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Search Results: 1 - 10 of 32653 matches for " Peter Bower "
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The effectiveness of self help technologies for emotional problems in adolescents: a systematic review
Ahmead Muna,Bower Peter
Child and Adolescent Psychiatry and Mental Health , 2008, DOI: 10.1186/1753-2000-2-20
Abstract: Background Adolescence is a transition period that involves physiological, psychological, and social changes. Emotional problems such as symptoms of anxiety and depression may develop due to these changes. Although many of these problems may not meet diagnostic thresholds, they may develop into more severe disorders and may impact on functioning. However, there are barriers that may make it difficult for adolescents to receive help from health professionals for such problems, one of which is the limited availability of formal psychological therapy. One way of increasing access to help for such problems is through self help technology (i.e. delivery of psychological help through information technology or paper based formats). Although there is a significant evidence base concerning self help in adults, the evidence base is much weaker in adolescents. This study aims to examine the effectiveness of self help technology for the treatment of emotional problems in adolescents by conducting a systematic review of randomized and quasi-experimental evidence. Methods Five major electronic databases were searched: Medline, PsycInfo, Embase, Cochrane Controlled Trials Register and CINAHL. In addition, nine journals were handsearched and the reference lists of all studies were examined for any additional studies. Fourteen studies were identified. Effect sizes were calculated across 3 outcome measures: attitude towards self (e.g. self esteem); social cognition (e.g. self efficacy); and emotional symptoms (i.e. depression and anxiety symptoms). Results Meta analysis showed small, non-significant effect size for attitude towards self (ES = -0.14, 95% CI = -0.72 to 0.43), a medium, non-significant effect size for social cognition (ES = -0.49, 95% CI = -1.23 to 0.25) and a medium, non-significant effect size for emotional symptoms (ES = -0.47, 95% CI = -1.00 to 0.07). However, these findings must be considered preliminary, because of the small number of studies, their heterogeneity, and the relatively poor quality of the studies. Conclusion At present, the adoption of self help technology for adolescents with emotional problems in routine clinical practice cannot be recommended. There is a need to conduct high quality randomised trials in clearly defined populations to further develop the evidence base before implementation.
The General Practice Assessment Questionnaire (GPAQ) – Development and psychometric characteristics
Nicola Mead, Peter Bower, Martin Roland
BMC Family Practice , 2008, DOI: 10.1186/1471-2296-9-13
Abstract: Description of scale development and preliminary analysis of psychometric characteristics (internal reliability, factor structure), based on a large dataset of routinely collected GPAQ surveys (n = 190,038 responses to the consultation version of GPAQ and 20,309 responses to the postal version) from practices in the United Kingdom during the 2005–6 contract year.Respondents tend to report generally favourable ratings. Responses were particularly skewed on the GP communication scale, though no more so than for other questionnaires in current use in the UK for which data were available. Factor analysis identified 2 factors that clearly relate to core concepts in primary care quality ('access' and 'interpersonal care') that were common to both version of the GPAQ. The other factors related to 'enablement' in the post-consultation version and 'nursing care' in the postal version.This preliminary evaluation indicates that the scales of the GPAQ are internally reliable and that the items demonstrate an interpretable factor structure. Issues concerning the distributions of GPAQ responses are discussed. Potential further developments of the item content for the GPAQ are also outlined.Continual quality improvement in primary care is an international priority. In the United Kingdom, there have been major initiatives to improve the quality of clinical and organisational aspects of care, most recently through implementation of the Quality and Outcomes Framework (QoF) of the 2004 General Practitioner (GP) contract [1].Although a large proportion of quality improvement efforts are appropriately targeted at indicators of clinical quality, comprehensive assessment additionally requires taking account of the patient perspective [2,3]. Valid and reliable measurement of patients' perceptions of the quality of their care is therefore of fundamental importance [4].A number of relevant questionnaires are currently available for assessing patients' views [5-8], but only two are currently
Can the feedback of patient assessments, brief training, or their combination, improve the interpersonal skills of primary care physicians? A systematic review
Sudeh Cheraghi-Sohi, Peter Bower
BMC Health Services Research , 2008, DOI: 10.1186/1472-6963-8-179
Abstract: Systematic review of randomised controlled trials. Three electronic databases were searched (CENTRAL, Medline and Embase) and augmented by searches of the bibliographies of retrieved articles. The quality of studies was appraised and results summarised in narrative form.Nine studies were included (two patient based feedback studies and seven brief training studies). Of the two feedback studies, one reported a significant positive effect. Only one training study reported a significant positive effect.There is limited evidence concerning the effects of patient based feedback. There is reasonable evidence that brief training as currently delivered is not effective, although the evidence is not definitive, due to the small number of trials and the variation in the training methods and goals. The lack of effectiveness of these methods may reflect a number of issues, such as differences in the effectiveness of the interventions in experienced practitioners and those in training, the lack of theory linking feedback to behaviour change, failure to provide sufficient training or to use a comprehensive range of behaviour change techniques. Further research into both feedback and brief training interventions is required before these interventions are routinely introduced to improve patient satisfaction with interpersonal care in primary care. The interventions to be tested in future research should consider using insights from the wider literature on communication outside primary care, might benefit from a clearer theoretical basis, and should examine the use of combined brief training and feedback.Improving quality of primary care is a key focus of health policy both nationally and internationally [1,2]. Quality improvement can take a number of forms. The approach adopted in the United Kingdom has placed a large focus on the clinical quality of care. Financial incentives in the Quality and Outcomes Framework (QOF) are provided on the basis of achieving certain quality indicat
Evaluating the Calorimeter Model with Broadband, Continuous Spectra of Starburst Galaxies Observed with the Allen Telescope Array
Peter K. G. Williams,Geoffrey C. Bower
Physics , 2009, DOI: 10.1088/0004-637X/710/2/1462
Abstract: Although the relationship between the far-infrared and cm-wave radio luminosities of normal galaxies is one of the most striking correlations in astronomy, a solid understanding of its physical basis is lacking. In one interpretation, the "calorimeter model," rapid synchrotron cooling of cosmic ray electrons is essential in reproducing the observed linear relationship. Observed radio spectra, however, are shallower than what is expected of cooled synchrotron emission. In Thompson et al. (2006), a simple parameterized model is presented to explain how relatively shallow observed spectra might arise even in the presence of rapid synchrotron cooling by accounting for ionization losses and other cooling mechanisms. During the commissioning of the 42-element Allen Telescope Array, we observed the starburst galaxies M82, NGC 253, and Arp 220 at frequencies ranging from 1 to 7 GHz, obtaining unprecedented broadband continuous radio spectra of these sources. We combine our observations with high-frequency data from the literature to separate the spectra into thermal and nonthermal components. The nonthermal components all steepen in the cm-wave regime and cannot be well-modeled as simple power laws. The model of Thompson et al. is consistent with our M82 results when plausible parameters are chosen, and our results in fact significantly shrink the space of allowed model parameters. The model is only marginally consistent with our NGC 253 data. Assuming the Thompson et al. model, a steep electron energy injection index of p = -2.5 is ruled out in M82 and NGC 253 to >99% confidence. We describe in detail the observing procedures, calibration methods, analysis, and consistency checks used for broadband spectral observations with the Allen Telescope Array.
The metallicity of galactic winds
Peter Creasey,Tom Theuns,Richard G. Bower
Physics , 2014, DOI: 10.1093/mnras/stu2233
Abstract: The abundance evolution of galaxies depends critically on the balance between the mixing of metals in their interstellar medium, the inflow of new gas and the outflow of enriched gas. We study these processes in gas columns perpendicular to a galactic disk using sub-parsec resolution simulations that track stellar ejecta with the Flash code. We model a simplified interstellar medium stirred and enriched by supernovae and their progenitors. We vary the density distribution of the gas column and integrate our results over an exponential disk to predict wind and ISM enrichment properties for disk galaxies. We find that winds from more massive galaxies are hotter and more highly enriched, in stark contrast to that which is often assumed in galaxy formation models. We use these findings in a simple model of galactic enrichment evolution, in which the metallicity of forming galaxies is the result of accretion of nearly pristine gas and outflow of enriched gas along an equilibrium sequence. We compare these predictions to the observed mass-metallicity relation, and demonstrate how the galaxy's gas fraction is a key controlling parameter. This explains the observed flattening of the mass-metallicity relation at higher stellar masses.
How supernova explosions power galactic winds
Peter Creasey,Tom Theuns,Richard G. Bower
Physics , 2012, DOI: 10.1093/mnras/sts439
Abstract: Feedback from supernovae is an essential aspect of galaxy formation. In order to improve subgrid models of feedback we perform a series of numerical experiments to investigate how supernova explosions power galactic winds. We use the Flash hydrodynamic code to model a simplified ISM, including gravity, hydrodynamics, radiative cooling above 10,000 K, and star formation that reproduces the Kennicutt-Schmidt relation. By simulating a small patch of the ISM in a tall box perpendicular to the disk, we obtain sub-parsec resolution allowing us to resolve individual supernova events and we investigate how the wind properties depend on those of the ISM and the galaxy. We find that outflows are more efficient in disks with lower surface densities or gas fractions. A simple model in which the warm cloudy medium is the barrier that limits the expansion of blast waves reproduces the scaling of outflow properties with disk parameters at high star formation rates. The scaling we find sets the investigation of galaxy winds on a new footing, providing a physically motivated sub-grid description of winds that can be implemented in cosmological hydrodynamic simulations and phenomenological models. [Abridged]
Collaborative Interventions for Circulation and Depression (COINCIDE): study protocol for a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease
Coventry Peter A,Lovell Karina,Dickens Chris,Bower Peter
Trials , 2012, DOI: 10.1186/1745-6215-13-139
Abstract: Background Depression is up to two to three times as common in people with long-term conditions. It negatively affects medical management of disease and self-care behaviors, and leads to poorer quality of life and high costs in primary care. Screening and treatment of depression is increasingly prioritized, but despite initiatives to improve access and quality of care, depression remains under-detected and under-treated, especially in people with long-term conditions. Collaborative care is known to positively affect the process and outcome of care for people with depression and long-term conditions, but its effectiveness outside the USA is still relatively unknown. Furthermore, collaborative care has yet to be tested in settings that resemble more naturalistic settings that include patient choice and the usual care providers. The aim of this study was to test the effectiveness of a collaborative-care intervention, for people with depression and diabetes/coronary heart disease in National Health Service (NHS) primary care, in which low-intensity psychological treatment services are delivered by the usual care provider - Increasing Access to Psychological Therapies (IAPT) services. The study also aimed to evaluate the cost-effectiveness of the intervention over 6 months, and to assess qualitatively the extent to which collaborative care was implemented in the intervention general practices. Methods This is a cluster randomized controlled trial of 30 general practices allocated to either collaborative care or usual care. Fifteen patients per practice will be recruited after a screening exercise to detect patients with recognized depression (≥10 on the nine-symptom Patient Health Questionnaire; PHQ-9). Patients in the collaborative-care arm with recognized depression will be offered a choice of evidence-based low-intensity psychological treatments based on cognitive and behavioral approaches. Patients will be case managed by psychological well-being practitioners employed by IAPT in partnership with a practice nurse and/or general practitioner. The primary outcome will be change in depressive symptoms at 6 months on the 90-item Symptoms Checklist (SCL-90). Secondary outcomes include change in health status, self-care behaviors, and self-efficacy. A qualitative process evaluation will be undertaken with patients and health practitioners to gauge the extent to which the collaborative-care model is implemented, and to explore sustainability beyond the clinical trial. Discussion COINCIDE will assess whether collaborative care can improve patient-center
Improving access to psychosocial interventions for common mental health problems in the United Kingdom: narrative review and development of a conceptual model for complex interventions
Gask Linda,Bower Peter,Lamb Jonathan,Burroughs Heather
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-249
Abstract: Background In the United Kingdom and worldwide, there is significant policy interest in improving the quality of care for patients with mental health disorders and distress. Improving quality of care means addressing not only the effectiveness of interventions but also the issue of limited access to care. Research to date into improving access to mental health care has not been strongly rooted within a conceptual model, nor has it systematically identified the different elements of the patient journey from identification of illness to receipt of care. This paper set out to review core concepts underlying patient access to mental health care, synthesise these to develop a conceptual model of access, and consider the implications of the model for the development and evaluation of interventions for groups with poor access to mental health care such as older people and ethnic minorities. Methods Narrative review of the literature to identify concepts underlying patient access to mental health care, and synthesis into a conceptual model to support the delivery and evaluation of complex interventions to improve access to mental health care. Results The narrative review adopted a process model of access to care, incorporating interventions at three levels. The levels comprise (a) community engagement (b) addressing the quality of interactions in primary care and (c) the development and delivery of tailored psychosocial interventions. Conclusions The model we propose can form the basis for the development and evaluation of complex interventions in access to mental health care. We highlight the key methodological challenges in evaluating the overall impact of access interventions, and assessing the relative contribution of the different elements of the model.
Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study
Sanders Caroline,Rogers Anne,Bowen Robert,Bower Peter
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-220
Abstract: Background Telehealth (TH) and telecare (TC) interventions are increasingly valued for supporting self-care in ageing populations; however, evaluation studies often report high rates of non-participation that are not well understood. This paper reports from a qualitative study nested within a large randomised controlled trial in the UK: the Whole System Demonstrator (WSD) project. It explores barriers to participation and adoption of TH and TC from the perspective of people who declined to participate or withdrew from the trial. Methods Qualitative semi-structured interviews were conducted with 22 people who declined to participate in the trial following explanations of the intervention (n = 19), or who withdrew from the intervention arm (n = 3). Participants were recruited from the four trial groups (with diabetes, chronic obstructive pulmonary disease, heart failure, or social care needs); and all came from the three trial areas (Cornwall, Kent, east London). Observations of home visits where the trial and interventions were first explained were also conducted by shadowing 8 members of health and social care staff visiting 23 people at home. Field notes were made of observational visits and explored alongside interview transcripts to elicit key themes. Results Barriers to adoption of TH and TC associated with non-participation and withdrawal from the trial were identified within the following themes: requirements for technical competence and operation of equipment; threats to identity, independence and self-care; expectations and experiences of disruption to services. Respondents held concerns that special skills were needed to operate equipment but these were often based on misunderstandings. Respondents’ views were often explained in terms of potential threats to identity associated with positive ageing and self-reliance, and views that interventions could undermine self-care and coping. Finally, participants were reluctant to risk potentially disruptive changes to existing services that were often highly valued. Conclusions These findings regarding perceptions of potential disruption of interventions to identity and services go beyond more common expectations that concerns about privacy and dislike of technology deter uptake. These insights have implications for health and social care staff indicating that more detailed information and time for discussion could be valuable especially on introduction. It seems especially important for potential recipients to have the opportunity to discuss their expectations and such views might usefully fe
Experiences of care planning in England: interviews with patients with long term conditions
Newbould Jenny,Burt Jenni,Bower Peter,Blakeman Tom
BMC Family Practice , 2012, DOI: 10.1186/1471-2296-13-71
Abstract: Background The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority in England for chronic disease management. However, it is not clear how care planning is currently understood, translated and implemented in primary care. This study explores experience of care planning in patients with long term conditions in three areas in England. Methods We conducted semi-structured interviews with 23 predominantly elderly patients with multiple long term conditions. The interviews were designed to explore variations in and emergent experiences of care planning. Qualitative analysis of interview transcripts involved reflexively coding and re-coding data into categories and themes. Results No participants reported experiencing explicit care planning discussions or receiving written documentation setting out a negotiated care plan and they were unfamiliar with the term ‘care planning’. However, most described some components of care planning which occurred over a number of contacts with health care professionals which we term”reactive” care planning. Here, key elements of care planning including goal setting and action planning were rare. Additionally, poor continuity and coordination of care, lack of time in consultations, and patient concerns about what was legitimate to discuss with the doctor were described. Conclusions Amongst this population, elements of care planning were present in their accounts, but a structured, comprehensive process and consequent written record (as outlined in English Department of Health policy) was not evident. Further research needs to explore the advantages and disadvantages of different approaches to care planning for different patient groups.
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