• Analysis of routinely collected data: determining associations of maternal risk factors and infant outcomes with gestational diabetes, in Pakistani, Indian, Bangladeshi and white British pregnant women in Luton, England

      Garcia, Rebecca; Ali, Nasreen; Guppy, Andy; Griffiths, Malcolm; Randhawa, Gurch; ; Open University; University of Bedfordshire; Luton & Dunstable University Hospital NHS Foundation Trust (Elsevier, 2020-12-15)
      This study aims to compare the prevalence of gestational diabetes in Indian, Pakistani, Bangladeshi and British women in Luton, England and further examine associations in maternal risk factors (age BMI, smoking status and birth outcome), with gestational diabetes, with maternal ethnicity. A retrospective analysis using routinely collected secondary data from Ciconia Maternity information System (CMiS), between 2008 and 2013. The ethnicity of women recorded as Indian, Pakistani, Bangladeshi and white British, residing in [removed] were included in the study. The outcomes for n=15,211 cases were analysed using adjusted standardised residuals, Pearson Chi-square, frequencies and percentages of women with gestational diabetes. = 43.1 df=4, p<0.001) and an early gestational age at delivery (24-37 weeks) (χ2= 4.084 df=1, p=0.043). There are important differences in the prevalence rates of gestational diabetes which varied by maternal ethnicity. Of the women who had GDM, 48.7% were Pakistani, compared with 28.3% Bangladeshi, 16.4% white British and 6.6% Indian. It is essential policy makers and service providers target GDM screening and associated interventions and future research seeks to understand the reasons behind these differences.
    • Analysis of sustained maximal grip contractions using Empirical Mode Decomposition

      Li, Ke; Hogrel, Jean-Yves; Duchêne, Jacques; Hewson, David (IEEE, 2010-12-31)
      Muscle fatigue and physiological tremor during a Sustained Maximal Grip Contraction (SMGC) were analyzed using Empirical Mode Decomposition (EMD) in this study. Thirty-nine healthy subjects volunteered for the experiment and performed a 25-s SMGC. Fatigue parameters such as the relative power output (RPO) were calculated from the residual of SMGC after applying EMD. Using the energy spectrum of the intrinsic mode functions (IMF) obtained using Hilbert-Huang Transform (HHT), physiological tremor was identified from the 4-12 Hz region in IMF3 and IMF4. Data were analyzed for five consecutive 5-s epochs to identify changes in fatigue and tremor over time. The EMD method was able to identify a greater resistance to fatigue in women compared to men (p<;;0.05) and in non-dominant hands compared to dominant hands (p<;;0.05). Consistent with the results for fatigue, women had less tremor than men (p<;;0.05), while non-dominant hands trembled less than did dominant hands (p<;;0.05). Higher levels of tremor were observed for non-fatigue-resistant subjects for both 10-15 s and 15-20 s epochs (p<;;0.05). The EMD is an appropriate method to indentify both fatigue and tremor during SMGC.
    • Antenatal care initiation in an ethnically dense socially disadvantaged maternal cohort

      Puthussery, Shuby; Tseng, Pei-Ching; Li, L.; Puthusserry, Thomas (Oxford University Press, 2019-11-20)
      Background: Differential utilisation of antenatal care among ethnic minority mothers is a contributor to their increased risk of poor birth outcomes in developed countries. Links between ethnicity, area deprivation and the timing of antenatal care initiation remain poorly understood. This study investigated patterns of antenatal care initiation among an ethnically dense, socially disadvantaged maternal cohort. Methods: We conducted a retrospective analysis of routinely collected anonymous data of live singleton births in a maternity unit serving an ethnically diverse population. We applied univariate regression models to examine the association between late antenatal care initiation and various predictor variables in particular ethnicity and area deprivation. Results: Gestational week at antenatal initiation was available for 46,089 births. One fifth (20.9%) of mothers initiated antenatal care after 12 weeks of gestation including 11.9% who had their first antenatal appointment at 13 -20 weeks (moderately late) and 8.9% who had it later than 20 weeks (extremely late). Among all the factors considered, late initiation was most strongly associated with non-White British ethnicity. Black African (34.2%) and Black Caribbean (29.0%) mothers were more than twice as likely to initiate antenatal care after 12 weeks of gestation compared to White British mothers [Odds ratio (OR) = 2.69 and 2.15 respectively). The odds did not increase with increasing area deprivation except for moderately late initiation in the most deprived and second most deprived areas [unadjusted OR = 1.54 and 1.24 respectively]. Conclusions: Non-White British ethnicity was the key predictor of late antenatal care initiation in our ethnically dense socially disadvantaged maternal cohort. Impact: Programs and policies should take in to account ethnic variations in antenatal careinitiation while designing programs and policies to improve birth outcomes in ethnically dense socially disadvantaged areas. Key messages: Non-White British ethnicity was the key predictor of late antenatal care initiation. Area deprivation per se appeared to have limited association with late antenatal care initiation.
    • Anthony Giddens: structuration, drug use, food choice and long-term illness

      Gabe, Jonathan; Almeida, Joana (Palgrave Macmillan, 2015-01-01)
    • Antimicrobial resistance: what can nurses do?

      Wilson, Aileen; University of Bedfordshire (MA Healthcare Ltd, 2019-01-08)
    • Attitudes and perceptions of pregnant women towards the use of Anti-Retroviral Therapy in Nigeria

      Major, Puremeluan Baldwin; Puthussery, Shuby; Pappas, Yannis; University of Bedfordshire (Elsevier, 2018-06-25)
      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.
    • Attitudes towards a programme of risk assessment and stratified management for ovarian cancer: a focus group study of UK South Asians' perspectives

      Hann, Katie E.J.; Ali, Nasreen; Gessler, Sue; Fraser, Lindsay Sarah Macduff; Side, Lucy; Waller, Jo; Sanderson, Saskia C.; Lanceley, Anne; Royal Holloway, University of London; University of Bedfordshire; et al. (BMJ, 2018-07-18)
      A crucial first step to enable implementation of population-based genetic risk assessment and management in OC is to raise awareness of OC within SA communities. It will be important to engage with the SA community early on in programme implementation to address their specific concerns and to ensure culturally tailored decision support. Population-based risk assessment, using genetic testing and the provision of appropriate risk management, could lead to prevention, early detection and improved clinical management of ovarian cancer (OC). Previous research with mostly white British participants found positive attitudes towards such a programme. The current study aimed to explore the attitudes of South Asian (SA) women and men in the UK with the aim of identifying how best to implement such a programme to minimise distress and maximise uptake. Semistructured qualitative focus group discussions. Community centres across North London and Luton. 49 women and 13 men who identified as SA (Indian, Pakistani or Bangladeshi), which constitutes the largest non-European ethnic minority group in the UK. Seven community-based focus groups were held. Group discussions were transcribed verbatim, coded and analysed thematically. Awareness and knowledge of OC symptoms and specific risk factors was low. The programme was acceptable to most participants and attitudes to it were generally positive. Participants' main concerns related to receiving a high-risk result following the genetic test. Younger women may be more cautious of genetic testing, screening or risk-reducing surgery due to the importance of marriage and childbearing in their SA cultures. CONCLUSIONS OBJECTIVE DESIGN SETTING PARTICIPANTS METHODS RESULTS
    • Autism stigma and the role of ethnicity and culture

      Papadopoulos, Chris (Network Autism, 2016-10-26)
    • Automated telephone communication systems for preventive healthcare and management of long-term conditions

      Posadzki, Pawel; Mastellos, Nikolaos; Ryan, Rebecca; Gunn, Laura H.; Felix, Lambert M.; Pappas, Yannis; Gagnon, Marie‐Pierre; Julious, Steven A.; Xiang, Liming; Oldenburg, Brian; et al. (Wiley, 2016-12-14)
      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.
    • Automatic threshold determination for a local approach of change detection in long-term signal recordings

      El Falou, Wassim; Khalil, Mohamad; Duchêne, Jacques; Hewson, David; Université de Technologie de Troyes; Université Libanaise (Hindawi, 2007-12-01)
      CUSUM (cumulative sum) is a well-known method that can be used to detect changes in a signal when the parameters of this signal are known. This paper presents an adaptation of the CUSUM-based change detection algorithms to long-term signal recordings where the various hypotheses contained in the signal are unknown. The starting point of the work was the dynamic cumulative sum (DCS) algorithm, previously developed for application to long-term electromyography (EMG) recordings. DCS has been improved in two ways. The first was a new procedure to estimate the distribution parameters to ensure the respect of the detectability property. The second was the definition of two separate, automatically determined thresholds. One of them (lower threshold) acted to stop the estimation process, the other one (upper threshold) was applied to the detection function. The automatic determination of the thresholds was based on the Kullback-Leibler distance which gives information about the distance between the detected segments (events). Tests on simulated data demonstrated the efficiency of these improvements of the DCS algorithm.
    • Balance quality assessment as an early indicator of physical frailty in older people

      Chkeir, Aly; Safieddine, Doha; Bera, Delphine; Collart, Michèle; Novella, Jean-Luc; Drame, M.; Hewson, David; Duchêne, Jacques (IEEE, 2016-10-01)
      Frailty is an increasingly common geriatric condition that results in an increased risk of adverse health outcomes such as falls. The most widely-used means of detecting frailty is the Fried phenotype, which includes several objective measures such as grip strength and gait velocity. One method of screening for falls is to measure balance, which can be done by a range of techniques including the assessment of the Centre of Pressure (CoP) during a balance assessment. The Balance Quality Tester (BQT) is a device based on a commercial bathroom scale that can evaluate balance quality. The BQT provides instantaneously the position of the CoP (stabilogram) in both anteroposterior (AP) and mediolateral (ML) directions and can estimate the vertical ground reaction force. The purpose of this study was to examine the relationship between balance quality assessment and physical frailty. Balance quality was compared to physical frailty in 186 older subjects. Rising rate (RR) was slower and trajectory velocity (TV) was higher in subjects classified as frail for both grip strength and gait velocity (p<;0.05). Balance assessment could be used in conjunction with functional tests of grip strength and gait velocity as a means of screening for frailty.
    • Barriers and facilitators to adherence to group exercise in institutionalized older people living with dementia: a systematic review

      Vseteckova, Jitka; Deepak-Gopinath, Manik; Borgstrom, Erica; Holland, Caroline; Draper, Jan; Pappas, Yannis; McKeown, Eamonn; Dadova, Klara; Gray, Steve; Open University; et al. (BioMed Central, 2018-12-28)
      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. 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. 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. 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. Objectives Methods Results Conclusions
    • Barriers and facilitators to adherence to walking group exercise in older people living with dementia in the community: a systematic review

      Vseteckova, Jitka; Dadova, Klara; Gracia, R.; Ryan, G.; Borgstrom, Erica; Abington, J.; Gopinath, M.; Pappas, Yannis; (BioMed Central Ltd, 2020-09-21)
      Summary: Background &amp; 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 &amp; 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 &amp; 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.
    • Barriers and facilitators to genetic testing amongst Black African women in the UK

      Kabeya, Valencia; Puthussery, Shuby; Furmanski, Anna L. (Oxford University Press, 2021-10-20)
      Background Black African women have the lowest attendance of genetic testing services and the highest mortality rate of breast and ovarian cancer amongst women from ethnic minority groups in the UK. Therefore, this study aimed to identify the barriers and facilitators to genetic testing to enable these women to make informed choices if found eligible. Methods A qualitative approach was used to explore the perceptions surrounding genetic testing amongst Twenty-four women aged 23-57 Black African women in Luton. Purposive sampling combined with snowballing sampling was used as a recruitment technique. Results The findings revealed that most of the participants had no awareness or knowledge of genetic testing and limited knowledge of their family medical history for eligibility to attend genetic testing services. Facilitators including family member's health, funding by the National Health services and accessibility and awareness and education on genetic testing were identified. Conclusions This study sought to explore the perceptions of Black African women on barriers and facilitators to genetic testing to enable researchers to implement efficient intervention that would increase genetic testing attendance whilst addressing the other barriers and facilitators to alter Black African's women health seeking behaviours.
    • Barriers and facilitators to smart home adoption

      Davidson, Rosemary (2015-11-12)
      This paper explores the social barriers and facilitators to smart home adoption with an analysis of public attitudes. Smart home services aim to improve the comfort, convenience and safety of householders, as well as allowing them to use energy more efficiently and cope with increasing costs. Despite the existence of smart homes and smart home technologies for some time, their prevalence is not widespread, and thus their potential largely untapped. Using in-depth deliberative public workshops this paper explores social barriers and facilitators to smart home technology, and how views vary by socio-economic status, expertise, life-stage and location. The research highlights the importance of themes such as environmental context, older housing stock, city living, perceptions of new homes, financial pressures/exclusion, lack of trust, and acceptability of smart home services.
    • Barriers towards organ donor registration and consent among people of Indian origin living globally: a systematic review and integrative synthesis - protocol

      Vincent, Britzer Paul; Randhawa, Gurch; Cook, Erica Jane; University of Bedfordshire (BMJ Publishing Group, 2020-06-21)
      Introduction The need for organs is comparatively higher among people of Indian origin due to the higher prevalence of end-stage organ failure. In spite of the higher need, they have a lower number of organ donors. Studies have been carried out among people of Indian origin living globally to understand the reasons for the low donation rate, but there has been no systematic review that has integrated all of these studies to synthesise the current literature. Therefore, the purpose of this review is to examine the barriers towards organ donor registration and consent among Indians living globally. Methods and analysis A systematic search will be conducted using the following relevant databases namely CINHAL, MEDLINE, PsycINFO, Scopus, Web of Science, PubMed Central, Global Health and Grey literature. Studies from 1994 that satisfy our inclusion criteria will be included. Two reviewers will conduct the screening, data extraction and quality assessment of the studies; in event of any disagreement between the two reviewers at any stage, the third reviewer will reconcile any disagreements and consensus will be made. Ethics and dissemination As this study includes only secondary data, ethical approval for secondary data usage has been sought. This study will use Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to report and the study outcomes will be disseminated through a relevant peer-review publication, related conferences and also to various non-governmental organisations globally which are working with this particular community; following which further research can be developed based on this evidence and also helps in building a culturally competent strategy. PROSPERO registration number CRD42019155274.
    • Beliefs about medicines and non-adherence in patients with stroke, diabetes mellitus and rheumatoid arthritis: a cross-sectional study in China

      Wei, Li; Champman, Sarah; Li, Xiaomei; Li, Xin; Li, Sumei; Chen, Ruoling; Bo, Nie; Chater, Angel M.; Horne, Robert; University College London School of Pharmacy; et al. (BMJ Publishing Group, 2017-10-01)
      OBJECTIVES: To investigate beliefs about medicines and their association with medicine adherence in patients with chronic diseases in China. DESIGN: A cross-sectional questionnaire-based study SETTING: Two large urban hospitals in Hefei and Tianjin, China PARTICIPANTS: Hospital inpatients (313 stroke patients) and outpatients (315 diabetic patients and 339 rheumatoid arthritis (RA) patients) were recruited between January 2014 and September 2014. OUTCOME MEASURES: The Beliefs about Medicines Questionnaire (BMQ), assessing patients' beliefs about the specific medicine (Specific-Necessity and Specific-Concerns) prescribed for their conditions (stroke/diabetes/RA) and more general background beliefs about pharmaceuticals as a class of treatment (BMQ-General Benefit, Harm and Overuse); the Perceived Sensitivity to Medicines scale (PSM) assessed patients' beliefs about how sensitive they were to the effects of medicines and the Medication Adherence Report Scale. The association between non-adherence and beliefs about medicines was assessed using a logistic regression model. RESULTS: Patients with diabetes mellitus had a stronger perceived need for treatment (mean (SD) Specific-Necessity score, 3.75 (0.40)) than patients with stroke (3.69 (0.53)) and RA (3.66 (0.44)) (p=0.049). Moderate correlations were observed between Specific-Concerns and General-Overuse, General-Harm and PSM (Pearson correlation coefficients, 0.39, 0.49 and 0.49, respectively, p<0.01). Three hundred and eleven patients were non-adherent to their medicine (159 (51.0%) in the stroke group, 60 (26.7%) in the diabetes mellitus group and 62 (19.8%) in the RA group, p<0.01). Across the whole sample, after adjusting for demographic characteristics, non-adherence was associated with patients who had higher concerns about their medicines (OR, 1.35, 95% CI 1.07 to 1.71) and patients who believed that they were personally sensitive to the effects of medications (OR 1.44, 95% CI 1.16 to 1.85). CONCLUSION: The BMQ is a useful tool to identify patients at risk of non-adherence. In the future, adherence intervention studies may use the BMQ to screen for patients who are at risk of non-adherence and to map interventional support.
    • A BEME systematic review of the effects of interprofessional education: BEME Guide No. 39

      Reeves, Scott; Fletcher, Simon; Barr, Hugh; Birch, Ivan; Boet, Sylvain; Davies, Nigel; McFadyen, Angus; Rivera, Josette; Kitto, Simon; ; et al. (Taylor and Francis Ltd, 2016-05-05)
      Abstract: Background: Interprofessional education (IPE) aims to bring together different professionals to learn with, from, and about one another in order to collaborate more effectively in the delivery of safe, high-quality care for patients/clients. Given its potential for improving collaboration and care delivery, there have been repeated calls for the wider-scale implementation of IPE across education and clinical settings. Increasingly, a range of IPE initiatives are being implemented and evaluated which are adding to the growth of evidence for this form of education. Aim: The overall aim of this review is to update a previous BEME review published in 2007. In doing so, this update sought to synthesize the evolving nature of the IPE evidence. Methods: Medline, CINAHL, BEI, and ASSIA were searched from May 2005 to June 2014. Also, journal hand searches were undertaken. All potential abstracts and papers were screened by pairs of reviewers to determine inclusion. All included papers were assessed for methodological quality and those deemed as “high quality” were included. The presage–process–product (3P) model and a modified Kirkpatrick model were employed to analyze and synthesize the included studies. Results: Twenty-five new IPE studies were included in this update. These studies were added to the 21 studies from the previous review to form a complete data set of 46 high-quality IPE studies. In relation to the 3P model, overall the updated review found that most of the presage and process factors identified from the previous review were further supported in the newer studies. In regard to the products (outcomes) reported, the results from this review continue to show far more positive than neutral or mixed outcomes reported in the included studies. Based on the modified Kirkpatrick model, the included studies suggest that learners respond well to IPE, their attitudes and perceptions of one another improve, and they report increases in collaborative knowledge and skills. There is more limited, but growing, evidence related to changes in behavior, organizational practice, and benefits to patients/clients. Conclusions: This updated review found that key context (presage) and process factors reported in the previous review continue to have resonance on the delivery of IPE. In addition, the newer studies have provided further evidence for the effects on IPE related to a number of different outcomes. Based on these conclusions, a series of key implications for the development of IPE are offered.