uptake with positive effects in several important areas including immunisation, screening, appointment attendance, and adherence to medications or tests. The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed. Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost-effective.
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Affiliation(s)
- Pawel Posadzki
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)3 Fusionopolis Link, #06‐13Nexus@one‐northSingaporeSingapore138543
| | - Nikolaos Mastellos
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthSt Dunstans RoadLondonHammersmithUKW6 8RP
| | - Rebecca Ryan
- La Trobe UniversityCentre for Health Communication and Participation, School of Psychology and Public HealthBundooraVICAustralia3086
| | - Laura H Gunn
- Stetson UniversityPublic Health Program421 N Woodland BlvdDeLandFloridaUSA32723
| | - Lambert M Felix
- Edge Hill UniversityFaculty of Health and Social CareSt Helens RoadOrmskirkLancashireUKL39 4QP
| | - Yannis Pappas
- University of BedfordshireInstitute for Health ResearchPark SquareLutonBedfordUKLU1 3JU
| | - Marie‐Pierre Gagnon
- Traumatologie – Urgence – Soins IntensifsCentre de recherche du CHU de Québec, Axe Santé des populations ‐ Pratiques optimales en santé10 Rue de l'Espinay, D6‐727QuébecQCCanadaG1L 3L5
| | - Steven A Julious
- University of SheffieldMedical Statistics Group, School of Health and Related ResearchRegent Court, 30 Regent StreetSheffieldUKS1 4DA
| | - Liming Xiang
- Nanyang Technological UniversityDivision of Mathematical Sciences, School of Physical and Mathematical Sciences21 Nanyang LinkSingaporeSingapore
| | - Brian Oldenburg
- University of MelbourneMelbourne School of Population and Global HealthMelbourneVictoriaAustralia
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)3 Fusionopolis Link, #06‐13Nexus@one‐northSingaporeSingapore138543
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthSt Dunstans RoadLondonHammersmithUKW6 8RP
- University of LjubljanaDepartment of Family Medicine, Faculty of MedicineLjubljanaSlovenia
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Adeoye-Agboola DI, Evans H, Hewson D, Pappas Y. Factors influencing HIV disclosure among people living with HIV/AIDS in Nigeria: a systematic review using narrative synthesis and meta-analysis. Public Health 2016; 136:13-28. [PMID: 27059370 DOI: 10.1016/j.puhe.2016.02.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 02/20/2016] [Accepted: 02/24/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To critically review, appraise and evaluate quality of evidence on HIV disclosure among people living with HIV/AIDS (PLWHA) in Nigeria, and to identify a possible gap in knowledge on HIV/AIDS and disclosure. STUDY DESIGN A systematic review using narrative synthesis and meta-analysis. METHODS MedLine, PsycINFO, PubMed Central, Scopus and CINAHL were searched. Data were extracted with the use of spread sheet. An analysis of heterogeneity was performed for the disclosure rate and the presence of a supportive reaction from partners. A meta-analysis was performed for the disclosure rates to sexual partners, with data available for all ten studies. RESULTS Ten studies met the inclusion criteria. The outcomes show that HIV disclosure of sero-positive status is most common between spouses or sexual partners than disclosure to relatives/family members, friends, pastor/Imam or work colleagues/employers. The participants in most of these studies are women, and amongst the most influential factors on disclosure are gender, anticipated outcome, marital status and knowledge of partners' status. Some studies reported non-disclosure as a way of limiting stigma. Almost all of the studies highlighted that there is fear of stigma and social exclusion associated with disclosure. CONCLUSION This review discusses the overall experience of HIV disclosure on the management of the disease and barriers to disclosure. We found that PLWHA in Nigeria disclosed to at least one person within their social networks. Stigma is still a major consideration for PLWHA who experience a range of misconceptions around HIV transmission. The findings of this study may inform local policies and plans for improving the PLWHA quality of life. Targeted policies to increase disclosure of sero-positive status and reduce stigma may facilitate disease prevention. The methodological rigour of the included studies was appraised low.
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Affiliation(s)
- D I Adeoye-Agboola
- Institute for Health Research, University of Bedfordshire, United Kingdom.
| | - H Evans
- Institute for Health Research, University of Bedfordshire, United Kingdom
| | - D Hewson
- Institute for Health Research, University of Bedfordshire, United Kingdom
| | - Y Pappas
- Institute for Health Research, University of Bedfordshire, United Kingdom
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Tseng PC, Puthussery S, Pappas Y, Gau ML. A systematic review of randomised controlled trials on the effectiveness of exercise programs on Lumbo Pelvic Pain among postnatal women. BMC Pregnancy Childbirth 2015; 15:316. [PMID: 26612732 PMCID: PMC4661954 DOI: 10.1186/s12884-015-0736-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 07/14/2015] [Accepted: 11/10/2015] [Indexed: 01/13/2023] Open
Abstract
Background A substantial number of women tend to be affected by Lumbo Pelvic Pain (LPP) following child birth. Physical exercise is indicated as a beneficial method to relieve LPP, but individual studies appear to suggest mixed findings about its effectiveness. This systematic review aimed to synthesise evidence from randomised controlled trials on the effectiveness of exercise on LPP among postnatal women to inform policy, practice and future research. Methods A systematic review was conducted of all randomised controlled trials published between January 1990 and July 2014, identified through a comprehensive search of following databases: PubMed, PEDro, Embase, Cinahl, Medline, SPORTDiscus, Cochrane Pregnancy and Childbirth Group’s Trials Register, and electronic libraries of authors’institutions. Randomised controlled trials were eligible for inclusion if the intervention comprised of postnatal exercise for women with LPP onset during pregnancy or within 3 months after delivery and the outcome measures included changes in LPP. Selected articles were assessed using the PEDro Scale for methodological quality and findings were synthesised narratively as meta-analysis was found to be inappropriate due to heterogeneity among included studies. Results Four randomised controlled trials were included, involving 251 postnatal women. Three trials were rated as of ‘good’ methodological quality. All trials, except one, were at low risk of bias. The trials included physical exercise programs with varying components, differing modes of delivery, follow up times and outcome measures. Intervention in one trial, involving physical therapy with specific stabilising exercises, proved to be effective in reducing LPP intensity. An improvement in gluteal pain on the right side was reported in another trial and a significant difference in pain frequency in another. Conclusion Our review indicates that only few randomised controlled trials have evaluated the effectiveness of exercise on LPP among postnatal women. There is also a great amount of variability across existing trials in the components of exercise programs, modes of delivery, follow up times and outcome measures. While there is some evidence to indicate the effectiveness of exercise for relieving LPP, further good quality trials are needed to ascertain the most effective elements of postnatal exercise programs suited for LPP treatment.
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Affiliation(s)
- Pei-Ching Tseng
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton LU2 8LE, Bedfordshire, UK.
| | - Shuby Puthussery
- Department of Clinical Education and Leadership & Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton LU2 8LE, Bedfordshire, UK.
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton LU2 8LE, Bedfordshire, UK.
| | - Meei-Ling Gau
- Graduate Institute of Nurse-Midwifery, National Taipei University of Nursing and Health Sciences, 365, Ming-Te Road, Peitou, Taipei, Taiwan.
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Affiliation(s)
- Ayodele Kazeem
- Imperial College; Faculty of Med, Epidemiology, Public Health & Primary Care and Social Medicine; 326, Reynolds Building, Charing Cross Campus London UK
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological University; Health Services and Outcomes Research Programme; 3 Fusionopolis Link, #03-08 Nexus@one-north Singapore Singapore 138543
| | - Yannis Pappas
- University of Bedfordshire; Institute for Health Research; Park Square Luton Bedford UK LU1 3JU
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Cash-Gibson L, Pappas Y, Car J. Computer-assisted versus oral-and-written history taking for the management of cardiovascular disease. Hippokratia 2015. [DOI: 10.1002/14651858.cd009751.pub2] [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: 11/05/2022]
Affiliation(s)
- Lucinda Cash-Gibson
- School of Public Health, Imperial College London; Global eHealth Unit, Department of Primary Care and Public Health; 306 The Reynolds Building St Duncans Road London UK W6 8RP
| | - Yannis Pappas
- University of Bedfordshire; Institute for Health Research; Park Square Luton Bedford UK LU1 3JU
| | - Josip Car
- Imperial College & Nanyang Technological University; Lee Kong Chian School of Medicine; 3 Fusionopolis Link, #03-08 Nexus@one-north Singapore Singapore 138543
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Kassianos AP, Ignatowicz A, Greenfield G, Majeed A, Car J, Pappas Y. "Partners rather than just providers…": A qualitative study on health care professionals' views on implementation of multidisciplinary group meetings in the North West London Integrated Care Pilot. Int J Integr Care 2015; 15:e032. [PMID: 26351410 PMCID: PMC4560079 DOI: 10.5334/ijic.2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Multidisciplinary group meetings are one of the key drivers of facilitating integrated care. Health care professionals attending such groups have a key role in the success of these discussions and hence, in the forming of multi-professional integrated care. The study aimed to explore the professionals' experiences and views of participating and implementing the groups in integrated care context. METHODS A qualitative study including 25 semi-structured interviews with professionals participating in the Northwest London Integrated Care Pilot analysed using thematic content analysis. RESULTS Participants mentioned a number of benefits of participating in the meetings, including shared learning and shared decision-making between different services and specialties. Yet, they perceived barriers that diminish the efficiency of the groups, such as time constraints, group dynamics and technicalities. The participants felt that the quality of discussions and facilitation could be improved, as well as technical arrangements that would make them easier to participate. Most of the participants perceived the groups to be beneficial for providers mostly questioning the benefits for patient care. CONCLUSION Findings provide an insight into how health professionals' views of their participation to the multidisciplinary group meetings can be more effectively translated into more tangible benefits to the patients. To benefit patient care, the multidisciplinary groups need to be more patient-oriented rather than provider-oriented, while overcoming professional boundaries for participating.
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Affiliation(s)
- Angelos P Kassianos
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Agnieszka Ignatowicz
- Social Science and Systems in Health, Warwick Medical School, University of Warwick, Coventry, UK
| | - Geva Greenfield
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- Primary Care, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Josip Car
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Yannis Pappas
- Health Servicers Research, Institute of Health Research, University of Bedfordshire, Luton, UK
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Cash-Gibson L, Pappas Y, Car J. Computer-assisted versus oral-and-written history taking for the prevention of cardiovascular disease. Hippokratia 2015. [DOI: 10.1002/14651858.cd009750.pub2] [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: 11/07/2022]
Affiliation(s)
- Lucinda Cash-Gibson
- School of Public Health, Imperial College London; Global eHealth Unit, Department of Primary Care and Public Health; 306 The Reynolds Building St Duncans Road London UK W6 8RP
| | - Yannis Pappas
- University of Bedfordshire; Institute for Health Research; Park Square Luton Bedford UK LU1 3JU
| | - Josip Car
- Imperial College & Nanyang Technological University; Lee Kong Chian School of Medicine; 3 Fusionopolis Link, #03-08 Nexus@one-north Singapore Singapore 138543
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Berber R, Pappas Y, Khoo M, Miles J, Carrington R, Skinner J, Hart A. A New Approach to Managing Patients with Problematic Metal Hip Implants: The Use of an Internet-Enhanced Multidisciplinary Team Meeting. AAOS Exhibit Selection. J Bone Joint Surg Am 2015; 97:e42. [PMID: 25948527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Sabah SA, Henckel J, Cook E, Whittaker R, Hothi H, Pappas Y, Blunn G, Skinner JA, Hart AJ. Validation of primary metal-on-metal hip arthroplasties on the National Joint Registry for England, Wales and Northern Ireland using data from the London Implant Retrieval Centre: a study using the NJR dataset. Bone Joint J 2015; 97-B:10-8. [PMID: 25568407 PMCID: PMC4548488 DOI: 10.1302/0301-620x.97b1.35279] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Arthroplasty registries are important for the
surveillance of joint replacements and the evaluation of outcome. Independent
validation of registry data ensures high quality. The ability for
orthopaedic implant retrieval centres to validate registry data
is not known. We analysed data from the National Joint Registry
for England, Wales and Northern Ireland (NJR) for primary metal-on-metal
hip arthroplasties performed between 2003 and 2013. Records were
linked to the London Implant Retrieval Centre (RC) for validation.
A total of 67 045 procedures on the NJR and 782 revised pairs of
components from the RC were included. We were able to link 476 procedures
(60.9%) recorded with the RC to the NJR successfully. However, 306
procedures (39.1%) could not be linked. The outcome recorded by the
NJR (as either revised, unrevised or death) for a primary procedure
was incorrect in 79 linked cases (16.6%). The rate of registry-retrieval
linkage and correct assignment of outcome code improved over time.
The rates of error for component reference numbers on the NJR were
as follows: femoral head category number 14/229 (5.0%); femoral head
batch number 13/232 (5.3%); acetabular component category number
2/293 (0.7%) and acetabular component batch number 24/347 (6.5%). Registry-retrieval linkage provided a novel means for the validation
of data, particularly for component fields. This study suggests
that NJR reports may underestimate rates of revision for many types
of metal-on-metal hip replacement. This is topical given the increasing
scope for NJR data. We recommend a system for continuous independent
evaluation of the quality and validity of NJR data. Cite this article: Bone Joint J 2015;97-B:10–18.
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Affiliation(s)
- S A Sabah
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - J Henckel
- Hillingdon Hospital, Uxbridge, London, UK
| | - E Cook
- University of Bedfordshire, Luton, Bedfordshire, UK
| | - R Whittaker
- University College London Hospitals, Institute of Orthopaedics and Musculoskeletal Science, Brockley Hill, Stanmore, HA7 4LP, UK
| | - H Hothi
- University College London Hospitals, Institute of Orthopaedics and Musculoskeletal Science, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Y Pappas
- University of Bedfordshire, Luton, Bedfordshire, UK
| | - G Blunn
- University College London Hospitals, Institute of Orthopaedics and Musculoskeletal Science, Brockley Hill, Stanmore, HA7 4LP, UK
| | - J A Skinner
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - A J Hart
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
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Berber R, Pappas Y, Khoo M, Miles J, Carrington R, Skinner J, Hart A. A new approach to managing patients with problematic metal hip implants: the use of an Internet-enhanced multidisciplinary team meeting: AAOS exhibit selection. J Bone Joint Surg Am 2015; 97:e20. [PMID: 25695991 DOI: 10.2106/jbjs.n.00973] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Over one million patients worldwide are estimated to have a metal-on-metal hip arthroplasty. To improve the management of these patients and reduce surgeon uncertainty regarding decision-making, we designed an Internet-enhanced multidisciplinary team (iMDT) working approach. METHODS From August 2012 to April 2014, the iMDT discussed 215 patients with 266 metal-on-metal hip arthroplasties. Of these, 236 primary arthroplasties (132 hip resurfacing and 104 total hip) were analyzed. The remaining thirty cases involved problematic revised hips and were therefore excluded. The possible recommendations of the iMDT were monitoring, further investigation, or surgery. The concordance between the recommendation and the actual management was used to assess the usefulness of this approach in reducing uncertainty in surgeon-level decision-making. RESULTS The median Oxford Hip Score was 35 (range, 4 to 48), and median cobalt and chromium levels in whole blood were 3.54 ppb (range, 0.18 to 161.46 ppb) and 3.17 ppb (range, 0.20 to 100.67 ppb), respectively. Magnetic resonance imaging revealed abductor muscle atrophy in ninety-two (39%) of the hips and a pseudotumor in eighty (34%). The iMDT recommended monitoring of 146 (61.9%) of the hips, further investigation of thirty (12.7%), and surgery in sixty (25.4%). The actual outcome was concordant with the recommendation in 211 (91.7%) of the hips. CONCLUSIONS Our iMDT approach to the metal-on-metal hip burden combines the tacit knowledge of an expert panel, regulatory guidance, and up-to-date evidence to improve decision-making among surgeons. The high level of concordance between the recommendation and the actual outcome, combined with the feasibility of the methods used, suggest that this method effectively reduces uncertainty among surgeons and may lead to improved patient outcomes.
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Affiliation(s)
- Reshid Berber
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Putteridge Bury Campus, Hitchin Road, Luton, Bedfordshire, LU2 8LE, United Kingdom
| | - Michael Khoo
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
| | - Jonathan Miles
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
| | - Richard Carrington
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
| | - John Skinner
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
| | - Alister Hart
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, Middlesex, HA7 4LP, United Kingdom. E-mail address for R. Berber:
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Ignatowicz A, Greenfield G, Pappas Y, Car J, Majeed A, Harris M. Achieving provider engagement: providers' perceptions of implementing and delivering integrated care. Qual Health Res 2014; 24:1711-20. [PMID: 25212855 PMCID: PMC4232313 DOI: 10.1177/1049732314549024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda.
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Affiliation(s)
| | | | | | - Josip Car
- Imperial College London, London, United Kingdom
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Greenfield G, Ignatowicz AM, Belsi A, Pappas Y, Car J, Majeed A, Harris M. Wake up, wake up! It's me! It's my life! patient narratives on person-centeredness in the integrated care context: a qualitative study. BMC Health Serv Res 2014; 14:619. [PMID: 25471663 PMCID: PMC4261575 DOI: 10.1186/s12913-014-0619-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/19/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Person-centered care emphasizes a holistic, humanistic approach that puts patients first, at the center of medical care. Person-centeredness is also considered a core element of integrated care. Yet typologies of integrated care mainly describe how patients fit within integrated services, rather than how services fit into the patient's world. Patient-centeredness has been commonly defined through physician's behaviors aimed at delivering patient-centered care. Yet, it is unclear how 'person-centeredness' is realized in integrated care through the patient voice. We aimed to explore patient narratives of person-centeredness in the integrated care context. METHODS We conducted a phenomenological, qualitative study, including semi-structured interviews with 22 patients registered in the Northwest London Integrated Care Pilot. We incorporated Grounded Theory approach principles, including substantive open and selective coding, development of concepts and categories, and constant comparison. RESULTS We identified six themes representing core 'ingredients' of person-centeredness in the integrated care context: "Holism", "Naming", "Heed", "Compassion", "Continuity of care", and "Agency and Empowerment", all depicting patient expectations and assumptions on doctor and patient roles in integrated care. We bring examples showing that when these needs are met, patient experience of care is at its best. Yet many patients felt 'unseen' by their providers and the healthcare system. We describe how these six themes can portray a continuum between having own physical and emotional 'Space' to be 'seen' and heard vs. feeling 'translucent', 'unseen', and unheard. These two conflicting experiences raise questions about current typologies of the patient-physician relationship as a 'dyad', the meanings patients attributed to 'care', and the theoretical correspondence between 'person-centeredness' and 'integrated care'. CONCLUSIONS Person-centeredness is a crucial issue for patients in integrated care, yet it was variably achieved in the current pilot. Patients in the context of integrated care, as in other contexts, strive to have their own unique physical and emotional 'space' to be 'seen' and heard. Integrated care models can benefit from incorporating person-centeredness as a core element.
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Curry N, Harris M, Gunn LH, Pappas Y, Blunt I, Soljak M, Mastellos N, Holder H, Smith J, Majeed A, Ignatowicz A, Greaves F, Belsi A, Costin-Davis N, Jones Nielsen JD, Greenfield G, Cecil E, Patterson S, Car J, Bardsley M. Integrated care pilot in north-west London: a mixed methods evaluation. Int J Integr Care 2013; 13:e027. [PMID: 24167455 PMCID: PMC3807631 DOI: 10.5334/ijic.1149] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [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: 04/05/2013] [Revised: 06/05/2013] [Accepted: 06/06/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION This paper provides the results of a year-long evaluation of a large-scale integrated care pilot in north-west London. The pilot aimed to integrate care across primary, acute, community, mental health and social care for people with diabetes and/or those aged 75+ through care planning, multidisciplinary case reviews, information sharing and project management support. METHODS The evaluation team conducted qualitative studies of change at organisational, clinician and patient levels (using interviews, focus groups and a survey); and quantitative analysis of change in service use and patient-level clinical outcomes (using patient-level datasets and a matched control study). RESULTS The pilot had successfully engaged provider organisations, created a shared strategic vision and established governance structures. However, the engagement of clinicians was variable and there was no evidence to date of significant reductions in emergency admissions. There was some evidence of changes in care processes. CONCLUSION Although the pilot has demonstrated the beginnings of large-scale change, it remains in the early stages and faces significant challenges as it seeks to become sustainable for the longer term. It is critical that National Health Service managers and clinicians have realistic expectations of what can be achieved in a relatively short period of time.
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Affiliation(s)
- Natasha Curry
- Health Policy, Nuffield Trust, 59 New Cavendish Street, London, UK
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Harris M, Greaves F, Gunn L, Patterson S, Greenfield G, Car J, Majeed A, Pappas Y. Multidisciplinary group performance-measuring integration intensity in the context of the North West London Integrated Care Pilot. Int J Integr Care 2013; 13:e001. [PMID: 23687473 PMCID: PMC3653286 DOI: 10.5334/ijic.996] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 08/15/2012] [Revised: 10/22/2012] [Accepted: 11/19/2012] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Multidisciplinary Group meetings (MDGs) are seen as key facilitators of integration, moving from individual to multi-disciplinary decision-making, and from a focus on individual patients to a focus on patient groups. We have developed a method for coding MDG transcripts to identify whether they are or are not vehicles for delivering the anticipated efficiency improvements across various providers and apply it to a test case in the North West London Integrated Care Pilot. METHODS We defined 'integrating' as the process within the MDG meeting that enables or promotes an improved collaboration, improved understanding, and improved awareness of self and others within the local healthcare economy such that efficiency improvements could be identified and action taken. Utterances within the MDGs are coded according to three distinct domains grounded in concepts from communication, group decision-making, and integrated care literatures-the Valence, the Focus, and the Level. Standardized weighted integrative intensity scores are calculated across ten time deciles in the Case Discussion providing a graphical representation of its integrative intensity. RESULTS Intra- and Inter-rater reliability of the coding scheme was very good as measured by the Prevalence and Bias-adjusted Kappa Score. Standardized Weighted Integrative Intensity graph mirrored closely the verbatim transcript and is a convenient representation of complex communication dynamics. Trend in integrative intensity can be calculated and the characteristics of the MDG can be pragmatically described. CONCLUSION This is a novel and potentially useful method for researchers, managers and practitioners to better understand MDG dynamics and to identify whether participants are integrating. The degree to which participants use MDG meetings to develop an integrated way of working is likely to require management, leadership and shared values.
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Affiliation(s)
- Matthew Harris
- Department of Primary Care and Public Health, Imperial College London, 3 Floor, Reynolds Building, St. Dunstan's Road, Hammersmith, W6 8RP, UK
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Greaves F, Pappas Y, Bardsley M, Harris M, Curry N, Holder H, Blunt I, Soljak M, Gunn L, Majeed A, Car J. Evaluation of complex integrated care programmes: the approach in North West London. Int J Integr Care 2013; 13:e006. [PMID: 23687478 PMCID: PMC3653284 DOI: 10.5334/ijic.974] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 06/22/2012] [Revised: 11/01/2012] [Accepted: 01/15/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Several local attempts to introduce integrated care in the English National Health Service have been tried, with limited success. The Northwest London Integrated Care Pilot attempts to improve the quality of care of the elderly and people with diabetes by providing a novel integration process across primary, secondary and social care organisations. It involves predictive risk modelling, care planning, multidisciplinary management of complex cases and an information technology tool to support information sharing. This paper sets out the evaluation approach adopted to measure its effect. STUDY DESIGN We present a mixed methods evaluation methodology. It includes a quantitative approach measuring changes in service utilization, costs, clinical outcomes and quality of care using routine primary and secondary data sources. It also contains a qualitative component, involving observations, interviews and focus groups with patients and professionals, to understand participant experiences and to understand the pilot within the national policy context. THEORY AND DISCUSSION This study considers the complexity of evaluating a large, multi-organisational intervention in a changing healthcare economy. We locate the evaluation within the theory of evaluation of complex interventions. We present the specific challenges faced by evaluating an intervention of this sort, and the responses made to mitigate against them. CONCLUSIONS We hope this broad, dynamic and responsive evaluation will allow us to clarify the contribution of the pilot, and provide a potential model for evaluation of other similar interventions. Because of the priority given to the integrated agenda by governments internationally, the need to develop and improve strong evaluation methodologies remains strikingly important.
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Affiliation(s)
- Felix Greaves
- Department of Primary Care and Public Health, Reynolds Building, Charing Cross Campus, Imperial College London, London, UK W6 8RP
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Abstract
BACKGROUND Email is a popular and commonly-used method of communication, but its use in healthcare is not routine. Where email communication has been utilised in health care, its purposes have included use for clinical communication between healthcare professionals, but the effects of using email in this way are not known. This review assesses the use of email for two-way clinical communication between healthcare professionals. OBJECTIVES To assess the effects of healthcare professionals using email to communicate clinical information, on healthcare professional outcomes, patient outcomes, health service performance, and service efficiency and acceptability, when compared to other forms of communicating clinical information. SEARCH METHODS We searched: the Cochrane Consumers and Communication Review Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (OvidSP) (1950 to January 2010), EMBASE (OvidSP) (1980 to January 2010), PsycINFO (1967 to January 2010), CINAHL (EbscoHOST) (1982 to February 2010), and ERIC (CSA) (1965 to January 2010). We searched grey literature: theses/dissertation repositories, trials registers and Google Scholar (searched July 2010). We used additional search methods: examining reference lists, contacting authors. SELECTION CRITERIA Randomised controlled trials, quasi-randomised trials, controlled before and after studies and interrupted time series studies examining interventions in which healthcare professionals used email for communicating clinical information, and that took the form of 1) unsecured email 2) secure email or 3) web messaging. All healthcare professionals, patients and caregivers in all settings were considered. DATA COLLECTION AND ANALYSIS Two authors independently assessed studies for inclusion, assessed the included studies' risk of bias, and extracted data. We contacted study authors for additional information. We report all measures as per the study report. MAIN RESULTS We included one randomised controlled trial involving 327 patients and 159 healthcare providers at baseline. It compared an email to physicians containing patient-specific osteoporosis risk information and guidelines for evaluation and treatment with usual care (no email). This study was at high risk of bias for the allocation concealment and blinding domains. The email reminder changed health professional actions significantly, with professionals more likely to provide guideline-recommended osteoporosis treatment (bone density measurement and/or osteoporosis medication) when compared with usual care. The evidence for its impact on patient behaviours/actions was inconclusive. One measure found that the electronic medical reminder message impacted patient behaviour positively: patients had a higher calcium intake, and two found no difference between the two groups. The study did not assess primary health service outcomes or harms. AUTHORS' CONCLUSIONS As only one study was identified for inclusion, the results are inadequate to inform clinical practice in regard to the use of email for clinical communication between healthcare professionals. Future research needs to use high-quality study designs that take advantage of the most recent developments in information technology, with consideration of the complexity of email as an intervention, and costs.
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Affiliation(s)
- Yannis Pappas
- School of Health Sciences, City University London, London, UK.
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Pappas Y, Anandan C, Liu J, Car J, Sheikh A, Majeed A. Computer-assisted history-taking systems (CAHTS) in health care: benefits, risks and potential for further development. Inform Prim Care 2012; 19:155-60. [PMID: 22688224 DOI: 10.14236/jhi.v19i3.808] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND A computer-assisted history-taking system (CAHTS) is a tool that aids clinicians in gathering data from patients to inform a diagnosis or treatment plan. Despite the many possible applications and even though CAHTS have been available for nearly three decades, these remain underused in routine clinical practice. OBJECTIVE Through an interpretative review of the literature, we provide an overview of the field of CAHTS, which also offers an understanding of the impact of these systems on policy, practice and research. METHODS We conducted a search and critique of the literature on CAHTS. Using a comprehensive set of terms, we searched: MEDLINE, EMBASE, The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, The Cochrane Central Register of Controlled Trials, The Cochrane Methodology Register, Health Technology Assessment Database and the NHS Economic Evaluation Database over a ten-year period (January 1997 to May 2007) to identify systematic reviews, technical reports and health technology assessments, and randomised controlled trials. RESULTS The systematic review of the literature suggests that CAHTS can save professionals' time, improve delivery of care to those with special needs and also facilitate the collection of information, especially potentially sensitive information (e.g. sexual history, alcohol consumption). The use of CAHTS also has disadvantages that impede the process of history taking and may pose risks to patients. CAHTS are inherently limited when detecting non-verbal communication, may pose irrelevant questions and frustrate the users with technical problems. Our review suggests that barriers such as a preference for pen-and-paper methods and concerns about data loss and security still exist and affect the adoption of CAHTS. In terms of policy and practice, CAHTS make input of data from disparate sites possible, which facilitates work from disparate sites and the collection of data for nationwide screening programmes such as the vascular risk assessment programme for people aged 40-74, now starting in England. CONCLUSIONS Our review shows that for CAHTS to be adopted in mainstream health care, important changes should take place in how we conceive, plan and conduct primary and secondary research on the topic so that we provide the framework for a comprehensive evaluation that will lead to an evidence base to inform policy and practice.
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Cash-Gibson L, Felix LM, Minorikawa N, Pappas Y, Gunn LH, Majeed A, Atun R, Car J. Automated telephone communication systems for preventive healthcare and management of long-term conditions. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009921] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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