• Computer-assisted versus oral-and-written dietary history taking for diabetes mellitus

      Wei, Igor; Pappas, Yannis; Car, Josip; Sheikh, Aziz; Majeed, Azeem; University of Edinburgh; Imperial College London (Wiley-Blackwell, 2011-12-07)
      Background: Diabetes is a chronic illness characterised by insulin resistance or deficiency, resulting in elevated glycosylated haemoglobin A1c (HbA1c) levels. Diet and adherence to dietary advice is associated with lower HbA1c levels and control of disease. Dietary history may be an effective clinical tool for diabetes management and has traditionally been taken by oral-and-written methods, although it can also be collected using computer-assisted history taking systems (CAHTS). Although CAHTS were first described in the 1960s, there remains uncertainty about the impact of these methods on dietary history collection, clinical care and patient outcomes such as quality of life. Objectives: To assess the effects of computer-assisted versus oral-and-written dietary history taking on patient outcomes for diabetes mellitus. Search methods: We searched The Cochrane Library (issue 6, 2011), MEDLINE (January 1985 to June 2011), EMBASE (January 1980 to June 2011) and CINAHL (January 1981 to June 2011). Reference lists of obtained articles were also pursued further and no limits were imposed on languages and publication status. Selection criteria: Randomised controlled trials of computer-assisted versus oral-and-written history taking in patients with diabetes mellitus. Data collection and analysis: Two authors independently scanned the title and abstract of retrieved articles. Potentially relevant articles were investigated as full text. Studies that met the inclusion criteria were abstracted for relevant population and intervention characteristics with any disagreements resolved by discussion, or by a third party. Risk of bias was similarly assessed independently. Main results: Of the 2991 studies retrieved, only one study with 38 study participants compared the two methods of history taking over a total of eight weeks. The authors found that as patients became increasingly familiar with using CAHTS, the correlation between patients' food records and computer assessments improved. Reported fat intake decreased in the control group and increased when queried by the computer. The effect of the intervention on the management of diabetes mellitus and blood glucose levels was not reported. Risk of bias was considered moderate for this study. Authors' conclusions: Based on one small study judged to be of moderate risk of bias, we tentatively conclude that CAHTS may be well received by study participants and potentially offer time saving in practice. However, more robust studies with larger sample sizes are needed to confirm these. We cannot draw on any conclusions in relation to any other clinical outcomes at this stage.
    • Diagnosis and decision-making in telemedicine

      Pappas, Yannis; Vseteckova, Jitka; Mastellos, Nikolas; Greenfield, Geva; Randhawa, Gurch; University of Bedfordshire; Open University; Imperial College London (SAGE, 2018-10-08)
      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.
    • Emerging technologies for health communication

      Pappas, Yannis; Car, Josip; Hill, Sophie; Imperial College London (Wiley-Blackwell, 2011-09-22)
      The widespread use of consumer-oriented information communication technologies (ICTs) such as cell phones, iPods and other electronic data devices is changing the way consumers think about and interact with healthcare. In light of this technology boom, a new field for researching, planning and implementing ICTs in healthcare has emerged called ‘eHealth’. Effective eHealth implementation requires a patient-centred approach to care, with health professionals utilising technology to share clinical information and guide patient self-care. This may include the use of electronic health records (EHRs), phone and text messaging interactions and web-based communication applications. Anticipated benefits of eHealth are improved patient access and choice, enhanced communication between professionals and improved health outcomes. However, the introduction of ICTs to the complex healthcare environment may also lead to disruptions, distractions or errors. To implement eHealth in a safe and effective way, the development of a comprehensive agenda for research, planning and implementation is essential.
    • Ethnic differences in body fat deposition and liver fat content in two UK-based cohorts

      Alenaini, Wareed; Parkinson, James R.; McCarthy, John; Goldstone, Anthony P.; Wilman, Henry R.; Banerjee, Rajarshi; Yaghootkar, Hanieh; Bell, Jimmy D.; Thomas, E. Louise; University of Westminster; et al. (Wiley, 2020-09-16)
      Objective: Differences in the content and distribution of body fat and ectopic lipids may be responsible for ethnic variations in metabolic disease susceptibility. The aim of this study was to examine the ethnic distribution of body fat in two separate UK-based populations. Methods: Anthropometry and body composition were assessed in two separate UK cohorts: the Hammersmith cohort and the UK Biobank, both comprising individuals of South Asian descent (SA), individuals of Afro-Caribbean descent (AC), and individuals of European descent (EUR). Regional adipose tissue stores and liver fat were measured by magnetic resonance techniques. Results: The Hammersmith cohort (n = 747) had a mean (SD) age of 41.1 (14.5) years (EUR: 374 men, 240 women; SA: 68 men, 22 women; AC: 14 men, 29 women), and the UK Biobank (n = 9,533) had a mean (SD) age of 55.5 (7.5) years (EUR: 4,483 men, 4,873 women; SA: 80 men, 43 women, AC: 31 men, 25 women). Following adjustment for age and BMI, no significant differences in visceral adipose tissue or liver fat were observed between SA and EUR individuals in the either cohort. Conclusions: Our data, consistent across two independent UK-based cohorts, present a limited number of ethnic differences in the distribution of body fat depots associated with metabolic disease. These results suggest that the ethnic variation in susceptibility to features of the metabolic syndrome may not arise from differences in body fat.
    • 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

      Lee, Puikwan; Greenfield, Geva; Pappas, Yannis; Imperial College London; University of Bedfordshire (BioMed Central Ltd., 2018-06-26)
      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.
    • The impact of the Luton social prescribing programme on energy expenditure: a quantitative before-and-after study

      Pescheny, Julia Vera; Gunn, Laura H.; Randhawa, Gurch; Pappas, Yannis; University of Bedfordshire; University of North Carolina (UNC); Imperial College London (BMJ, 2019-06-16)
      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. Uncontrolled before-and-after study. This study was set in the East of England (Luton). Service users with complete covariate information and baseline measurements (n=146) were included in the analysis. 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. Energy expenditure measured as metabolic equivalent (MET) minutes per week. 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. 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.
    • A mixed methods evaluation of the Northwest London Integrated Care Pilot

      Harris, Matthew; Pappas, Yannis; Mastellos, Nikolas; Soljak, Michael; Gunn, Laura H.; Cecil, Elizabeth; Greaves, Felix; Car, Josip; Majeed, Azeem; Imperial College London; et al. (Ubiquity Press, 2016-12-16)