• Clinical. Critically ill patients' perspectives of hope

      Cutcliffe, John (1996)
      This study examines critical care patients' perspectives of hope. It focuses on the patients' expression of their experience of hope while being critically ill on a coronary care unit. Using a phenomenological methodology, the data were coded and underwent a thematic analysis. The resulting theory of the critical care patients' perspectives of hope comprised four key themes: hope relative to help; hope interwoven with caring; the presence of hope as synonymous with a personal future; and hope as a coping resource. The researcher believes that hope is of great therapeutic benefit for these critically ill individuals, and that the nurse's role is pivotal in inspiring this hope. Furthermore, due to the often subtle, unobtrusive nature of hope inspiration, these interventions may enhace the more visible, tangible nursing interventions.
    • Antipyretic therapy in acute stroke

      Sharma, Jagdish C.; Ross, Ian N. (1998)
    • Management of cognitive impairment of vascular origin

      Andrews, C. (1998)
      Comments on the article by M. Dennis and A. Boyle (see record 2000-03461-004) concerning management of cognitive impairment of vascular origin. The author argues that in clinical practice the health personnel should be considering the use of low-dose aspirin in combination with dipyridamole in treatment of cognitive impairment from vascular origin. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Does the personal questionnaire provided a more sensitive measure of cardiac surgery related-anxiety than a standard pencil-and-paper checklist?

      Egan, Vincent (1998)
      Fifty-five men undergoing cardiac bypass surgery completed the state measure of Spielberger's State-Trait Anxiety Inventory (STAI-S) and an anxiety-investigating personal questionnaire (PQ) using the Shapiro method. Of the 55 men tested at baseline, 29 were seen immediately before surgery and 51 post-operatively; 48 were followed-up 8 weeks later. PQs were not more sensitive to anxiety than the STAI-S; when made comparable, both were similar in their sensitivity to anxiety. The psychometric properties of the PQ and the STAI-S were very similar. PQ reliability was negatively correlated with lower verbal ability and higher trait anxiety, suggesting these characteristics affect PQ responses. PQ techniques are psychometrically rigorous, but provide no advantage in measurement. Concurrent personality assessment at the first and final test sessions using the revised, abridged Eysenck Personality Questionnaire (EPQR-A) found all four subscales of the measure highly reliable over time (minimum test-retest r = 0.59); the only subscale to show a significant change was a slight reduction in self-reported Psychoticism at follow-up. Despite a significant reduction in state anxiety after life-transforming, radically health-improving cardiac bypass surgery, the major traits of personality remained essentially stable. © 1998 Elsevier Science Ltd. All rights reserved.
    • An analysis of the intervention provided by a stroke family support organizer service

      Groom, Madeleine J.; Lilley, Steven A.; Francis, Valerie M. (2003)
      This article describes the input of a stroke family support organizer (FSO) service and investigates whether patient needs are directly related to the number and nature of FSO contacts. Patients seen by the FSO for more visits were significantly younger, less disabled before the stroke, more disabled at recruitment and with lower mood than those with fewer contacts. Significant relationships were found between the amount of contact that involved discussion of benefits and knowledge of benefits, and between discussion of physical health and knowledge of prevention of future stroke. The FSO provided useful information about benefits and physical recovery following stroke. © 2003, MA Healthcare Ltd. All rights reserved.
    • A qualitative study of stroke patients' and carers' perceptions of the stroke family support organizer service

      Lilley, Steven A.; Francis, Valerie M. (2003)
      Objective: To investigate stroke patients' and carers' perceptions of the family support organizer (FSO) service in order to highlight its value for potential purchasers and to help shed light on findings from randomized controlled trials.; Design and Subjects: Twenty semi-structured interviews were undertaken with a subsample of stroke patients and their primary informal carers after completion of nine-month outcome assessments as part of a randomized controlled trial.; Setting: Community stroke services in North Nottinghamshire, UK.; Results: Interviewees who received the service reported that the presence of an FSO was valuable in many respects, including helping to claim benefits, as a source of information on stroke, and providing continuity between stroke services. Emotional support was only described by a few. Interviewees who did not receive the service described feelings of isolation and being let down by other stroke services after discharge. They also reported problems accessing information. Help needed to address the practical problems after stroke was commonly reported. For those who did not receive the FSO service, access to support appeared to be found through other channels.; Conclusion: The FSO service appeared to be an information service. In order to evaluate community stroke services, a mixture of qualitative and quantitative outcome measures are necessary.;
    • Evaluation of a stroke family support organiser: A randomized controlled trial

      Francis, Valerie M.; Lilley, Steven A. (2003)
      Background and Purpose - There is inconclusive evidence of the effectiveness of the Stroke Family Support Organiser (FSO) service. We report the results from a randomized controlled trial of the service. Methods - Stroke patients admitted to hospital and their informal caregivers were randomly allocated to receive the FSO service (n = 126) or standard care (n = 124). Outcome assessments were undertaken 4 and 9 months after recruitment with the General Health Questionnaire 12, Carer Strain Index, Barthel Index, Extended Activities of Daily Living scale, and a specially designed questionnaire to determine knowledge of stroke and satisfaction with services. Results - There were no significant differences between groups in patients' mood and independence in personal or instrumental activities of daily living or caregivers' mood, strain, or independence. Patients in the intervention group were significantly more knowledgeable about whom to contact for stroke information, reducing the risk of stroke, practical help, community services, and emotional support. Patients in the intervention group were also significantly more satisfied with the stroke information received. Caregivers in the intervention group were significantly more knowledgeable about whom to contact for information on stroke, reducing the risk of stroke, community services, and emotional support. Caregivers in the intervention group were also significantly more satisfied with stroke information. Conclusions - The FSO service had no significant effect on mood, independence in activities of daily living, or reduction in caregiver strain, but it did increase knowledge of stroke and satisfaction with that knowledge. The results may not be representative of all FSO services, and the sample was small relative to the heterogeneity of the participants. However, results suggest that the policies and training procedures of FSOs need to be evaluated to ensure that a cost-effective service is being provided to stroke patients and their caregivers.
    • Psychological intervention with a child experiencing reflex anoxic seizures: A case report

      Bennett, E. J.; Meldrum, Emma (2009)
      Objectives: We describe the case of a ten-year old girl who experienced anoxic seizures in response to medical instruments and settings. The girl was referred to Clinical Psychology and received around fifteen weekly sessions of therapy. We summarise the key strategies and principles of the intervention and outline the positive impact of the work on both the girl and her family. Methods: Intervention utilised an integrated approach including psychoeducation about anxiety, graded exposure to feared stimuli (eg blood pressure monitors), family work, and the use of narrative therapy techniques. It particularly focused on enhancing the girl's ability to cope with triggers and the reduction of unhelpful avoidance behaviours. Results: By the end of the initial treatment phase, the girl was able to have her blood pressure taken by a nurse, tolerate medical settings and watch procedures on the television. Despite increased contact with triggers, she had not experienced any seizures since starting therapy. Both the girl and her parents reported large reductions in anxiety about seizures and increases in their belief in her ability to cope. Standardised measures reflected a fall in the girl's anxiety and depression levels, and in her mother's parenting stress levels. Conclusions: In this case, psychological intervention offered effective support in the management of anoxic seizures. Techniques can be used to reduce the frequency of seizures, to enhance self-efficacy and to lower family anxiety levels. Medical professionals should consider referring children experiencing reflex anoxic seizures and their parents for psychological assessment, intervention and support.
    • Alcohol and the NHS Health Check programme: Could we be left with a hangover?

      Holmes, Mark (2010)
      Alcohol misuse costs the NHS in the order of £2.7 billion per year; the total annual cost to the UK economy has been calculated at up to £25.1 billion. This article will examine if the Department of Health?s NHS Health Check programme policy launched in April 2009 has missed an important opportunity to contribute to tackling the growing health and economic burden of alcohol misuse. The authors believe that alcohol 'identification and brief advice' (IBA) should be a standard requirement for this programme. Consequently the article also provides a practical over view of the principles of IBA.
    • Health checks: Could we be left with a hangover?

      Holmes, Mark (2010)
      Alcohol misuse costs £2.7 billion a year to the NHS. Mark Holmes and Jamie Waterall ask whether the NHS Health Check programme has missed a chance to help reduce the health risks of alcohol misuse
    • The application of a stroke cognitive pathway across a county: An exploration of current clinical practice

      Rowley, Emma (2012)
      Introduction: The 'Accelerating Stroke Improvement Programme' calls for specialist expertise and competence in the assessment, treatment and monitoring of patients with cognitive disturbance. Occupational therapists and clinical psychologists from Nottinghamshire collaborated with a regional special interest group to develop a cognitive pathway for use across acute and community settings. The standardised pathway identifies a toolkit of appropriate assessments and suggests at what point they should be administered. Method: To explore local current practice in the assessment and treatment of cognition, an online survey (developed and supported by National Institute of Health Research, Collaboration for Leadership in Applied Health Research and Care -Nottinghamshire, Derbyshire and Lincolnshire, NIHR CLAHRC-NDL) was distributed to 58 practitioners across Nottinghamshire. The survey was live for six weeks, and required respondents to complete an online questionnaire (www.surveymonkey. com), using open and closed questions. Results: Out of 28 respondents, the preferred cognitive assessment mechanisms were function (96.1%), standardised assessment (88.5%) and observation (84.6%). 22 standardised and non-standardised assessments were identified, with 75% of respondents choosing the Montreal Cognitive Assessment as their local favoured assessment. Less than half (42.9%) of the respondents had had formal training in the use and interpretation of cognitive assessments. Conclusion: Despite there being locally preferred cognitive assessments, practitioners rely on using a wide range and type of assessments, selected on their perceived appropriateness and their own clinical experience. Indicators for use of a formal assessment were diverse and often arbitrary. Further training is required to support the recommendations and implementation of the cognitive pathway.
    • Communication and Low Mood (CALM): a randomized controlled trial of behavioural therapy for stroke patients with aphasia

      Haworth, Helen (2012)
      Objective: The aim was to evaluate behavioural therapy as a treatment for low mood in people with aphasia. Design: A randomized controlled trial comparing behavioural therapy plus usual care with a usual care control. Potential participants with aphasia after stroke were screened for the presence of low mood. Those who met the criteria and gave consent were randomly allocated. Setting: Participants were recruited from hospital wards, community rehabilitation, speech and language therapy services and stroke groups. Subjects: Of 511 people with aphasia identified, 105 had low mood and were recruited. Interventions: Behavioural therapy was offered for up to three months. Outcomes were assessed three and six months after random allocation. Main measures: Stroke Aphasic Depression Questionnaire, Visual Analog Mood Scales ‘sad’ item, and Visual Analogue Self-Esteem Scale. Results: Participants were aged 29 to 94 years (mean 67.0, SD 13.5) and 66 (63%) were men. Regression analysis showed that at three months, when baseline values and communication impairment were controlled for, group allocation was a significant predictor of the Stroke Aphasic Depression Questionnaire (P < 0.05), visual analogue ‘sad’ (P = 0.03), and Visual Analogue Self-Esteem Scale (P < 0.01). At six months, group alone was a significant predictor of the Stroke Aphasic Depression Questionnaire (P < 0.05), and remained significant when baseline values were controlled for (P = 0.02). Mean Stroke Aphasic Depression Questionnaire 10-item hospital version scores decreased from baseline to six months by six points in the intervention group as compared with an increase of 1.9 points in the control group.
    • Commissioning vocational rehabilitation after stroke: Can the Cinderella services get to the ball? A qualitative study

      Crompton, Amanda; Stainer, Karen (2013)
      OBJECTIVE: To understand the barriers and enablers to commissioning vocational rehabilitation (VR) after stroke.
    • Mental Health Nurses; Meeting the psychological needs of stroke survivors

      Greensmith, Christopher (2013)
      Introduction: The National Stroke Strategy-2007 and Accelerated Stroke Improvement metrics state that 40% of all stroke patients should have their psychological needs reviewed within six months after stroke. In Nottingham this role is carried by a Specialist Mental Health Nurse as an integral part of amulti-disciplinary community stroke service. The aim of the study was to review whether a Mental Health Nurse led model meets the stroke strategy standard. Method: Routinely collected data from 426 patients collated over a 12 month period was audited. The percentage of patients who received a psychological assessment with the BASDEC tool was calculated and a review of the psychological interventions offered was conducted. Results: 90% of patients (n = 383) within the community stroke service were screened for mood disturbance. Patients who scored 5 or above (n = 144) were offered assessments and further psychological interventions. The main presenting symptoms were anxiety, panic, low mood and adjustment disorders. The majority of these patients relate to level 2 of the stepped care model for psychological intervention in stroke. Conclusion: Specialist Mental Health Nurses, operating within a community stroke service should be considered as a potential service model for meeting psychological needs of stroke survivors.
    • Stroke specific vocational rehabilitation (SSVR): A feasibility randomised controlled trial

      Sampson, Christopher J.; Rowley, Emma; Guo, Boliang (2013)
      Introduction: A quarter of UK strokes occur in working age people but fewer than half resume work. Rehabilitation frequently fails to address work needs and evidence for post-stroke vocational rehabilitation is lacking. This pilot trial tested the feasibility of delivering SSVR and measuring its effects and costs compared to usual care (UC). Method: Previously employed stroke survivors (SS) aged >16 recruited from a stroke unit were randomised to receive SSVR or UC. Exclusion criteria: refusing consent; not intending to work, medical preclusion. Primary outcomes: occupational and benefit status.Mood, function, participation, quality of life and resource use were measured using standardized and bespoke postal questionnaires at 3, 6 and 12 months. Service use was cross-referenced in 10% of participants and costs calculated. Results: 46/126 patients screened (36 men, mean 56 (SD 12.7, 18-78 years) were recruited in 15 months; 40 declined. Most (29) had NIHSS scores <15, were in professional roles (65%), self-employed (21.7) at onset. 32 were available at 12-month follow-up, with poorer response (61%) among UC. Intervention was successfully deployed in 22/23 cases. 39% returned to work at 12 months - twice as many in SSVR. Crossreferencing for 5 participants involved 51 phone calls, 23 letters/emails. Self-reported and actual service use data were discrepant. SS underestimated GP and consultant and overestimated therapy input. Conclusion: SSVR can be delivered and its effects/costs measured. Severe strokes and communication difficulties influenced participation. More reliable methods of capturing service use, income and benefit data and clearer definitions of work are needed. Findings inform the definitive trial.
    • Individual participant data meta-analyses should not ignore clustering

      Guo, Boliang (2013)
      Objectives: Individual participant data (IPD) meta-analyses often analyze their IPD as if coming from a single study. We compare this approach with analyses that rather account for clustering of patients within studies. Study Design and Setting: Comparison of effect estimates from logistic regression models in real and simulated examples. Results: The estimated prognostic effect of age in patients with traumatic brain injury is similar, regardless of whether clustering is accounted for. However, a family history of thrombophilia is found to be a diagnostic marker of deep vein thrombosis [odds ratio, 1.30; 95% confidence interval (CI): 1.00, 1.70; P = 0.05] when clustering is accounted for but not when it is ignored (odds ratio, 1.06; 95% CI: 0.83, 1.37; P = 0.64). Similarly, the treatment effect of nicotine gum on smoking cessation is severely attenuated when clustering is ignored (odds ratio, 1.40; 95% CI: 1.02, 1.92) rather than accounted for (odds ratio, 1.80; 95% CI: 1.29, 2.52). Simulations show models accounting for clustering perform consistently well, but downwardly biased effect estimates and low coverage can occur when ignoring clustering. Conclusion: Researchers must routinely account for clustering in IPD meta-analyses; otherwise, misleading effect estimates and conclusions may arise. &#xa9; 2013 Elsevier Inc. All rights reserved.
    • Occupational therapy predischarge home visits for patients with a stroke (HOVIS): Results of a feasibility randomized controlled trial

      Sampson, Christopher J. (2013)
      Objective: To assess the feasibility of conducting a randomized controlled trial of occupational therapy predischarge home visits for people after stroke. Design: Randomized controlled trial and cohort study. We randomized eligible patients for whom there was clinical uncertainty about the need to conduct a home visit to a randomized controlled trial; patients for whom a visit was judged 'essential' were enrolled into a cohort study. Setting: Stroke rehabilitation unit of teaching hospital. Participants: One hundred and twenty-six participants hospitalized following recent stroke. Interventions: Predischarge home visit or structured, hospital-based interview. Main outcome measures: The primary objective was to collect information on the feasibility of a randomized controlled trial, including eligibility, control intervention and outcome assessments. The primary outcome measure was the Nottingham Extended Activities of Daily Living Scale at one month after discharge from hospital. Secondary outcomes included mood, quality of life and costs at one week and one month following discharge. Results: Ninety-three people were allocated to the randomized controlled trial; 47 were randomized to intervention and 46 to control. Thirty-three were enrolled into the cohort study. More people were allocated to the randomized controlled trial as the study progressed. One hundred and thirteen people (90%) received the proposed intervention, although there was a need for stricter protocol adherence. Follow-up was good: at one month 114 (90%) were assessed. There were no significant differences between the groups in the randomized controlled trial for the primary outcome measure at one month. The average cost of a home visit was 208. Conclusion: A trial is feasible and warranted given the resource implications of predischarge occupational therapy home visits. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Is early supported discharge still beneficial in practice?

      Byrne, Adrian (2014)
      Introduction: Randomised controlled trials have shown the benefits of Stroke Early Supported Discharge (ESD). Whether ESD is still beneficial when operating in the unpredictable context of frontline healthcare provision remains unknown. Aim: to evaluate the effectiveness of ESD services operating in practice using a cohort study with quasi experimental design. Methods: 293 stroke survivors (transfer independently or with assistance of one, identified rehabilitation goals) within 2 naturally formed groups were recruited from 2 acute stroke units: 'ESD' n = 135 and 'Non ESD' n = 158 and 84 caregivers. The 'ESD' group accessed either of 2 ESD services operating in Nottinghamshire. The 'Non ESD' group (no ESD access as GP practice 'out of area') experienced standard practices for discharge and onward referral. Primary outcome measure: Barthel Index measure. Results: The ESD group had a significantly shorter length of hospital stay (p = 0.029) and reported significantly higher levels of satisfaction with services received (p < 0.01). Following adjustment for age differences at baseline, participants in the ESD group (n = 71) had significantly higher odds (compared to the Non ESD group) of being in the >90 Barthel Index category at 6 weeks (OR = 1.557, 95% CI 2.579 to 8.733), 6 months (OR = 1.541, 95% CI 2.617 to 8.340) and 12 months (OR 0.837, 95% CI 1.306 to 4.087) respectively in relation to baseline. Carers of patients accessing ESD services showed significant improvement in mental health scores (p < 0.01). Discussion: The health benefits of ESD are still evident when evidence based models of these services are implemented in clinical practice.