BACKGROUND: Conventional insulin therapy requires patients with Type 1 diabetes to adhere to rigid dietary and insulin injection practices. Recent trends towards flexible intensive insulin therapy enable patients to match insulin to dietary intake and lifestyle; however, little work has examined patients' experiences of incorporating these practices into real-life contexts. This qualitative longitudinal study explored patients' experiences of using flexible intensive insulin therapy to help inform the development of effective long-term support. METHODS: Semi-structured interviews were conducted with 30 adult patients with Type 1 diabetes following participation in a structured education programme on using flexible intensive insulin therapy, and 6 and 12 months post-course. Longitudinal data analysis used an inductive, thematic approach. RESULTS: Patients consistently reported feeling committed to and wanting to sustain flexible intensive insulin therapy. This regimen was seen as a logical and effective method of self-management, as patients experienced improved blood glucose readings and/or reported feeling better. Implementing and sustaining flexible intensive insulin therapy was enhanced when patients had stable routines, with more challenges reported by those working irregular hours and during weekends/holidays. Some patients re-crafted their lives to make this approach work for them; for instance, by creating dietary routines or adjusting dietary choices. CONCLUSIONS: Clinical data have shown that flexible intensive insulin therapy can lead to improvement in glycaemic control. This study, drawing on patients' perspectives, provides further endorsement for flexible intensive insulin therapy by demonstrating patients' liking of, and their motivation to sustain, this approach over time. To help patients implement and sustain flexible intensive insulin therapy, follow-up support should encourage them to identify routines to better integrate this regimen into their lives.
Aims: Despite improvements in insulin therapy, hypoglycaemia remains an inevitable part of life for many people with Type 1 diabetes. Little attention has been paid to how individuals self-treat hypoglycaemia and their likes and dislikes of clinically recommended treatments. We explored participants' experiences of self-treating hypoglycaemia after attending a structured education programme for people with Type 1 diabetes. Our aims were: to identify treatments that are acceptable to people with Type 1 diabetes; and to provide recommendations for promoting self-treatment in line with clinical guidelines. Methods: Thirty adults with Type 1 diabetes were recruited from the Dose Adjustment for Normal Eating (DAFNE) programme in the UK. Study participants were interviewed post-course and 6 and 12 months later, enabling their experiences to be explored over time. Results: Study participants described a poor knowledge of how to self-treat hypoglycaemia correctly pre-course. Post-course, individuals often struggled to adhere to clinically recommended guidelines because of: panic, disorientation, hunger sensations and consequent difficulties ingesting fixed quantities of fast-acting carbohydrate; use of sweets to manage hypoglycaemia; reversion to habituated practices when cognitive impairment as a result of hypoglycaemia supervened; difficulties ingesting dextrose tablets; and other people's anxieties about under-treatment. Conclusions: Historical experiences of hypoglycaemia and habituated practices can influence present self-treatment approaches. Professionals need to be aware of the range of difficulties individuals may experience restricting themselves to fixed quantities of fast-acting carbohydrate to manage hypoglycaemia. There may be merit in developing a more acceptable range of treatments tailored to people's own preferences, circumstances and needs. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.
OBJECTIVE To determine whether improvements in glycemic control and diabetes-specific quality of life (QoL) scores reported in research studies for the type 1 diabetes structured education program Dose Adjustment for Normal Eating (DAFNE) are also found when the intervention is delivered within routine U.K. health care. RESEARCH DESIGN AND METHODS Before and after evaluation of DAFNE to assess impact on glycemic control and QoL among 262 adults with type 1 diabetes.RESULTS There were significant improvements in hemoglobin A(1c) from baseline to 6 and 12 months (from 9.1 to 8.6 and 8.8%, respectively) in a subgroup with suboptimal control. QoL was significantly improved by 3 months and maintained at both follow-up points. CONCLUSIONS Longer term improved glycemic control and QoL is achievable among adults with type 1 diabetes through delivery of structured education in routine care, albeit with smaller effect sizes than reported in trials.
Background: Structured education programmes for patients with diabetes and other chronic conditions are being widely adopted. However, follow-up studies suggest that course graduates may struggle to sustain the self-care practices taught on their courses over time. This study explored the support needs of patients with type 1 diabetes after attending a structured education programme promoting an empowerment approach and training in use of flexible intensive insulin therapy, a regimen now widely advocated and used to manage this condition. The objective was to inform future support offered to course graduates. Methods. Repeat, in-depth interviews with 30 type 1 diabetes patients after attending Dose Adjustment for Normal Eating (DAFNE) courses in the UK, and six and 12months later. Data were analysed using an inductive, thematic approach. Results: While the flexible intensive insulin treatment approach taught on DAFNE courses was seen as a logical and effective way of managing ones diabetes, it was also considered more technically complex than other insulin regimens. To sustain effective disease self-management using flexible intensive insulin treatment over time, patients often expected, and needed, on-going input and support from health care professionals trained in the approach. This included: help determining insulin dose adjustments; reassurance; and, opportunities to trouble-shoot issues of concern. While some benefits were identified to receiving follow-up support in a group setting, most patients stated a preference or need for tailored and individualised support from appropriately-trained clinicians, accessible on an as and when needed basis. Conclusions: Our findings highlight potential limitations to group-based forms of follow-up support for sustaining diabetes self-management. To maintain the clinical benefits of structured education for patients with type 1 diabetes over time, course graduates may benefit from and prefer ongoing, one-to-one support from health care professionals trained in the programmes practices and principles. This support should be tailored and personalised to reflect patients specific and unique experiences of applying their education and training in the context of their everyday lives, and could be the subject of future research. © 2012 Rankin et al.; licensee BioMed Central Ltd.
Research demonstrates that patients have a poor understanding of glycosylated haemoglobin A1c (HbA1c) and that this impacts on effective diabetes self-management. This study attempted to replicate these findings in a UK outpatient sample of people with diabetes.
Few studies have identified determinants of glycemic control (HbA1c) and diabetes-specific quality of life (DSQoL) in adults with type 1 diabetes. To identify factors predicting outcomes following structured diabetes education. 262 participants completed biomedical and questionnaire assessments before, and throughout 1 year of follow-up. The proportion of variance explained ranged from 28 to 62 % (DSQoLS) and 14-20 % (HbA1c). When change in psychosocial variables were examined, reduced hypoglycemia fear, lower 'perceived diabetes seriousness', greater self-efficacy and well-being predicted QoL improvements from baseline to 3-months. Increased frequency of blood glucose testing predicted improvements in HbA1c from baseline to 6-months. Greater benefits may be achieved if programs focus explicitly on psychosocial factors. Self-care behaviours did not predict HbA1c suggesting existing assessment tools need refinement. Evaluation of treatment mechanisms in selfmanagement programs is recommended.
OBJECTIVES: Psychiatric morbidity among the physically ill is an important issue, particularly in the light of research documenting the difficulties in accurately diagnosing and effectively treating psychiatric disorders in this group. The objectives of this study were: (1) To compare psychiatric morbidity in 11 physical conditions and a healthy comparison group. (2) To compare psychiatric morbidity between respondents with one of the 11 illnesses to those with more than one physical illness. DESIGN: The sample was derived from the cross-sectional Household Survey of Psychiatric Morbidity. METHODS: Psychiatric morbidity (excluding psychosis) was assessed by interview using the revised Clinical Interview Schedule (CIS-R) and physical illness through self-report in 10,108 adults. RESULTS: Eight of the 11 illness groups were more likely to be classified as having psychiatric morbidity on the CIS-R than the physically healthy group. There were no differences in psychiatric morbidity between the different illness groups. The presence of more than one physical illness significantly increased the likelihood of psychiatric morbidity in 10 of the 11 groups. CONCLUSIONS: This study further supports the association between physical and psychiatric illness. Importantly, it suggests an increased likelihood of psychiatric morbidity in the presence of more than one physical condition.
BACKGROUND: Stroke is a leading cause of mortality and disability across the globe. Emergency Medical Services assess and transport a large number of these patients in the prehospital setting. Guidelines for UK ambulance services recommend recording a 12-lead electrocardiogram in the prehospital environment, providing this does not add to significant delay in transporting the patient to hospital; however, this recommendation is not based on any evidence. METHODS: A systematic review was conducted to search and synthesise the literature surrounding the use of prehospital electrocardiograms in acute stroke patients, focusing on the prevalence of abnormalities and their association with prognosis and outcome. Online databases, references from selected articles and hand searches were made to identify eligible studies. Two authors independently reviewed the studies to ensure eligibility criteria were met. Main outcomes were presence of abnormality on electrocardiogram, mortality and disability. No studies set in the prehospital environment were found by the search; therefore the eligibility criteria were widened to include hospital-based studies. A total of 18 studies were subsequently included in the review. RESULTS: Although the prevalence of electrocardiogram abnormalities appears common in hospitalised patients, their prognostic impact on mortality, disability and other adverse outcomes is conflicting amongst the literature. There is a lack of research surrounding the use of prehospital electrocardiogram in acute stroke patients. CONCLUSION: Future studies should be based in the prehospital environment and should investigate whether undertaking an electrocardiogram in the prehospital setting affects clinical management decisions or has an association with mortality or morbidity.
The purpose of this study was to examine self-management and educational interventions developed to support people with inflammatory bowel disease (IBD) and to identify which type of intervention seems to be most effective. The search was deliberately overinclusive to capture studies that evaluated educational and self-management interventions. The following databases were searched: MEDLINE, Embase, CINAHL, PsycINFO, the National Research Register, and Cochrane. Twenty-three studies were included. Thirteen of these were randomized controlled trials. The content of the interventions reviewed varied widely. As expected, it is the three studies that have explicitly labeled themselves as self-management interventions that have incorporated the greatest number of self-management techniques. Two of these studies reported the greatest number of improved outcomes in relation to symptom reporting, psychological well-being, and healthcare resource use. There is clearly a role for information in IBD, but this review supports research in other conditions that shows that education cannot be assumed to lead to improvements in health and well-being. Much of the research in this area focuses on education rather than self-management. Where self-management techniques have been applied, the findings tend to be more promising. Gastroenterology nurses (or in the United Kingdom, IBD specialist nurses) may be best placed to facilitate self-management in this group.
L Grant, J Lawton, D Hopkins, J Elliott, S Lucas, M Clark, I MacLellan, M Davies, S Heller, D Cooke (2013)Type1 diabetes structured education: what are the core self-management behaviours?, In: DIABETIC MEDICINE30(6)pp. 724-730
We assessed temporal trends in diabetes prevalence and key diabetes risk factors (obesity, physical activity, smoking) over 5 years in a nationally representative sample.
SP Newman, D Cooke, A Casbard, S Walker, S Meredith, A Nunn, L Steed, A Manca, M Sculpher, M Barnard, D Kerr, J Weaver, J Ahlquist, SJ Hurel (2009)A randomised controlled trial to compare minimally invasive glucose monitoring devices with conventional monitoring in the management of insulin-treated diabetes mellitus (MITRE)., In: Health Technol Assess13(28)pp. iii-194
To evaluate whether the additional information provided by minimally invasive glucose monitors results in improved glycaemic control in people with poorly controlled insulin-requiring diabetes, and to assess the acceptability and health economic impact of the devices.
Objective: Research demonstrates that patients have a poor understanding of glycosylated haemoglobin A1c (HbA1c) and that this impacts on effective diabetes self-management. This study attempted to replicate these findings in a UK outpatient sample of people with diabetes. Method: 83 participants were recruited and asked to fill in a questionnaire assessing their understanding of HbA1c, diabetes self-care behaviours and diabetes-specific self-efficacy in relation to carrying out these self-care behaviours. Results: Only 26.5% of the participants were classified as having a good understanding of HbA1c. Correlational and univariate analyses indicated that this level of understanding was related to demographic variables, HbA1c levels and certain aspects of self-care and self-efficacy. A series of multiple regressions found that understanding was a significant predictor of HbA1c levels. Conclusion: The majority of participants seemed to have a poor understanding of HbA1c and this was related to aspects of their diabetes management, self-efficacy and HbA1c levels. Practical implications: These findings provide support for the application of programmes and initiatives aimed at improving patients understanding of clinical disease markers. © 2009 Elsevier Ireland Ltd.twofold: first, to investigate the acceptability of two continuous glucose monitoring devices for people with diabetes; and second, to develop a valid questionnaire measure to assess the acceptability of continuous glucose monitoring devices.
D Cooke, SJ Hurel, A Casbard, L Steed, S Walker, S Meredith, AJ Nunn, A Manca, M Sculpher, M Barnard, D Kerr, JU Weaver, J Ahlquist, SP Newman (2009)Randomized controlled trial to assess the impact of continuous glucose monitoring on HbA(1c) in insulin-treated diabetes (MITRE Study)., In: Diabet Med26(5)pp. 540-547
To determine whether continuous glucose information provided through use of either the GlucoWatch G2 Biographer or the MiniMed continuous glucose monitoring system (CGMS) results in improved glycated haemoglobin (HbA(1c)) for insulin-treated adults with diabetes mellitus, relative to an attention control and standard care group.
Childhood obesity predicts the risk of adult adiposity, which is associated with the earlier onset of cardiovascular disease [adult atherosclerotic cardiovascular disease, ACVD: hypertension, increased carotid intima media thickness (CIMT) stroke, ischemic heart disease (IHD)] and dysglycemia. Because it is not known whether childhood obesity contributes to these diseases, we conducted a systematic review of studies that examine the ability of measures of obesity in childhood to predict dysglycemia and ACVD. Data sources were: Web of Science, MEDLINE, PubMed, CINAHL, Cochrane, SCOPUS, ProQuest, and reference lists. Studies measuring BMI, SF, and WC were selected; of 1954 studies, 18 met study criteria. Results: Childhood BMI predicted CIMT: OR, 3.39 (95% CI, 2.02 to 5.67, P <0.001) and risk of impaired glucose tolerance in adulthood, but its ability to predict ACVD events (stroke, IHD; OR, 1.04; 95% CI, 1.02 to 1.07; P<0.001) and hypertension (OR, 1.17, 95% CI 1.06 to 1.27, P = 0.003), was weak-moderate. BMI was not predictive of systolic BP (r -0.57, P =0.08) and weakly predicted diastolic BP (r 0.21, P =0.002). SF in childhood weakly predicted CIMT in female adults only (r58 s0.09, P <0.05). Conclusion: Childhood BMI predicts the risk of dysglycemia and abnormal CIMT in adulthood but its ability to predict hypertension and ACVD events was weak and moderate respectively. SF was a weak predictor of CIMT in female adults.
K Griva, J Stygall, MH Wilson, D Martin, D Levett, K Mitchell, M Mythen, HE Montgomery, MP Grocott, G Aref-Adib, M Edsell, T Plant, C Imray, DD Cooke, J Harrington, M Khosravi, SP Newman (2017)Caudwell Xtreme Everest: A prospective study of the effects of environmental hypoxia on cognitive functioning, In: PLoS One12(3)pp. e0174277-e0174277
Public Library of Science (PLoS)
Background The neuropsychological consequences of exposure to environmental hypobaric hypoxia (EHH) remain unclear. We thus investigated them in a large group of healthy volunteers who trekked to Mount Everest base camp (5,300 m). Methods A neuropsychological (NP) test battery assessing memory, language, attention, and executive function was administered to 198 participants (age 44.5±13.7 years; 60% male). These were studied at baseline (sea level), 3,500 m (Namche Bazaar), 5,300 m (Everest Base Camp) and on return to 1,300 m (Kathmandu) (attrition rate 23.7%). A comparable control group (n = 25; age 44.5±14.1 years; 60% male) for comparison with trekkers was tested at/or near sea level over an equivalent timeframe so as to account for learning effects associated with repeat testing. The Reliable Change Index (RCI) was used to calculate changes in cognition and neuropsychological function during and after exposure to EHH relative to controls. Results Overall, attention, verbal ability and executive function declined in those exposed to EHH when the performance of the control group was taken into account (RCI .05 to -.95) with decline persisting at descent. Memory and psychomotor function showed decline at highest ascent only (RCI -.08 to -.56). However, there was inter-individual variability in response: whilst NP performance declined in most, this improved in some trekkers. Cognitive decline was greater amongst older people (r = .42; p < .0001), but was otherwise not consistently associated with socio-demographic, mood, or physiological variables. Conclusions After correcting for learning effects, attention, verbal abilities and executive functioning declined with exposure to EHH. There was considerable individual variability in the response of brain function to sustained hypoxia with some participants not showing any effects of hypoxia. This might have implications for those facing sustained hypoxia as a result of any disease.
Self-management interventions have become increasingly popular in the management of long term health conditions; however, little is known about their impact on psychological well-being in people with Multiple Sclerosis (MS). Purpose
To examine the effectiveness of self-management interventions on improving depression, anxiety and health related quality of life in people with MS. Method
A structured literature search was conducted for the years 2000 to 2016. The review process followed the PRISMA guidelines, and is registered with PROSPERO (no. CRD42016033925). Results
The review identified 10 RCT trials that fulfilled selection criteria and quality appraisal. Self-management interventions improved health-related quality of life in 6 out of 7 studies, with some evidence of improvement in depression and anxiety symptoms. Conclusion
Although the results are promising more robust evaluation is required in order to determine the effectiveness of self-management interventions on depression, anxiety and quality of life in people with MS. Evaluation of the data was impeded by a number of methodological issues including incomplete content and delivery information for the intervention and the exclusion of participants representing the disease spectrum. Recommendations are made for service development and research quality improvement.
AIMS: Use of blood glucose targets is considered essential to help patients with Type 1 diabetes achieve tight glycaemic control following structured education. To foster effective use of blood glucose targets, we explored patients' experiences and views of implementing clinically recommended blood glucose targets after attending a structured education programme promoting intensive insulin treatment. METHODS: Repeat, in-depth interviews with 30 patients with Type 1 diabetes recruited from Dose Adjustment for Normal Eating (DAFNE) courses in the UK. Data were analysed using an inductive, thematic approach. RESULTS: Patients found use of blood glucose targets motivational. Targets enabled patients to identify problems with blood glucose control and prompted them to make insulin dose adjustments independently, or with assistance. However, patients tended to adapt or simplify targets over time to: make them more attainable and easy to remember; reduce risk of hypoglycaemia; and, mitigate feelings of failure when attempts to attain clinically defined targets were unsuccessful. Some patients were advised to use elevated targets to counter hypoglycaemia unawareness and required help from health professionals to determine when/if these should be reduced. CONCLUSIONS: Although blood glucose targets are an important component of diabetes self-management, patients may adapt and personalize them over time, sometimes inadvertently, with a potentially detrimental impact on long-term glycaemic control. Blood glucose targets should be regularly revisited during clinical reviews and revised/new targets agreed to accommodate patients' concerns and difficulties. Other interventions may need to be considered to promote effective use of blood glucose targets.
Jane Frankland, Hazel Brodie, Deborah Cooke, Claire Foster, Rebecca Foster, Heather Gage, Jake Jordan, Ines Mesa-Eguiagaray, Ruth Pickering, Alison Richardson (2017)Follow-up care after treatment for prostate cancer: protocol for an evaluation of a nurse-led supported self-management and remote surveillance programme, In: BMC Cancer17(656)
Background: As more men survive a diagnosis of prostate cancer, alternative models of follow-up care that address men’s enduring unmet needs and are economical to deliver are needed. This paper describes the protocol for an ongoing evaluation of a nurse-led supported self-management and remote surveillance programme implemented within the secondary care setting.
Methods/design: The evaluation is taking place within a real clinical setting, comparing the outcomes of men enrolled in the Programme with the outcomes of a pre-service change cohort of men, using a repeated measures design. Men are followed up at four and eight months post recruitment on a number of outcomes, including quality of life, unmet need, psychological wellbeing and activation for self-management. An embedded health economic analysis and qualitative evaluation of implementation processes are being undertaken.
Discussion: The evaluation will provide important information regarding the effectiveness, cost effectiveness and implementation of an integrated supported self-management follow-up care pathway within secondary care.
DD Cooke, S Newman (2009)Concluding Chapter, In: Self-Management in Chronic, Physical Illness
Purpose: This study reports an innovative theory-driven approach for developing filmed peer support for cancer self-management. Peer support conventionally includes empathetic interaction between people with shared experiences. This unique study considers how to authentically communicate peer empathy in a one-way film narrative. Methods: We co-created a film based on phenomenological interviews with seven men who had volunteered to support other men by sharing their experiences of coping with prostate cancer. The film contributed to successful engagement with self-management. Interpretative Phenomenological Analysis of the interview data was conducted to explore the components of experiential empathy that the men had communicated. Results: Four themes were identified illustrating what men wanted other men to know about coping with prostate cancer: Going into the unknown, it was difficult but I got through highlighted trauma and the importance of having a determined attitude; Only you can do it illustrated the triumph of their journey and of regaining control; I haven’t changed massively reflected the importance of a constant self; and Stay involved represented the overriding need to remain part of pre-cancer social environments. Conclusions: We propose a construct framework of experiential empathy for men with prostate cancer: Resilience, Regaining Control, Continuity-of-Self and Social Connectedness. Filmed peer support that communicates these constructs will offer wide-ranging benefit to meet the needs of this group of men in both e-health and face-to-face self-management contexts. Further research could develop this theory-driven approach to filmed peer support for other cancer groups.
S Heller, J Lawton, S Amiel, DD Cooke, P Mansell, A Brennan, J Elliott, J Boote, C Emery, W Baird, H Basarir, S Beveridge, R Bond, M Campbell, T Chater, P Choudhary, M Clark, N de Zoysa, S Dixon, C Gianfrancesco, D Hopkins, R Jacques, J Kruger, S Moore, L Oliver, T Peasgood, D Rankin, S Roberts, H Rogers, C Taylor, P Thokala, G Thompson, C Ward (2014)Improving management of type 1 diabetes in the UK: the Dose Adjustment For Normal Eating (DAFNE) programme as a research test-bed. A mixed-method analysis of the barriers to and facilitators of successful diabetes self-management, a health economic analysis, a cluster randomised controlled trial of different models of delivery of an educational intervention and the potential of insulin pumps and additional educator input to improve outcomes, In: Programme Grants for Applied Research2(5)
National Institute for Health Research
Improving management of type 1 diabetes in the UK: the Dose Adjustment For Normal Eating (DAFNE) programme as a research test-bed. A mixed-method analysis of the barriers to and facilitators of successful diabetes self-management, a health economic analysis, a cluster randomised controlled trial of different models of delivery of an educational intervention and the potential of insulin pumps and additional educator input to improve outcomes.
AIM: To explore whether, and why, patients change their food and eating practices following conversion to flexible intensive insulin therapy (FIIT), a regimen which requires quick acting insulin doses to be matched to the carbohydrate content of meals/snacks consumed. METHODS: repeat, in-depth interviews with 30 type 1 diabetes patients converted to FIIT recruited from Dose Adjustment for Normal Eating (DAFNE) courses in the UK. Data were analysed using an inductive, thematic approach. RESULTS: despite the potential of FIIT to enable greater dietary flexibility and freedom, most patients reported food and eating practices which were remarkably resistant to change. In some cases, FIIT adoption resulted in greater dietary rigidity over time. The opportunities FIIT presented for greater dietary freedom were counterbalanced by new challenges and burdens (e.g. having to simplify food choices to make carbohydrate estimation easier). Due to the emphasis FIIT places on carbohydrate counting, and patients' fears of hypos, low/no carbohydrate foodstuffs sometimes came to be seen as the healthiest or safest options. CONCLUSION: concerns that FIIT may result in more excessive or unhealthy eating appear largely unfounded; however, consideration needs to be paid to the ways in which patients' conceptualisations of, and relationship with, food may change following FIIT conversion.
D Rankin, K Barnard, J Elliott, D Cooke, S Heller, C Gianfrancesco, C Taylor, J Lawton (2014)Type 1 diabetes patients' experiences of, and need for, social support after attending a structured education programme: a qualitative longitudinal investigation, In: JOURNAL OF CLINICAL NURSING23(19-20)pp. 2919-2927
D Cooke, P James, J Frankland, R Foster, C Marsh, J Cockle-Hearne, C Foster, M Benney, H Brodie, A Richardson (2015)Transitioning Men with Prostate Cancer, after Treatment, to Remote Monitoring and Followup: Development and Preliminary Evaluation of a Supported Self-management Workshop, In: PSYCHO-ONCOLOGY24pp. 292-292
Aims: To examine predictors of quality of life gains among people with type 1 diabetes following the Dose Adjustment for Normal Eating (DAFNE) self-management training programme. Methods: Clinical and questionnaire data were collected from 437 patients from 6 hospital centres before, and 18 months post-DAFNE intervention. Glycated haemoglobin (HbA ), weight, height, and blood pressure levels were recorded by clinicians during clinic appointments. Questionnaires included the Diabetes-Specific Quality of Life Scale (DSQOLS), the Problem Areas in Diabetes Scale (PAID) and the Hospital Anxiety and Depression Scale (HADS). Basic demographics were recorded at baseline. Linear mixed models were fitted to identify predictors of change in quality of life at an 18 month follow-up assessment. Results: Patients with high levels of diabetes-related distress experienced greatest improvement in DSQOLS quality of life scores (p = 0.001). Patients with poor glycaemic control (higher levels of HbA ; p = 0.03) and those with high levels of anxiety (p = 0.001) experienced the greatest reductions in diabetes-related distress. Conclusions: Patients with higher baseline levels of anxiety, higher levels of diabetes-related distress and higher baseline levels of HbA are most likely to experience quality of life gain from participation in self-management programmes such as DAFNE. © 2012 Elsevier Ireland Ltd. All rights reserved.
Jane Frankland, Hazel Brodie, Debbie Cooke, Claire Foster, Rebecca Foster, Heather Gage, Jake Jordan, Ines Mesa-Eguiagaray, Ruth Pickering, Alison Richardson (2019)Follow-up care after treatment for prostate cancer: evaluation of a supported self-management and remote surveillance programme, In: BMC Cancer19(1)
Alternative models of cancer follow-up care are needed to ameliorate pressure on services and better meet survivors’ long-term needs. This paper reports an evaluation of a service improvement initiative for the followup care of prostate cancer patients based on remote monitoring and supported self-management.
This multi-centred, historically controlled study compared patient reported outcomes of men experiencing the new Programme with men experiencing a traditional clinic appointment model of follow-up care, who were recruited in the period immediately prior to the introduction of the Programme. Data were collected by self-completed questionnaires, with follow up measurement at four and eight months post-baseline. The primary outcome was men’s unmet survivorship needs, measured by the Cancer Survivors’ Unmet Needs Survey. Secondary outcomes included cancer specific quality of life, psychological wellbeing and satisfaction with care. The analysis was intention to treat. Regression analyses were conducted for outcomes at each time point separately, controlling for pre-defined clinical and demographic variables. All outcome analyses are presented in the paper. Costs were compared between the two groups. Results: Six hundred and twenty-seven men (61%) were consented to take part in the study (293 in the Programme and 334 in the comparator group.) Regarding the primary measure of unmet survivorship needs, 25 of 26 comparisons favoured the Programme, of which 4 were statistically significant. For the secondary measures of activation for self-management, quality of life, psychological well-being and lifestyle, 20 of 32 comparisons favoured the Programme and 3 were statistically significant. There were 22 items on the satisfaction with care questionnaire and 13 were statistically significant. Per participant costs (British pounds, 2015) in the 8 month follow up period were slightly lower in the programme than in the comparator group (£289 versus £327). The Programme was acceptable to patients.
The Programme is shown to be broadly comparable to traditional follow-up care in all respects, adding to evidence of the viability of such models.
Background: Universities in the United Kingdom (UK) are required to incorporate values based recruitment (VBR) into their healthcare student selection processes. This reflects an international drive to strengthen the quality of healthcare service provision. This paper presents novel findings in relation to the reliability and predictive validity of multiple mini interviews (MMIs); one approach to VBR widely being employed by universities. Objectives: To examine the reliability (internal consistency) and predictive validity of MMIs using end of Year One practice outcomes of under-graduate pre-registration adult, child, mental health nursing, midwifery and paramedic practice students. Design: Cross-discipline evaluation study. Setting: One university in the United Kingdom. Participants: Data were collected in two streams: applicants to A) The September 2014 and 2015 Midwifery Studies programmes; B) September 2015 adult; Child and Mental Health Nursing and Paramedic Practice programmes. Fifty-seven midwifery students commenced their programme in 2014 and 69 in 2015; 47 and 54 agreed to participate and completed Year One respectively. 333 healthcare students commenced their programmes in September 2015. Of these, 281 agreed to participate and completed their first year (180 adult, 33 child and 34 mental health nursing and 34 paramedic practice students). Methods: Stream A featured a seven station four-minute model with one interviewer at each station and in Stream B a six station model was employed. Cronbach’s alpha was used to assess MMI station internal consistency and Pearson’s moment correlation co-efficient to explore associations between participants’ admission MMI score and end of Year one clinical practice outcomes (OSCE and mentor grading). Results: Stream A: Significant correlations are reported between midwifery applicant’s MMI scores and end of Year One practice outcomes. A multivariate linear regression model demonstrated that MMI score significantly predicted end of Year One practice outcomes controlling for age and academic entry level: coefficients 0.195 (p = 0.002) and 0.116 (p = 0.002) for OSCE and mentor grading respectively. In Stream B no significant correlations were found between MMI score and practice outcomes measured by mentor grading. Internal consistency for each MMI station was ‘excellent’ with values ranging from 0.966–0.974 across Streams A and B. Conclusion: This novel, cross-discipline study shows that MMIs are reliable VBR tools which have predictive validity when a seven station model is used. These data are important given the current international use of different MMI models in healthcare student selection processes.