• Assessing the impact of diabetes on the quality of life of older adults living in a care home: validation of the ADDQoL Senior

      Speight, J.; Sinclair, Alan J.; Browne, J. L.; Woodcock, A.; Bradley, C.; Australian Centre for Behavioural Research in Diabetes; Deakin University; AHP Research; Bedfordshire and Hertfordshire Postgraduate Medical School; Royal Holloway, University of London (Wiley, 2013-01)
      Aims  Around a quarter of UK care-home residents have diabetes. Diabetes is known to impact quality of life but existing diabetes-specific quality of life measures are unsuitable for elderly care-home residents. We aimed to develop and evaluate a new measure for use with older adults, to be particularly suitable for use with care-home residents: the Audit of Diabetes-Dependent Quality of Life (ADDQoL) Senior*. Methods  Content and format changes were made to the 19-domain ADDQoL, informed by related measures for people with visual impairments (12 domain-specific items were retained, four items were revised/added and three items were removed). This revision was modified further following cognitive debriefing interviews with three older adults living in a care home. Psychometric evaluation of the newly developed 17-domain ADDQoL Senior was conducted using data from 90 care-home residents with diabetes who took part in a broader intervention study. Results  The life domains most impacted by diabetes were ‘independence’ and ‘freedom to eat as I wish’. The ADDQoL Senior demonstrated good factor structure and internal consistency (Cronbach’s alpha = 0.924). Domain scores were, as expected, significantly intercorrelated. Conclusions  The ADDQoL Senior measures the perceived impact of diabetes on quality of life in older adults, and has been found to be suitable for those living in care homes if administered by interview. The scale has demonstrated acceptability and excellent psychometric properties. It is anticipated that the number of items may be reduced in the future if our current findings can be replicated.
    • Automated telephone communication systems for preventive healthcare and management of long-term conditions

      Cash-Gibson, Lucinda; Felix, Lambert M.; Minorikawa, Nami; Pappas, Yannis; Gunn, Laura H.; Majeed, Azeem; Atun, Rifat; Car, Josip (Wiley, 2012)
      The objectives are as follows: • To assess the effects of automated telephone communication systems (ATCS) compared with usual care, for improving primary preventive healthcare and management of long-term conditions in terms of: 1) behavioural change; 2) clinical outcomes; 3) process outcomes; 4) cognitive outcomes; and 5) adverse outcomes. • To determine which type of ATCS is most effective for primary preventive healthcare and management of long-term conditions. • To explore which interventional design components may contribute to positive consumer behavioural change.
    • Caring for older adults with diabetes mellitus: characteristics of carers and their prime roles and responsibilities.

      Sinclair, Alan J.; Armes, David Grahame; Randhawa, Gurch; Bayer, Antony J.; University of Bedfordshire (Wiley, 2010-09)
    • Email for clinical communication between healthcare professionals

      Sawmynaden, Prescilla; Atherton, Helen; Sheikh, Aziz; Car, Josip; Majeed, Azeem (Wiley, 2012)
      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.
    • Email for clinical communication between healthcare professionals

      Goyder, Clare; Atherton, Helen; Heneghan, Carl; Car, Mate; Car, Josip (Wiley, 2015)
      Email is one of the most widely used methods of communication, but its use in healthcare is still uncommon. Where email communication has been utilised in health care, its purposes have included clinical communication between healthcare professionals, but the effects of using email in this way are not well known. We updated a 2012 review of the use of email for two-way clinical communication between healthcare professionals.
    • Endothelial dysfunction in aged humans is related with oxidative stress and vascular inflammation

      Rodríguez-Mañas, Leocadio; El-Assar, Mariam; Vallejo, Susana; López-Dóriga, Pedro; Solís, Joaquin; Petidier, Roberto; Montes, Manuel; Nevado, Julián; Castro, Marta; Gómez-Guerrero, Carmen; et al. (Wiley, 2009-06)
      Vascular endothelial dysfunction occurs during the human aging process, and it is considered as a crucial event in the development of many vasculopathies. We investigated the underlying mechanisms of this process, particularly those related with oxidative stress and inflammation, in the vasculature of subjects aged 18-91 years without cardiovascular disease or risk factors. In isolated mesenteric microvessels from these subjects, an age-dependent impairment of the endothelium-dependent relaxations to bradykinin was observed. Similar results were observed by plethysmography in the forearm blood flow in response to acetylcholine. In microvessels from subjects aged less than 60 years, most of the bradykinin-induced relaxation was due to nitric oxide release while the rest was sensitive to cyclooxygenase (COX) blockade. In microvessels from subjects older than 60 years, this COX-derived vasodilatation was lost but a COX-derived vasoconstriction occurred. Evidence for age-related vascular oxidant and inflammatory environment was observed, which could be related to the development of endothelial dysfunction. Indeed, aged microvessels showed superoxide anions (O(2)(-)) and peroxynitrite (ONOO(-)) formation, enhancement of NADPH oxidase and inducible NO synthase expression. Pharmacological interference of COX, thromboxane A(2)/prostaglandin H(2) receptor, O(2)(-), ONOO(-), inducible NO synthase, and NADPH oxidase improved the age-related endothelial dysfunction. In situ vascular nuclear factor-kappaB activation was enhanced with age, which correlated with endothelial dysfunction. We conclude that the age-dependent endothelial dysfunction in human vessels is due to the combined effect of oxidative stress and vascular wall inflammation.
    • Faith leaders united in their support for organ donation: findings from the UK Organ Donation Taskforce study

      Randhawa, Gurch; Brocklehurst, Anna; Pateman, Ruth; Kinsella, Suzannah; Parry, Vivienne; University of Bedfordshire (Wiley, 2010-02)
      This article reports the findings from the one-to-one interviews with the main UK faith and belief leaders, which were commissioned by the Organ Donation Taskforce. Interviews were arranged with the main faith and belief organizations within the UK and covered a range of issues related to organ donation. No faith or belief groups were against organ donation in principle. The interviewees stated that the majority opinion in their faith or belief group is to permit organ donation, with some actively supporting it. Interviewees were keen to stress that there is a broad spectrum of opinions on organ transplantation within each faith and belief group, and that consequently it is difficult to speak on behalf of an entire group. One complication mentioned by interviewees is that as organ transplantation is a relatively new medical procedure, there is no explicit reference to it in many original religious texts. Consequently positions on the receipt and donation of organs are based on interpretation. It was felt that a much greater level of engagement is needed, as organ donation is currently not a priority for many faith and belief groups.
    • Impaired insulin sensitivity as an underlying mechanism linking hepatitis C and posttransplant diabetes mellitus in kidney recipients

      Baid-Agrawal, S.; Frei, U.; Reinke, P.; Schindler, R.; Kopp, M.A.; Martus, P.; Berg, T.; Juergensen, J.S.; Anker, Stefan D.; Doehner, Wolfram; et al. (Wiley, 2009-12)
      Aim of this study was to investigate the mechanism/s associating hepatitis C virus (HCV) infection and posttransplant diabetes mellitus in kidney recipients. Twenty HCV-positive and 22 HCV-negative kidney recipients, 14 HCV-positive nontransplant patients and 24 HCV-negative nontransplant (healthy) subjects were analyzed. A 3-h intravenous glucose tolerance test was performed; peripheral insulin sensitivity was assessed by minimal modeling. Pancreatic insulin secretion, hepatic insulin uptake, pancreatic antibodies and proinflammatory cytokines in serum (tumor necrosis factor-alpha, intereukin-6, high-sensitive C-reactive protein) were also assessed. HCV-positive recipients showed a significantly lower insulin sensitivity as compared to HCV-negative recipients (3.0 +/- 2.1 vs. 4.9 +/- 3.0 min(-1).microU.mL(- 1).10(4), p = 0.02), however, insulin secretion and hepatic insulin uptake were not significantly different. Pancreatic antibodies were negative in all. HCV status was an independent predictor of impaired insulin sensitivity (multivariate analysis, p = 0.008). The decrease of insulin sensitivity due to HCV was comparable for transplant and non-transplant subjects. No significant correlation was found between any of the cytokines and insulin sensitivity. Our results suggest that impaired peripheral insulin sensitivity is associated with HCV infection irrespective of the transplant status, and is the most likely pathogenic mechanism involved in the development of type 2 diabetes mellitus associated with HCV infection.
    • 'It's different from my culture; they're very different': providing community-based, 'culturally competent' palliative care for South Asian people in the UK

      Owens, Alastair; Randhawa, Gurch (Wiley, 2004-08-19)
      This article investigates the challenges faced by those trying to develop ‘culturally competent’ palliative care for South Asian cancer patients in Luton, UK. It discusses the findings of a phenomenological study of service providers’ attitudes to and experiences of caring for South Asian patients. Ten semi-structured in-depth interviews were carried out with a range of staff who work in home and community-based palliative care settings, including nurses, community liaison personnel and representatives of non-statutory organisations. The authors begin by considering how these service providers construct ideas of cultural difference and how these relate to philosophies of palliative care. They then examine attempts to deal with cultural diversity in everyday practice, focusing in particular on the social context of care in the home. The paper considers the ways in which staff attempt to incorporate the cultural needs of patients, family, kin and community. Rather than criticising current working practices, the authors highlight the complexity of delivering culturally competent services from the perspective of those working directly with patients. In doing so, they contribute to ongoing debates about the development of anti-discriminatory practice in health and social care.
    • Lack of awareness of kidney complications despite familiarity with diabetes - a multi-ethnic qualitative study

      Wilkinson, Emma; Randhawa, Gurch; Farrington, Ken; Greenwood, Roger; Feehally, John; Choi, Peter; Lightstone, Liz (Wiley, 2011-03)
    • Towards effective outcomes in teaching, learning and assessment of law in medical education

      Preston-Shoot, Michael; McKimm, Judy (Wiley, 2011)
      Context  Law is slowly emerging as a core subject area in medical education, alongside content on the ethical responsibilities of doctors to protect and promote patient health and well-being. Curriculum statements have begun to advise on core content and methods for organising teaching and assessment. However, no comprehensive overview of approaches to the delivery of this law curriculum has been undertaken.Objectives  This paper reports an assessment of the nature and strength of the published evidence base for the teaching, learning and assessment of law in medical education. It also provides a thematic content overview from the best available literature on the teaching of law to medical students and on the assessment of their legal knowledge and skills.Methods  A systematic review of the evidence base was completed. Detailed scrutiny resulted in the inclusion of 31 empirical sources and 11 conceptual papers. The quality of the included material was assessed. Results  Significant gaps exist in the evidence base. Empirical studies of the teaching of law are characterised by insufficient sample sizes and a focus on individual study programmes. They rely on measures of student satisfaction and on evaluating short-term outcomes rather than assessing whether knowledge is retained and whether learning impacts on patient outcomes. Studies reveal a lack of coordination between pre- or non-clinical and clinical medico-legal education. Although evidence on the development of students’ knowledge is available, much learning is distant from the practice in which its application would be tested. Law learning in clinical placements appears to be opportunistic rather than structured. Conclusions  The place of law in the curriculum remains uncertain and should be more clearly identified. A more robust knowledge base is needed to realise the aspirations behind curriculum statements on law and to enable medical students to develop sufficient legal literacy to manage challenging practice encounters. Further research is needed into effective methods of teaching, learning and assessing legal knowledge and skills during and following initial medical education.
    • Training interventions for improving telephone consultation skills in clinicians

      Grewal, Rumant S.; Kazeem, Ayodele; Pappas, Yannis; Majeed, Azeem; Car, Josip (Wiley, 2012)
      The objectives are as follows: To assess the effectiveness of training interventions on clinician telephone skills.
    • Work stressors, social support, and burnout in junior doctors: exploring direct and indirect pathways

      Sochos, Antigonos; Bowers, Alexis; Kinman, Gail (Wiley, 2012-07-24)
      The study tested a pathway model linking different occupational stressors, different sources of social support, and burnout. A sample of 184 junior medical doctors was used. Pathway analysis suggested that doctors who experienced increased time demands, organizational constraints, and a lack of personal confidence perceived their consultants as less supportive, whereas those who experienced greater clinical responsibility perceived their supervisors as more supportive. A lack of support from coworkers was linked with a lack of support from consultants, top management, and family. The perception of consultant support was linked with lower burnout, whereas the perception of coworker support was linked with higher burnout. The present findings may inform interventions aimed to support junior doctors experiencing burnout.