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Search Results: 1 - 10 of 833 matches for " Debbie Sharp "
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Complementary therapy use by patients and parents of children with asthma and the implications for NHS care: a qualitative study
Alison Shaw, Elizabeth A Thompson, Debbie Sharp
BMC Health Services Research , 2006, DOI: 10.1186/1472-6963-6-76
Abstract: Qualitative study, comprising 50 semi-structured interviews with a purposeful sample of 22 adults and 28 children with asthma (plus a parent), recruited from a range of NHS and non-NHS settings in Bristol, England. Data analysis was thematic, drawing on the principles of constant comparison.A range of complementary therapies were being used for asthma, most commonly Buteyko breathing and homeopathy. Most use took place outside of the NHS, comprising either self-treatment or consultation with private complementary therapists. Complementary therapies were usually used alongside not instead of conventional asthma treatment. A spectrum of complementary therapy users emerged, including "committed", "pragmatic" and "last resort" users. Motivating factors for complementary therapy use included concerns about conventional NHS care ("push factors") and attractive aspects of complementary therapies ("pull factors"). While participants were often uncertain whether therapies had directly helped their asthma, breathing techniques such as the Buteyko Method were most notably reported to enhance symptom control and enable reduction in medication. Across the range of therapies, the process of seeking and using complementary therapies seemed to help patients in two broad ways: it empowered them to take greater personal control over their condition rather than feel dependant on medication, and enabled exploration of a broader range of possible causes of their asthma than commonly discussed within NHS settings.Complementary therapy use reflects patients' and parents' underlying desire for greater self-care and need of opportunities to address some of their concerns regarding NHS asthma care. Self-management of chronic conditions is increasingly promoted within the NHS but with little attention to complementary therapy use as one strategy being used by patients and parents. With their desire for self-help, complementary therapy users are in many ways adopting the healthcare personas th
Designing a 'NHS friendly' complementary therapy service: A qualitative case study
Lesley Wye, Alison Shaw, Debbie Sharp
BMC Health Services Research , 2008, DOI: 10.1186/1472-6963-8-173
Abstract: Using a case study approach, two sites offering complementary therapies on NHS premises were studied using interview and documentary data. We conducted interviews with 20 NHS professionals, including PCT managers and clinicians. We used descriptive content analysis to analyse interview data. We collected and analysed documentation, such as referral data, funding bids and evaluations, to compare reported and documented behaviour.Ideally, a 'NHS friendly' complementary therapy service should offer a limited number of therapies for a specific condition for high priority patient populations (e.g. acupuncture for addictions). In this service model, the therapies should be perceived to have 'good' evidence for conditions where there are 'effectiveness gaps' (i.e. current treatments are limited). The service should be evaluated and regularly promoted. Inter-professional relationships would flourish through opportunities for informal contact and formal interactions, such as observations of consultations. However, the service should include gatekeeper mechanisms to control demand and avoid picking up 'unmet need' (i.e. individuals currently not accessing NHS services). The complementary therapy service should pay for itself and reduce NHS costs elsewhere, such as hospital admissions.The service design model identified in this study is problematic. For example, it is contradictory to provide specific interventions for specific conditions within a holistic healthcare framework. It is difficult to avoid providing for 'unmet need' while concurrently filling 'effectiveness gaps'. In addition, demonstrating the impact of a community service on reducing hospital admissions is challenging. Those seeking to establish a NHS complementary therapy service might be well-advised to meet as many of the criteria of a 'NHS friendly' model as possible, recognising that its full realisation may be impossible. However, during periods of innovation and financial security, some relaxation of expe
The prevalence of suicidal ideation identified by the Edinburgh Postnatal Depression Scale in postpartum women in primary care: findings from the RESPOND trial
Louise M Howard, Clare Flach, Anita Mehay, Debbie Sharp, Andre Tylee
BMC Pregnancy and Childbirth , 2011, DOI: 10.1186/1471-2393-11-57
Abstract: Women in primary care were sent postal questionnaires at 6 weeks postpartum to screen for postnatal depression before recruitment into an RCT. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for postnatal depression and in those with high levels of symptoms, a home visit with a standardised psychiatric interview was carried out using the Clinical Interview Schedule-Revised version (CIS-R). Other socio-demographic and clinical variables were measured, including functioning (SF12) and quality of the marital relationship (GRIMS). Women who entered the trial were followed up for 18 weeks.9% of 4,150 women who completed the EPDS question relating to suicidal ideation reported some suicidal ideation (including hardly ever); 4% reported that the thought of harming themselves had occurred to them sometimes or quite often. In women who entered the randomised trial and completed the EPDS question relating to suicidal ideation (n = 253), suicidal ideation was associated with younger age, higher parity and higher levels of depressive symptoms in the multivariate analysis. Endorsement of 'yes, quite often' to question 10 on the EPDS was associated with affirming at least two CIS-R items on suicidality. We found no association between suicidal ideation and SF-12 physical or mental health or the EPDS total score at 18 weeks.Healthcare professionals using the EPDS should be aware of the significant suicidality that is likely to be present in women endorsing 'yes, quite often' to question 10 of the EPDS. However, suicidal ideation does not appear to predict poor outcomes in women being treated for postnatal depression.Current Controlled Trials ISRCTN16479417.Suicide is a leading cause of maternal deaths in the perinatal period in industrialised countries [1,2]. Suicide is more common in people with suicidal thoughts [3] and suicidal thoughts are therefore a cause for concern when elicited by health professionals. Outside of the perinatal period, being female and h
The risk of colorectal cancer with symptoms at different ages and between the sexes: a case-control study
William Hamilton, Robert Lancashire, Debbie Sharp, Tim J Peters, KK Cheng, Tom Marshall
BMC Medicine , 2009, DOI: 10.1186/1741-7015-7-17
Abstract: This was a case-control study using pre-existing records in a large electronic primary care database. Cases were patients aged 30 years or older with a diagnosis of colorectal cancer between January 2001 and July 2006, matched to seven controls by age, sex and practice. All features of colorectal cancer recorded in the 2 years before diagnosis were identified. Features independently associated with cancer were identified using multivariable conditional logistic regression, and their risk of cancer quantified.We identified 5477 cases, with 38,314 age, sex and practice-matched controls. Six symptoms and two abnormal investigations (anaemia and microcytosis) were independently associated with colorectal cancer. The positive predictive values of symptoms were: rectal bleeding, positive predictive value for a male aged ≥ 80 years 4.5% (95% confidence interval 3.5, 5.9); change in bowel habit 3.9% (2.8, 5.5); weight loss 0.8% (0.5, 1.3); abdominal pain 1.2% (1.0, 1.4); diarrhoea 1.2% (1.0, 1.5) and constipation 0.7% (0.6, 0.8). Positive predictive values were lower in females and younger patients. Only 27% of patients had reported either of the two higher risk symptoms.Most symptomatic colorectal cancers present with only a low-risk symptom. There is a need to find a method of identifying those at highest risk of cancer from the large number presenting with such symptoms.Over 35,000 colorectal cancers were diagnosed in England in 2004 [1]. Survival in the UK is worse than in other European countries and the US, partly because of later presentation in the UK [2]. Delays in presentation to medical care and diagnosis have been observed in several studies [3].Early diagnosis may reduce mortality. The relative risk of death from colorectal cancer is between 0.67 and 0.85 following faecal occult blood screening [4]. A large UK prospective study of screening in half a million patients aged 50 to 69 years found 2% to be faecal occult blood (FOB) positive, of whom 11% had colorect
Getting out and about in older adults: the nature of daily trips and their association with objectively assessed physical activity
Mark G Davis, Kenneth R Fox, Melvyn Hillsdon, Jo C Coulson, Debbie J Sharp, Afroditi Stathi, Janice L Thompson
International Journal of Behavioral Nutrition and Physical Activity , 2011, DOI: 10.1186/1479-5868-8-116
Abstract: Participants (n = 214, aged 78.1 SD 5.7 years), completed a seven-day trips log recording daily-trip frequency, purpose and transport mode. Concurrently participants wore an accelerometer which provided mean daily steps (steps·d-1), and minutes of moderate to vigorous PA (MVPA·d-1). Participants' physical function (PF) was estimated and demographic, height and weight data obtained.Trip frequency was associated with gender, age, physical function, walking-aid use, educational attainment, number of amenities within walking distance and cars in the household. Participants reported 9.6 (SD 4.2) trips per week (trips·wk-1). Most trips (61%) were by car (driver 44%, passenger 17%), 30% walking or cycling (active) and 9% public transport/other. Driving trips·wk-1 were more common in participants who were males (5.3 SD 3.6), well-educated (5.0 SD 4.3), high functioning (5.1 SD 4.6), younger (5.6 SD 4.9), affluent area residents (5.1 SD 4.2) and accessing > one car (7.2 SD 4.7). Active trips·wk-1 were more frequent in participants who were males (3.4 SD 3.6), normal weight (3.2 SD 3.4), not requiring walking aids (3.5 SD 3.3), well-educated (3.7 SD 0.7), from less deprived neighbourhoods (3.9 SD 3.9) and with ≥ 8 amenities nearby (4.4 SD 3.8).Public transport, and active trip frequency, were significantly associated with steps·d-1 (p < 0.001), even after adjustment for other trip modes and potential confounders. Public transport, active, or car driving trips were independently associated with minutes MVPA·d-1 (p < 0.01).Daily trips are associated with objectively-measured PA as indicated by daily MVPA and steps. Public transport and active trips are associated with greater PA than those by car, especially as a car passenger. Strategies encouraging increased trips, particularly active or public transport trips, in OAs can potentially increase their PA and benefit public health.In the UK, the number of adults aged over 65 years increased between 1983 and 2008 by 1.5 m and thos
The effectiveness of exercise as a treatment for postnatal depression: study protocol
Amanda J Daley, Kate Jolly, Debbie J Sharp, Katrina M Turner, Ruth V Blamey, Sarah Coleman, Mary McGuinness, Andrea K Roalfe, Ian Jones, Christine MacArthur
BMC Pregnancy and Childbirth , 2012, DOI: 10.1186/1471-2393-12-45
Abstract: We aim to recruit 208 women with postnatal depression in the West Midlands. Recently delivered women who meet the ICD-10 diagnosis for depression will be randomised to usual care plus exercise or usual care only. The exercise intervention will be delivered over 6?months. The primary outcome measure is difference in mean Edinburgh Postnatal Depression Scale score between the groups at six month follow-up. Outcome measures will be assessed at baseline and at six and 12?month post randomisation.Findings from the research will inform future clinical guidance on antenatal and postnatal mental health, as well as inform practitioners working with postnatal depression.ISRCTN84245563It is estimated that depression will be the second most common cause of disability worldwide by 2020 [1]. Postnatal depression (PND) is a serious problem across cultures and affects about 10-15% of women some time in the year after giving birth [2,3]. Women with postnatal depression can experience disabling symptoms of low mood, irritability, fatigue, insomnia, changes in appetite, anxiety, guilt, inability to cope, feelings of worthlessness and thoughts of suicide. Frequently exacerbating these symptoms are low self-esteem, lack of confidence, and unrealistic expectations of motherhood. Women who have PND are twice as likely to experience subsequent episodes of depression in later life [4]. PND has health consequences not only for the mother but also for the child and family as a whole. Cognitive and emotional development and social behaviour have been shown to be adversely affected in children whose mothers have PND [5]. PND can cause impaired maternal-infant interactions and negative perceptions of infant behaviour [6]. Marital difficulties are not uncommon and the partner may also become depressed [7]. Suicide is a rare but devastating consequence of PND.After giving birth, many women have excess weight and decreased fitness levels [8,9]. New mothers have reported weight gain to be a signific
A pilot randomised controlled trial of cognitive behavioural therapy for antenatal depression
Alison Burns, Heather O?Mahen, Helen Baxter, Kristina Bennert, Nicola Wiles, Paul Ramchandani, Katrina Turner, Debbie Sharp, Joanna Thorn, Sian Noble, Jonathan Evans
BMC Psychiatry , 2013, DOI: 10.1186/1471-244x-13-33
Abstract: Women in North Bristol, UK between 8--18 weeks pregnant were recruited through routine contact with midwives and randomised to receive up to 12 sessions of individual CBT in addition to usual care or to continue with usual care only. Women were eligible for randomisation if they screened positive on a 3-question depression screen used routinely by midwives and met ICD-10 criteria for depression assessed using the clinical interview schedule -- revised version (CIS-R). Two CBT therapists delivered the intervention. Follow-up was at 15 and 33 weeks post-randomisation when assessments of mental health were made using measure which included the CIS-R.Of the 50 women assessed for the trial, 36 met ICD-10 depression criteria and were randomised: 18 to the intervention and 18 to usual care. Thirteen of the 18 (72%) women who were allocated to receive the intervention completed 9 or more sessions of CBT before the end of pregnancy. Follow-up rates at 15 and 33 weeks post-randomisation were higher in the group who received the intervention (89% vs. 72% at 15 weeks and 89% vs. 61% at 33 weeks post-randomisation). At 15 weeks post-randomisation (the end of pregnancy), there were more women in the intervention group (11/16; 68.7%) who recovered (i.e. no longer met ICD-10 criteria for depression), than those receiving only usual care (5/13; 38.5%).This pilot trial shows the feasibility of conducting a large RCT to assess the effectiveness of CBT for treating antenatal depression before the end of pregnancy. The intervention could be delivered during the antenatal period and there was some evidence to suggest that it could be effective.Trial registration: ISRCTN44902048
Primary care Identification and Referral to Improve Safety of women experiencing domestic violence (IRIS): protocol for a pragmatic cluster randomised controlled trial
Alison Gregory, Jean Ramsay, Roxane Agnew-Davies, Kathleen Baird, Angela Devine, Danielle Dunne, Sandra Eldridge, Annie Howell, Medina Johnson, Clare Rutterford, Debbie Sharp, Gene Feder
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-54
Abstract: This protocol describes IRIS, a pragmatic cluster randomised controlled trial with the general practice as unit of randomisation. Our trial tests the effectiveness and cost-effectiveness of a training and support programme targeted at general practice teams. The primary outcome is referral of women to specialist domestic violence agencies. Forty-eight practices in two UK cities (Bristol and London) are randomly allocated, using minimisation, into intervention and control groups. The intervention, based on an adult learning model in an educational outreach framework, has been designed to address barriers to asking women about domestic violence and to encourage appropriate responses to disclosure and referral to specialist domestic violence agencies. Multidisciplinary training sessions are held with clinicians and administrative staff in each of the intervention practices, with periodic feedback of identification and referral data to practice teams. Intervention practices have a prompt to ask about abuse integrated in the electronic medical record system. Other components of the intervention include an IRIS champion in each practice and a direct referral pathway to a named domestic violence advocate.This is the first European randomised controlled trial of an intervention to improve the health care response to domestic violence. The findings will have the potential to inform training and service provision.ISRCTN74012786Domestic violence is threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are in the same family or who are (or have been) intimate partners. The prevalence of physical and sexual violence varies internationally from 15 to 71% [1]. The 2001 British Crime Survey reported that 20% of women in England and Wales were physically assaulted by a current or former partner at some time in their lives. When threats, financial abuse and emotional abuse are included, this increased to 25% of women [2]
GENetic and clinical Predictors Of treatment response in Depression: the GenPod randomised trial protocol
Laura Thomas, Jean Mulligan, Victoria Mason, Debbie Tallon, Nicola Wiles, Philip Cowen, David Nutt, Michael O'Donovan, Deborah Sharp, Tim Peters, Glyn Lewis
Trials , 2008, DOI: 10.1186/1745-6215-9-29
Abstract: Firstly, this study aims to investigate the influence of a polymorphism (SLC6A4) in the 5HT transporter in altering response to SSRI medication. Secondly, the study will investigate whether those with more severe depression have a better response to NaRIs than SSRIs.The GenPod trial is a multi-centre randomised controlled trial. GPs referred patients aged between 18–74 years presenting with a new episode of depression, who did not have any medical contraindications to antidepressant medication and who had no history of psychosis or alcohol/substance abuse. Patients were interviewed to ascertain their suitability for the study. Eligible participants (with a primary diagnosis of depression according to ICD10 criteria and a Beck Depression Inventory (BDI) score > 14) were randomised to receive one of two antidepressant treatments, either the SSRI Citalopram or the NaRI Reboxetine, stratified according to severity. The final number randomised to the trial was 601. Follow-up assessments took place at 2, 6 and 12 weeks following randomisation. Primary outcome was measured at 6 weeks by the BDI. Outcomes will be analysed on an intention-to-treat basis and will use multiple regression models to compare treatments.The results of the trial will provide information about targeting antidepressant treatment for individual patients; in turn this may increase prescribing efficacy, thereby speeding recovery and reducing the cost to the NHS. It will also help to understand the different roles that noradrenaline and serotonin might play in the biology of depression.The trial is expected to report in the autumn of 2008.ISRCTN 31345163Depression is the most common mental disorder in community settings. Indeed, the Global Burden of Disease study suggests that depression will be second only to cardiovascular disease in causing disability by the year 2020[1].Depression is an illness that is characterised by low mood and the inability to experience pleasure. Symptoms can impact upon the em
Objectively Assessed Physical Activity and Subsequent Health Service Use of UK Adults Aged 70 and Over: A Four to Five Year Follow Up Study
Bethany Simmonds, Kenneth Fox, Mark Davis, Po-Wen Ku, Selena Gray, Melvyn Hillsdon, Debbie Sharp, Afroditi Stathi, Janice Thompson, Joanna Coulson, Tanya Trayers
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0097676
Abstract: Objectives To examine the associations between volume and intensity of older peoples' physical activity, with their subsequent health service usage over the following four to five years. Study Design A prospective cohort design using baseline participant characteristics, objectively assessed physical activity and lower limb function provided by Project OPAL (Older People and Active Living). OPAL-PLUS provided data on numbers of primary care consultations, prescriptions, unplanned hospital admissions, and secondary care referrals, extracted from medical records for up to five years following the baseline OPAL data collection. Participants and Data Collection OPAL participants were a diverse sample of 240 older adults with a mean age of 78 years. They were recruited from 12 General Practitioner surgeries from low, middle, and high areas of deprivation in a city in the West of England. Primary care consultations, secondary care referrals, unplanned hospital admissions, number of prescriptions and new disease diagnoses were assessed for 213 (104 females) of the original 240 OPAL participants who had either consented to participate in OPAL-PLUS or already died during the follow-up period. Results In regression modelling, adjusted for socio-economic variables, existing disease, weight status, minutes of moderate-to-vigorous physical activity (MVPA) per day predicted subsequent numbers of prescriptions. Steps taken per day and MVPA also predicted unplanned hospital admissions, although the strength of the effect was reduced when further adjustment was made for lower limb function. Conclusions Community-based programs are needed which are successful in engaging older adults in their late 70s and 80s in more walking, MVPA and activity that helps them avoid loss of physical function. There is a potential for cost savings to health services through reduced reliance on prescriptions and fewer unplanned hospital admissions.
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