• 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.;
    • 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.
    • 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.
    • Antidepressant use and risk of cardiovascular outcomes in people aged 20 to 64: Cohort study using primary care database

      Morriss, Richard K. (2016)
      OBJECTIVE: To assess associations between different antidepressant treatments and rates of three cardiovascular outcomes (myocardial infarction, stroke or transient ischaemic attack, and arrhythmia) in people with depression. DESIGN: Cohort study. SETTING: UK general practices contributing to the QResearch primary care database. PARTICIPANTS: 238,963 patients aged 20 to 64 years with a first diagnosis of depression between 1 January 2000 and 31 July 2011. EXPOSURES: Antidepressant class (tricyclic and related antidepressants, selective serotonin reuptake inhibitors, other antidepressants), dose, duration of use, and commonly prescribed individual antidepressant drugs. MAIN OUTCOME MEASURES: First diagnoses of myocardial infarction, stroke or transient ischaemic attack, and arrhythmia during five years' follow-up. Cox proportional hazards models were used to estimate hazard ratios, adjusting for potential confounding variables. RESULTS: During five years of follow-up, 772 patients had a myocardial infarction, 1106 had a stroke or transient ischaemic attack, and 1452 were diagnosed as having arrhythmia. No significant associations were found between antidepressant class and myocardial infarction over five years' follow-up. In the first year of follow-up, patients treated with selective serotonin reuptake inhibitors had a significantly reduced risk of myocardial infarction (adjusted hazard ratio 0.58, 95% confidence interval 0.42 to 0.79) compared with no use of antidepressants; among individual drugs, fluoxetine was associated with a significantly reduced risk (0.44, 0.27 to 0.72) and lofepramine with a significantly increased risk (3.07, 1.50 to 6.26). No significant associations were found between antidepressant class or individual drugs and risk of stroke or transient ischaemic attack. Antidepressant class was not significantly associated with arrhythmia over five years' follow-up, although the risk was significantly increased during the first 28 days of treatment with tricyclic and related antidepressants (adjusted hazard ratio 1.99, 1.27 to 3.13). Fluoxetine was associated with a significantly reduced risk of arrhythmia (0.74, 0.59 to 0.92) over five years, but citalopram was not significantly associated with risk of arrhythmia even at high doses (1.11, 0.72 to 1.71 for doses > 40 mg/day). CONCLUSIONS: This study found no evidence that selective serotonin reuptake inhibitors are associated with an increased risk of arrhythmia or stroke/transient ischaemic attack in people diagnosed as having depression between the ages of 20 to 64 or that citalopram is associated with a significantly increased risk of arrhythmia. It found some indication of a reduced risk of myocardial infarction with selective serotonin reuptake inhibitors, particularly fluoxetine, and of an increased risk with lofepramine.Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    • Antipyretic therapy in acute stroke

      Sharma, Jagdish C.; Ross, Ian N. (1998)
    • Behavioural activation therapy for post-stroke depression: the BEADS feasibility RCT

      das Nair, Roshan (2019)
      Background: There is currently insufficient evidence for the clinical effectiveness and cost-effectiveness of psychological therapies for post-stroke depression. Objective: To evaluate the feasibility of undertaking a definitive trial to evaluate the clinical effectiveness and cost-effectiveness of behavioural activation (BA) compared with usual stroke care for treating post-stroke depression. Design: Parallel-group, feasibility, multicentre, randomised controlled trial with nested qualitative research and a health economic evaluation. Setting: Acute and community stroke services in three sites in England. Participants: Community-dwelling adults 3 months to 5 years post stroke who are depressed, as determined by the Patient Health Questionnaire-9 (PHQ-9) or the Visual Analogue Mood Scales 'Sad' item. Exclusions: patients who are blind and/or deaf, have dementia, are unable to communicate in English, do not have mental capacity to consent, are receiving treatment for depression at the time of stroke onset or are currently receiving psychological intervention. Randomisation and blinding: Participants were randomised (1 : 1 ratio) to BA or usual stroke care. Randomisation was conducted using a computer-generated list with random permuted blocks of varying sizes, stratified by site. Participants and therapists were aware of the allocation, but outcome assessors were blind. Interventions: The intervention arm received up to 15 sessions of BA over 4 months. BA aims to improve mood by increasing people's level of enjoyable or valued activities. The control arm received usual care only. Main outcome measures: Primary feasibility outcomes concerned feasibility of recruitment to the main trial, acceptability of research procedures and measures, appropriateness of baseline and outcome measures, retention of participants and potential value of conducting the definitive trial. Secondary feasibility outcomes concerned the delivery of the intervention. The primary clinical outcome 6 months post randomisation was the PHQ-9. Secondary clinical outcomes were Stroke Aphasic Depression Questionnaire - Hospital version, Nottingham Leisure Questionnaire, Nottingham Extended Activities of Daily Living, Carer Strain Index, Euro-QoI 5 Dimensions, five-level version and health-care resource use questionnaire. Results: Forty-eight participants were recruited in 27 centre-months of recruitment, at a recruitment rate of 1.8 participants per centre per month. The 25 participants randomised to receive BA attended a mean of 8.5 therapy sessions [standard deviation (SD) 4.4 therapy sessions]; 23 participants were allocated usual care. Outcome assessments were completed by 39 (81%) participants (BA, n = 18; usual care, n = 21). Mean PHQ-9 scores at 6-month follow-up were 10.1 points (SD 6.9 points) and 14.4 points (SD 5.1 points) in the BA and control groups, respectively, a difference of -3.8 (95% confidence interval -6.9 to -0.6) after adjusting for baseline PHQ-9 score and centre, representing a reduction in depression in the BA arm. Therapy was delivered as intended. BA was acceptable to participants, carers and therapists. Value-of-information analysis indicates that the benefits of conducting a definitive trial would be likely to outweigh the costs. It is estimated that a sample size of between 580 and 623 participants would be needed for a definitive trial. Limitations: Target recruitment was not achieved, although we identified methods to improve recruitment. Conclusions: The Behavioural Activation Therapy for Depression after Stroke trial was feasible with regard to the majority of outcomes. The outstanding issue is whether or not a sufficient number of participants could be recruited within a reasonable time frame for a definitive trial. Future work is required to identify whether or not there are sufficient sites that are able to deliver the services required for a definitive trial.
    • A Biopsychosocial Intervention for Stroke Carers (BISC): development and description of the intervention

      Kontou, Eirini (2022)
      ABSTRACTObjective Family members of stroke survivors are often not supported for their caring role, with many reporting adjustment difficulties. This paper describes the development and content of a group-based intervention for informal carers of stroke survivors.Method The intervention is based on the theoretical foundation of the biopsychosocial model with the aim to understand and address the physical, psychological and social factors of caring for stroke survivors. Findings from a comprehensive literature review and a qualitative study with carers and stroke professionals were synthesized to guide the intervention development. The Template for Intervention Description and Replication (TIDieR) checklist was used as a framework to describe the intervention.Results The intervention integrates cognitive-behavioural approaches via the identification of the biopsychosocial (physical, emotional, social) factors that can have an impact on the well-being of carers. It includes education on stroke-specific topics and advice on coping strategies. It consists of six structured two-hour group sessions facilitated in a community setting. It provides information and support on adjusting to the caring role in the first year post-stroke. Intervention materials were designed for addressing carers? specific needs using psychological techniques, such as problem-solving, goal setting and relaxation exercises.Conclusion We have underlined the importance for describing and reporting the process of intervention development for complex interventions in the context of stroke rehabilitation. An intervention addressing the needs of informal stroke carers (Biopsychosocial Intervention for Stroke Carers; BISC) has been developed and described. BISC was further evaluated in a single-centre feasibility randomized controlled trial.
    • Biopsychosocial intervention for stroke carers (BISC): results of a feasibility randomised controlled trial and nested qualitative interview study

      Greensmith, Christopher; Kontou, Eirini (2020)
      OBJECTIVETo determine the feasibility of recruiting to and delivering a biopsychosocial intervention for carers of stroke survivors.DESIGNFeasibility randomised controlled study with nested qualitative interview study.SETTINGThe intervention was delivered in the community in either a group or one-to-one format.SUBJECTSCarers and stroke survivors within one year of stroke onset.INTERVENTIONSA carer targeted intervention delivered by a research psychologist in six structured two-hour sessions or usual care control. The intervention combined education about the biological, psychological and social effects of stroke with strategies and techniques focussing on adjustment to stroke and caregiving. Stroke survivors in both groups received baseline and follow-up assessment but no intervention.MAIN OUTCOMERecruitment rate, study attrition, fidelity of intervention delivery, acceptability and sensitivity of outcome measures used (health related quality of life, anxiety and depression and carer burden six months after randomisation).RESULTSOf the 257 carers approached, 41 consented. Six withdrew before randomisation. Eighteen participants were randomised to receive the intervention and 17 to usual care. Attendance at sessions was greater when treated one-to-one. Feedback interviews suggested that participants found the intervention acceptable and peer support particularly helpful in normalising their feelings. Thirty participants were assessed at follow-up with improvements from baseline on all health measures for both groups.CONCLUSIONSOur results suggest that a biopsychosocial intervention was acceptable to carers and can be delivered in group and one-to-one formats. Timing of approach and mode of intervention delivery is critical and requires tailoring to the carers individual needs.
    • Cardiovascular effects of stimulant and non-stimulant medication for children and adolescents with ADHD: A systematic review and meta-analysis of trials of methylphenidate, amphetamines and atomoxetine

      Hollis, Chris P. (2017)
      This article presents a review to evaluate potential cardiovascular effects of these treatments, the authors conducted a systematic review and meta-analysis of the effects of methylphenidate (MPH), amphetamines (AMP), and atomoxetine (ATX) on diastolic and systolic blood pressure (DBP, SBP) and heart rate (HR) in children and adolescents with attention deficit/hyperactivity disorder (ADHD). The authors conducted systematic searches in electronic databases (PsychINFO, EMBASE and Medline) to identify published trials which involved individuals who were (i) diagnosed with ADHD and were aged between 0–18 years; (ii) treated with MPH, AMP or ATX and (iii ) had their DBP and SBP and/or HR measured at baseline (pre) and the endpoint (post) of the study treatment. Eighteen clinical trials met the inclusion criteria (10 for MPH, 5 for AMP, and 7 for ATX) with data from 5837 participants (80.7% boys) and average duration of 28.7 weeks (range 4–96 weeks). Statistically significant pre–post increases of SBP, DBP and HR were associated with AMP and ATX treatment in children and adolescents with ADHD, while MPH treatment had a statistically significant effect only on SBP in these patients. These increases may be clinically significant for a significant minority of individuals that experience larger increases. Since increased BP and HR in general are considered risk factors for cardiovascular morbidity and mortality during adult life, pediatric patients using ADHD medication should be monitored closely and regularly for HR and BP. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    • Clinical and cost-effectiveness of adapted cognitive behaviour therapy for non-cardiac chest pain: A multicentre, randomised controlled trial

      Morriss, Richard K.; Guo, Boliang (2017)
      Objective To investigate the cost-effectiveness of a modified form of cognitive behavioural therapy (CBT) for recurrent non-cardiac chest pain. Methods We tested the effectiveness and cost-effectiveness of a modified form of CBT for chest pain (CBT-CP)(4-10 sessions) in patients who attended cardiology clinics or emergency medical services repeatedly. Patients were randomised using a remote web-based system to CBT-CP or to standard care in the clinic. Assessments were made at baseline and at 6 months and 12 months. The primary outcome was the change in the Health Anxiety Inventory Score at 6 months. Other clinical measures, social functioning, quality of life and costs of services were also recorded. Results Sixty-eight patients were randomised with low attrition rates at 6 months and 12 months with 81% of all possible assessments completed at 6 months and 12 months. Although there were no significant group differences between any of the outcome measures at either 6 months or 12 months, patients receiving CBT-CP had between two and three times fewer hospital bed days, outpatient appointments, and A&E attendances than those allocated to standard care and total costs per patient were £1496.49 lower, though the differences in costs were not significant. There was a small non-significant gain in quality adjusted life years in those allocated to CBT-CP compared with standard care (0.76 vs 0.74). Conclusions It is concluded that CBT-CP in the context of current hospital structures is not a viable treatment, but is worthy of further research as a potentially cost-effective treatment for non-cardiac chest pain. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017.
    • Clinical assessment of depth sensor based pose estimation algorithms for technology supervised rehabilitation applications

      Simcox, Christopher; Killick, Catherine; Hughes, Emma (2019)
      Encouraging rehabilitation by the use of technology in the home can be a cost-effective strategy, particularly if consumer-level equipment can be used. We present a clinical qualitative and quantitative analysis of the pose estimation algorithms of a typical consumer unit (Xbox One Kinect), to assess its suitability for technology supervised rehabilitation and guide development of future pose estimation algorithms for rehabilitation applications. We focused the analysis on upper-body stroke rehabilitation as a challenging use case. We found that the algorithms require improved joint tracking, especially for the shoulder, elbow and wrist joints, and exploiting temporal information for tracking when there is full or partial occlusion in the depth data.<br/>Copyright &#xa9; 2018 The Authors
    • 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.
    • Cognitive behaviour therapy for non-cardiac pain in the chest (COPIC): A multicentre randomized controlled trial with economic evaluation

      Kings, Stephanie; Lazarevic, Valentina; Bransby-Adams, Kate; Whittamore, Katherine; Walker, Gemma M.; Guo, Boliang (2015)
      BACKGROUND: Most patients with chest pain have nothing wrong with their cardiac function. Psychological forms of treatment for this condition are more likely to be successful than others. METHODS/DESIGN: A two-arm parallel controlled randomized trial of standard care versus a modified form of cognitive behaviour therapy for chest pain (CBT-CP) in patients who have attended emergency hospital services. Inclusion criteria include (i) emergency attendance more than once in the previous year with chest pain when no physical pathology has been found, (ii) aged between 16 and 75, (iii) signed consent to take part in the study. Exclusion criteria are (i) under current psychiatric care, (ii) those who have had new psychotropic drugs prescribed within the last two months, (iii) are receiving or about to receive a formal psychological treatment. Those satisfying these criteria will be randomized to 4-10 sessions of CBT-CP or to continue with standard care. Participants are randomized using a remote web-based system using permuted stacked blocks stratified by study centre. Assessment is carried out at baseline by researchers subsequently masked to allocation and at 6 months and 1 year after randomization. The primary outcome is the Health Anxiety Inventory score at 6 months, and secondary outcomes are generalised anxiety and depressive symptoms, the Lucock Health Anxiety Questionnaire adapted for chest pain, visual analogue scales for chest pain and discomfort (Inskip Scale), the Schedule for Evaluating Persistent Symptoms (SEPS), health related quality of life, social functioning and medical resource usage. Intention to treat analyses will be carried out with clinical and functioning data, and a cost-utility analysis will compare differences in total costs and differences in quality of life using QALYs derived from the EQ-5D. The data will also be linked to another parallel study in New Zealand where 126 patients with the same inclusion criteria have been treated in a similar trial; the form of analysis of the combined data has yet to be determined. DISCUSSION: The morbidity and costs of non-cardiac chest pain are substantial and if a simple psychological treatment given by health professionals working in medical departments is beneficial it should prove to be of great value. Combining data with a similar study in New Zealand is an additional asset. TRIAL REGISTRATION: ISRCTN14711101 (registered 05/03/2015).
    • 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.
    • 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.
    • Conceptual framework for personal recovery in patients with acute myocardial infarction

      Slade, Mike (2021)
      Background Although there has been movement in cardiology to advance patient-centered approaches to postacute myocardial infarction (AMI) care, work remains to be done in aligning patient preferences with clinical care. Our objective was to characterize patients' experience of AMI and treatment to develop a new conceptual framework of patient-centered recovery in cardiology. Methods and Results We conducted in-depth interviews with people who previously experienced an AMI (2016-2019). The interview focused on participants' experiences of their recovery, which were audio-recorded, transcribed verbatim, and analyzed using a phenomenological framework. The overarching theme described by the 42 participants was feeling like a "different person" after the AMI. This shift manifested itself in both losses and gains, each of which posed new challenges to everyday life. The experience appeared to be an active process requiring people to take responsibility for their health. In terms of loss, participants describe how the AMI threatened their sense of safety and security and led to social isolation, fragility, uncertainty about the future, and difficulty expressing emotions accompanied this new fear. A conceptual framework describing the relationship between AMI, identity change, and functioning was developed. Conclusions Participants experienced the AMI as an unexpected disruption in their lives that had far-reaching effects on their daily functioning, and were resolved in numerous ways. The conceptual framework may assist in providing a theoretical basis for future interventions in cardiology that not only engage and retain patients in care but also improve long-term adherence to secondary prevention and other aspects of self-care.
    • 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.
    • Effects of long-term methylphenidate use on growth and blood pressure: results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

      Hollis, Chris P.; Liddle, Elizabeth B. (2018)
      BACKGROUND: Concerns have been raised over the safety of methylphenidate (MPH), with regard to adverse effects on growth and blood pressure. Our study investigates whether, and to what extent, methylphenidate use in boys with ADHD is associated with having low body mass index (BMI), having low height, and increased systolic and diastolic blood pressure. METHODS: Data used for this study stem from the German KiGGS dataset. Three different groups of boys aged 6-15 years were included in the analysis: ADHD patients who used MPH for less than 12 months; ADHD patients who used MPH for 12 months or more; and ADHD patients without current MPH treatment. Each of these three groups was compared to a non-ADHD control group regarding low weight (BMI </= 3rd percentile), low height (</=3rd percentile) and raised systolic and diastolic blood pressure. For growth outcomes, boys were categorized according to age (< 11 years/>/=11 years, to account for pubertal maturation). Multivariable logistic regression was conducted to test for associations. RESULTS: 4244 boys were included in the study; MPH < 12 months: n = 65 (n = 36 < 11 years), MPH >/= 12 months: n = 53 (n = 22 < 11 years), ADHD controls: n = 320 (n = 132 < 11 years), non-ADHD controls: n = 3806 (n = 2003 < 11 years). Pre-pubertal boys with MPH use less than 12 months and pubertal/postpubertal boys with MPH use of 12 months or greater were significantly more likely to have a BMI </= 3rd percentile compared to non-ADHD controls. Boys from the ADHD control group were significantly less likely to have a raised systolic blood pressure compared to non-ADHD controls. Beyond that, no significant between group differences were observed for any other growth and BP parameter. CONCLUSION: The analyses of the KiGGS dataset showed that MPH use in boys with ADHD is associated with low BMI. However, this effect was only observed in certain groups. Furthermore, our analysis was unable to confirm that MPH use is also associated with low height (</=3rd percentile) and changes in blood pressure.
    • 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.