Publications by authors named "Matthew Hankins"

58 Publications

Observing bacterial membrane proteins in their quasi-natural habitat.

Nat Rev Microbiol 2020 12;18(12):676

Department of Biochemistry, University of Oxford, Oxford, UK.

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http://dx.doi.org/10.1038/s41579-020-00463-xDOI Listing
December 2020

The Medication Adherence Report Scale: A measurement tool for eliciting patients' reports of nonadherence.

Br J Clin Pharmacol 2020 07 18;86(7):1281-1288. Epub 2020 May 18.

Department of Practice and Policy, Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, London, UK.

Aims: This study aimed to establish the psychometric properties of a questionnaire measure of patients' adherence to medications to elicit patients' report of medication use in a variety of clinical samples. The reliability and validity were assessed in patients with hypertension. Additional analyses were performed on other patient groups.

Methods: Using a cross-sectional study design, a 10-item version of the Medication Adherence Report Scale (©Professor Rob Horne) was piloted in two samples of patients receiving treatment for hypertension (n = 50 + 178), asthma (n = 100) or diabetes (n = 100) at hospital outpatient or community clinics in London and the south-east of England. Following principal components analysis, five items were retained to form MARS-5 (©Professor Rob Horne). Evaluation comprised internal reliability, test-retest reliability, criterion-related validity (relationship with blood pressure control) and construct validity (relationship with patients' beliefs about medicines).

Results: The MARS-5 demonstrated acceptable reliability (internal and test-retest) and validity (criterion-related and construct validity) in these patient groups. Internal reliability (Cronbach's α) ranged from 0.67 to 0.89 across all patient groups; test-retest reliability (Pearson's r) was 0.97 in hypertension. Criterion-related validity was established with more adherent hypertension patients showing better blood-pressure control (χ = 4.24, df = 1, P < .05). Construct validity with beliefs about medicines was demonstrated with higher adherence associated with stronger beliefs in treatment necessity and lower treatment concerns.

Conclusions: The MARS-5 performed well on several psychometric indicators in this study. It shows promise as an effective self-report tool for measuring patients' reports of their medication use across a range of health conditions.
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http://dx.doi.org/10.1111/bcp.14193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319010PMC
July 2020

Barriers and facilitators of effective self-management in asthma: systematic review and thematic synthesis of patient and healthcare professional views.

NPJ Prim Care Respir Med 2017 Oct 9;27(1):57. Epub 2017 Oct 9.

Academic Unit of Psychology, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.

Self-management is an established, effective approach to controlling asthma, recommended in guidelines. However, promotion, uptake and use among patients and health-care professionals remain low. Many barriers and facilitators to effective self-management have been reported, and views and beliefs of patients and health care professionals have been explored in qualitative studies. We conducted a systematic review and thematic synthesis of qualitative research into self-management in patients, carers and health care professionals regarding self-management of asthma, to identify perceived barriers and facilitators associated with reduced effectiveness of asthma self-management interventions. Electronic databases and guidelines were searched systematically for qualitative literature that explored factors relevant to facilitators and barriers to uptake, adherence, or outcomes of self-management in patients with asthma. Thematic synthesis of the 56 included studies identified 11 themes: (1) partnership between patient and health care professional; (2) issues around medication; (3) education about asthma and its management; (4) health beliefs; (5) self-management interventions; (6) co-morbidities (7) mood disorders and anxiety; (8) social support; (9) non-pharmacological methods; (10) access to healthcare; (11) professional factors. From this, perceived barriers and facilitators were identified at the level of individuals with asthma (and carers), and health-care professionals. Future work addressing the concerns and beliefs of adults, adolescents and children (and carers) with asthma, effective communication and partnership, tailored support and education (including for ethnic minorities and at risk groups), and telehealthcare may improve how self-management is recommended by professionals and used by patients. Ultimately, this may achieve better outcomes for people with asthma.
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http://dx.doi.org/10.1038/s41533-017-0056-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634481PMC
October 2017

Early drug use of dapagliflozin prescribed by general practitioners and diabetologists in Germany.

Diabetes Res Clin Pract 2017 Mar 9;125:29-38. Epub 2016 Nov 9.

Medical Evidence & Observational Research, Global Medical Affairs, AstraZeneca, Mölndal, Sweden; Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address:

Objectives: Dapagliflozin is an inhibitor of the human sodium-glucose co-transporter 2 (SGLT2) that has been shown to improve glycaemic control in patients with type 2 diabetes mellitus (T2DM). This study aimed to evaluate the characteristics and treatment patterns of dapagliflozin users in comparison to users of other anti-diabetic (AD) treatments in Germany.

Methods: Data from patients with T2DM initiating at least one prescription for dapagliflozin or other AD therapy between November 2012 and April 2014 were collected from the IMS German Disease Analyzer database.

Results: The use of dapagliflozin combination therapy (n=1034; 74%) was more common than monotherapy (n=371; 26%). In comparison with other AD therapy users, a higher percentage of dapagliflozin users were ⩽64years of age (62.3% vs. 36.4%), and a higher proportion were male (59.1% vs. 53.6%). The average duration of diabetes was comparable between dapagliflozin patients and other AD therapy users (5.7yearsvs. 5.5years), however higher levels of HbA1c were found in dapagliflozin users (8.2% (66mmol/mol) vs. 7.5% (58mmol/mol). For the vast majority (71.5% of 10mg dapagliflozin users and 88.9% of 5mg users), dapagliflozin was prescribed in combination with other AD therapy.

Conclusions: Patients starting on dapagliflozin differed in several demographic and health-related respects to patients starting another AD therapy during the same period. Dapagliflozin was predominantly used as a component of combination therapy, adding on to existing therapy. After initiation, switching to other AD treatments or adding to therapy was comparatively rare during the first year.
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http://dx.doi.org/10.1016/j.diabres.2016.10.025DOI Listing
March 2017

Stress, Illness Perceptions, Behaviors, and Healing in Venous Leg Ulcers: Findings From a Prospective Observational Study.

Psychosom Med 2017 Jun;79(5):585-592

From the Institute of Pharmaceutical Science (Walburn, Weinman), Institute of Psychiatry, Psychology and Neuroscience, (Norton) King's College London; IMS Health (Hankins); School of Social and Community Medicine (Dawe), Faculty of Medicine and Dentistry (Banjoko), University of Bristol; and Division of Primary Care, School of Medicine (Vedhara), University of Nottingham, United Kingdom.

Objective: The aim of the study was to investigate the impact of stress, illness perceptions, and behaviors on healing of venous leg ulcers.

Methods: A prospective observational study of 63 individuals for 24 weeks investigated possible psychosocial predictors of healing. There were two indices of healing: rate of change in ulcer area and number of weeks to heal. Psychological variables were assessed at baseline using self-report measures (Perceived Stress Scale, Hospital Anxiety and Depression Scale, Revised Illness Perception Questionnaire, adapted Summary of Diabetes Self-Care Activities, Adherence Questionnaire, and Short-Form Health Survey).

Results: Controlling for sociodemographic and clinical variables, for the 24 weeks, a slower rate of change in ulcer area was predicted by greater stress (standardized β = -0.61, p = .008), depression (standardized β = -0.51, p = .039), and holding negative perceptions or beliefs about the ulcer (standardized β = -1.4, p = .045). By 24 weeks, 69% of ulcers had closed. A more negative emotional response to the ulcer at baseline (i.e., emotional representation of the ulcer) was associated with a greater number of weeks to heal (hazard ratio [HR] = 0.63, 95% confidence interval [CI] = 0.41-0.95, p = .028). Higher educational attainment (HR = 3.22, 95% CI = 1.37-7.55, p = .007) and better adherence to compression bandaging (HR = 1.41, 95% CI = 1.06-1.88, p = .019) were associated with fewer weeks to heal. No other psychosocial variable (stress, perceptions about the ulcer, health behaviors) predicted weeks to heal.

Conclusions: Alongside ulcer-related predictors, psychological and sociodemographic factors were associated with healing. Future research should explore mediating mechanisms underlying these associations and develop interventions to target these variables.
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http://dx.doi.org/10.1097/PSY.0000000000000436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5638426PMC
June 2017

Prevalence of cancer chemotherapy-related problems, their relation to health-related quality of life and associated supportive care: a cross-sectional survey.

Support Care Cancer 2016 12 27;24(12):4901-4911. Epub 2016 Jul 27.

Faculty of Health Sciences, Highfield, University of Southampton, Southampton, UK.

Purpose: The purpose of this study was to identify the treatment-associated problems that most impact on patients undergoing cancer chemotherapy, how problems relate to experiences of supportive care and variations in experience between cancer treatment centres.

Methods: A survey administered to patients at six cancer centres in England explored variations of prevalence of 17 cancer chemotherapy-associated problems and associated supportive care. Problem items were identified as the most frequently experienced and severe when experienced in a scoping and consensus exercise. A health-related quality of life (HRQoL) measure, the EQ5D, was included to measure impact of problems.

Results: A total of 363 completed questionnaires were returned (response rate 43 %, median 61 %). The most prevalent problem was 'tiredness/fatigued' (90 %), followed by 'changes in taste & smell' (69 %) and 'difficulty managing everyday tasks' (61 %). Significant variations in problem prevalence existed between centres, and some common problems were rarely reported in the literature. Regression analysis found that almost all problems were significantly associated with HRQoL, with social/emotional problems having as much impact on HRQoL as physical/psychological side effects of treatment. Greatest effect size was for difficulty managing everyday tasks. Respondents reported significant variations in supportive care between centres, with more supportive care received for physical/psychological problems than for social/emotional problems. Findings indicated that patients who received increased supportive care experienced less severe problems.

Conclusion: The most common and distressing chemotherapy-associated problems were identified. These problems are mitigated by quality supportive care. Routine measurement and monitoring of problem items and supportive care are warranted to facilitate benchmarking and service improvements both within and between cancer centres.
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http://dx.doi.org/10.1007/s00520-016-3346-4DOI Listing
December 2016

Microvascular Outcomes in Patients with Type 2 Diabetes Treated with Vildagliptin vs. Sulfonylurea: A Retrospective Study Using German Electronic Medical Records.

Diabetes Ther 2016 Sep 4;7(3):483-96. Epub 2016 Jun 4.

IMS Health, Paris, France.

Introduction: Preliminary data suggest that dipeptidyl peptidase-4 (DPP-4) inhibitors may reduce microvascular events, but there is a little evidence to support this from adequate real-world studies. This study aimed to compare microvascular outcomes between patients-prescribed vildagliptin and those prescribed sulfonylurea (SU).

Methods: This retrospective cohort study was conducted on a large sample from the German electronic medical records database IMS Lifelink Disease Analyzer. We used propensity score-matched samples of patients prescribed either vildagliptin or SU. Exposure was defined as therapy (SU or vildagliptin); primary outcomes were a diagnosis of retinopathy, nephropathy, neuropathy, or diabetic foot ulcer over the observation period in patients with no previous record of these outcomes. Secondary outcome was a composite of any primary outcome occurring in the observation period.

Results: In total, 16,321 patients prescribed SU and 4481 prescribed vildagliptin met the inclusion criteria. After propensity score matching, each sample comprised 3015 patients. Mean age was 63.7/64.6 years for SU/vildagliptin, respectively, with mean disease duration of 3.2/3.1 years, and mean treatment duration of 2.5/2.3 years. Treatment with vildagliptin was associated with a significant lower incidence of retinopathy [odds ratio (OR) = 0.55, P = 0.0004], neuropathy (OR 0.71, P = 0.0001), and composite outcome (OR 0.70, P < 0.0001). Incidences of nephropathy and diabetic foot ulcer were lower for vildagliptin, but not significantly so (OR 0.90, P = 0.3920; OR 0.76, P = 0.0742, respectively). There were no significant differences in incident rate ratios (all P > 0.05).

Conclusion: Treatment with vildagliptin was associated with a reduced incidence of microvascular complications, especially neuropathy and retinopathy, compared to treatment with SU in this clinical practice setting.

Funding: Novartis Pharma AG.
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http://dx.doi.org/10.1007/s13300-016-0177-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014784PMC
September 2016

Development and psychometric evaluation of a new patient -reported outcome measure for stroke self -management: The Southampton Stroke Self - Management Questionnaire (SSSMQ).

Health Qual Life Outcomes 2015 Oct 3;13:165. Epub 2015 Oct 3.

Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK.

Background: Self-management is important to the recovery and quality of life of people following stroke. Many interventions to support self-management following stroke have been developed, however to date no reliable and valid outcome measure exists to support their evaluation. This study outlines the development and preliminary investigation of the psychometric performance of a newly developed patient-reported outcome measure (PROM) of self-management competency following stroke; the Southampton Stroke Self-Management Questionnaire (SSSMQ).

Methods: A convenience sample of 87 people who had had a stroke completed responses to the SSSMQ, the Stroke Self-Efficacy Questionnaire and the Stroke Impact Scale. Scaling properties were assessed using Mokken Scale Analysis. Reliability and construct validity were assessed using intra-class correlation coefficient (ICC), Mokken and Cronbach's reliability coefficients and Spearman rank order correlations with relevant measures.

Results: Mokken scaling refined the SSSMQ to 28 scalable items. Internal consistency reliability (Mokken r = 0.89) and test-retest reliability (ICC = 0.928) were excellent. Hypotheses of expected correlations with additional measures held, demonstrating good evidence for construct validity.

Conclusions: Early findings suggest the Southampton Stroke Self-Management Questionnaire is a reliable and valid scale of self-management competency. The SSSMQ represents a potentially valid PROM for the evaluation of self-management following stroke.
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http://dx.doi.org/10.1186/s12955-015-0349-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592550PMC
October 2015

The effects of expressive writing on lung function, quality of life, medication use, and symptoms in adults with asthma: a randomized controlled trial.

Psychosom Med 2015 May;77(4):429-37

From the Division of Public Health & Primary Care (Smith, Jones), Brighton & Sussex Medical School, Brighton, United Kingdom; Real-World Evidence Solutions (Hankins), IMS Health, London, United Kingdom; School of Psychology (Field), University of Sussex, Brighton, United Kingdom; National Institute for Stroke and Applied Neurosciences (Theadom), Auckland University of Technology, Auckland, New Zealand; Mill View Hospital (Bowskill), Sussex Partnership Trust, East Sussex, United Kingdom; Department of Practice & Policy (Horne), School of Pharmacy, University of London, Centre for Behavioural Medicine, London, United Kingdom; and Department of Respiratory Medicine (Frew), Royal Sussex County Hospital, Brighton & Sussex University Hospitals Trust, Brighton, United Kingdom.

Objectives: Asthma is a chronic condition affecting 300 million people worldwide. Management involves adherence to pharmacological treatments such as corticosteroids and β-agonists, but residual symptoms persist. As asthma symptoms are exacerbated by stress, one possible adjunct to pharmacological treatment is expressive writing (EW). EW involves the disclosure of traumatic experiences which is thought to facilitate cognitive and emotional processing, helping to reduce physiological stress associated with inhibiting emotions. A previous trial reported short-term improvements in lung function. This study aimed to assess whether EW can improve lung function, quality of life, symptoms, and medication use in patients with asthma.

Methods: Adults (18-45 years) diagnosed as having asthma requiring regular inhaled corticosteroids were recruited from 28 general practices in South East England (n = 146). In this double-blind randomized controlled trial, participants were allocated either EW or nonemotional writing instructions and asked to write for 20 minutes for 3 consecutive days. Lung function (forced expired volume in 1 second [FEV1]% predicted), quality of life (Mark's Asthma Quality of Life Questionnaire), asthma symptoms (Wasserfallen Symptom Score Questionnaire), and medication use (inhaled corticosteroids and β-agonist) were recorded at baseline, 1, 3, 6, and 12 months.

Results: Hierarchical linear modeling indicated no significant main effects between time and condition on any outcomes. Post hoc analyses revealed that EW improved lung function by 14% for 12 months for participants with less than 80% FEV1% predicted at baseline (β = 0.93, p = .002) whereas no improvement was observed in the control condition (β = 0.10, p = .667).

Conclusions: EW seems to be beneficial for patients with moderate asthma (<80% FEV1% predicted). Future studies of EW require stratification of patients by asthma severity.

Trial Registration: ISRCTN82986307.
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http://dx.doi.org/10.1097/PSY.0000000000000166DOI Listing
May 2015

Patients' treatment beliefs in low back pain: development and validation of a questionnaire in primary care.

Pain 2015 Aug;156(8):1489-1500

Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, United Kingdom Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom Real-World Evidence Solutions, IMS Health, London, United Kingdom Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, the Netherlands Centre for Applications of Health Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, United Kingdom.

Choosing the most appropriate treatment for individual patients with low back pain (LBP) can be challenging, and clinical guidelines recommend taking into account patients' preferences. However, no tools exist to assess or compare patients' views about LBP treatments. We report the development and validation of the Low Back Pain Treatment Beliefs Questionnaire (LBP-TBQ) for use across different treatments in clinical practice and research. Using qualitative data, we developed a pool of items assessing perceived credibility, effectiveness, concerns about, and individual "fit" of specific treatments. These items were included in a survey completed by 429 primary care patients with LBP, of whom 115 completed it again 1 to 2 weeks later. We performed psychometric analyses using nonparametric item response theory and classical test theory. The 4 subscales of the resulting 16-item LBP-TBQ showed good homogeneity (H = 0.46-0.76), internal consistency (α = 0.73-0.94), and stability (r = 0.63-0.83), confirmed most convergent and discriminant validity hypotheses, and had acceptable structural validity for 4 guideline-recommended treatments: pain medication, exercise, manual therapy, and acupuncture. Participants with stronger positive treatment beliefs were more likely to rank that treatment as their first choice, indicating good criterion validity (t values = 3.11-9.80, all P < 0.01, except pain medication effectiveness beliefs, t(339) = 1.35; P = 0.18). A short 4-item version also displayed good homogeneity (H = 0.43-0.66), internal consistency (α = 0.70-0.86), and stability (r = 0.82-0.85) and was significantly related to treatment choice (t values = 4.33-9.25, all P < 0.01). The LBP-TBQ can be used to assess treatment beliefs in primary care patients with LBP and to investigate the effects of treatment beliefs on treatment uptake and adherence.
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http://dx.doi.org/10.1097/j.pain.0000000000000193DOI Listing
August 2015

Parents' expressed emotion and mood, rather than their physical disability are associated with adolescent adjustment: a longitudinal study of families with a parent with multiple sclerosis.

Clin Rehabil 2016 Mar 14;30(3):303-11. Epub 2015 Apr 14.

Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.

Objective: This study investigated the impact of the severity of parental multiple sclerosis, parents' expressed emotion and psychological well-being on offspring's psychological difficulties.

Design: A longitudinal study including baseline and 6-month follow-up data collected from parents and children.

Subjects: Adolescents (n=75), their parents with multiple sclerosis (n=56) and the partner without multiple sclerosis (n=40).

Main Measures: Parents completed the Hospital Anxiety and Depression Scale and the Five Minutes Speech Sample, a standardised interview of expressed emotion towards their child. Parents with multiple sclerosis also completed the Expanded Disability Status Scale, a measure of illness severity. Adolescents completed the Strength and Difficulties Questionnaire, a self-report measure of psychological difficulties.

Results: Higher depression scores of the parents with multiple sclerosis at baseline correlated with increased adolescents' internalising symptoms at 6-month follow-up (γdep=0.31, P=.004). Higher expressed emotion scores of parents with multiple sclerosis at baseline were associated with increased adolescent externalising symptoms at 6-month follow-up (γEE=4.35, P=.052). There was no direct effect of severity, duration or type of multiple sclerosis on adolescents' adjustment at baseline or follow-up.

Conclusions: Emotional distress and expressed emotion in parents with multiple sclerosis, rather than the severity and type of multiple sclerosis had an impact on adolescents' psychological difficulties.
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http://dx.doi.org/10.1177/0269215515580600DOI Listing
March 2016

Detecting acute distress and risk of future psychological morbidity in critically ill patients: validation of the intensive care psychological assessment tool.

Crit Care 2014 Sep 24;18(5):519. Epub 2014 Sep 24.

Introduction: The psychological impact of critical illness on a patient can be severe, and frequently results in acute distress as well as psychological morbidity after leaving hospital. A UK guideline states that patients should be assessed in critical care units, both for acute distress and risk of future psychological morbidity; but no suitable method for carrying out this assessment exists. The Intensive care psychological assessment tool (IPAT) was developed as a simple, quick screening tool to be used routinely to detect acute distress, and the risk of future psychological morbidity, in critical care units.

Methods: A validation study of IPAT was conducted in the critical care unit of a London hospital. Once un-sedated, orientated and alert, critical care patients were assessed with the IPAT and validated tools for distress, to determine the IPAT's concurrent validity. Fifty six patients took IPAT again to establish test-retest reliability. Finally, patients completed posttraumatic stress disorder (PTSD), depression and anxiety questionnaires at three months, to determine predictive validity of the IPAT.

Results: One hundred and sixty six patients completed the IPAT, and 106 completed follow-up questionnaires at 3 months. Scale analysis showed IPAT was a reliable 10-item measure of critical care-related psychological distress. Test-retest reliability was good (r =0.8). There was good concurrent validity with measures of anxiety and depression (r =0.7, P <0.01; r =0.6, P <0.01). With a cut-point of ≥7, the IPAT had 82% sensitivity and 65% specificity to detect concurrent anxiety; and 80% sensitivity and 66% specificity to detect concurrent low mood (area under the curve (AUC) =0.8 for both). Predictive validity for psychological morbidity was good (r =0.4, P <0.01; r =0.64, P <0.01 for PTSD with days 1 and 2 data). The IPAT had 69% specificity and 57% sensitivity to predict future psychological morbidity (AUC =0.7).

Conclusions: The IPAT was found to have good reliability and validity. Sensitivity and specificity analysis suggest the IPAT could provide a way of allowing staff to assess psychological distress among critical care patients after further replication and validation. Further work is also needed to determine its utility in predicting future psychological morbidity.
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http://dx.doi.org/10.1186/s13054-014-0519-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207352PMC
September 2014

The impact of nutritional labels and socioeconomic status on energy intake. An experimental field study.

Appetite 2014 Oct 28;81:12-9. Epub 2014 May 28.

Section of Health Psychology, King's College London, Guy's Campus, London Bridge, SE1 9RT, UK; Behaviour and Health Policy Research Unit, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK.

There is some evidence for paradoxical effects of nutritional labelling on energy intake particularly amongst restrained eaters and those with a higher body mass index (BMI) resulting in greater consumption of energy from foods with a positive health message (e.g. "low-fat") compared with the same foods, unlabelled. This study aimed to investigate, in a UK general population sample, the likelihood of paradoxical effects of nutritional labelling on energy intake. Participants (n = 287) attended a London cinema and were offered a large tub of salted or toffee popcorn. Participants were randomised to receive their selected flavour with one of three labels: a green low-fat label, a red high-fat label or no label. Participants watched two film clips while completing measures of demographic characteristics, emotional state and taste of the popcorn. Following the experiment, popcorn consumption was measured. There were no main effects of nutritional labelling on consumption. Contrary to predictions neither BMI nor weight concern moderated the effect of label on consumption. There was a three-way interaction between low-fat label, weight concern and socioeconomic status (SES) such that weight-concerned participants of higher SES who saw a low-fat label consumed more than weight unconcerned participants of similar SES (t = -2.7, P = .04). By contrast, weight-concerned participants of lower SES seeing either type of label, consumed less than those seeing no label (t = -2.04, P = .04). Nutritional labelling may have different effects in different socioeconomic groups. Further studies are required to understand fully the possible contribution of food labelling to health inequalities.
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http://dx.doi.org/10.1016/j.appet.2014.05.024DOI Listing
October 2014

Written emotional disclosure for asthma.

Cochrane Database Syst Rev 2014 May 19(5):CD007676. Epub 2014 May 19.

Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.

Background: Psychological stress has been widely implicated in asthma exacerbation. Evidence suggests that written emotional disclosure, an intervention that involves writing about traumatic or stressful experiences, helps to reduce stress and promote physical and psychological well-being. Written emotional disclosure may have a role in the management of asthma.

Objectives: This review aims to determine the effectiveness of written emotional disclosure for people with asthma, specifically, to assess:1. overall efficacy of emotional disclosure compared with emotionally neutral writing on self reported quality of life in people with asthma;2. overall efficacy of emotional disclosure compared with emotionally neutral writing on objective measures of health outcome in people with asthma; and3. comparative efficacy of different types of emotional disclosure for people with asthma.

Search Methods: Trials were identified from the Cochrane Airways Group Specialised Register of trials, CENTRAL, MEDLINE, EMBASE, CINAHL, AMED and PsycINFO. The latest search was conducted in January 2014.

Selection Criteria: Randomised controlled trials published in any language comparing written emotional disclosure intervention versus a control writing (emotionally neutral) intervention in participants with asthma were included in the review.

Data Collection And Analysis: Two review authors independently assessed studies against predetermined inclusion criteria and extracted the data. Corresponding authors were contacted when necessary to provide additional information.

Main Results: Four studies, involving a total of 414 participants, met the inclusion criteria. Three studies were conducted in adult participants and one in adolescents. The average age of participants ranged from 14 to 43 years. The trials lasted between two months and 12 months. The interventions were based on Pennebaker's method. The risk of bias across most domains of the studies was generally considered to be low, however three of four studies were considered at high risk of bias due to lack of assessor blinding and one study was at high risk of bias for selective reporting. The interpretation of these studies was limited by diverse outcome measurements, measurement tools, control group techniques, and number and/or times of follow-up. A pooled result from the four studies, including a total of 146 intervention and 135 control participants, indicated uncertain effect in forced expiratory volume in one second (FEV1) % predicted between the disclosure group and the control group (mean difference (MD) 3.43%, 95% confidence interval (CI) -0.61% to 7.47%; very low-quality evidence) at ≤ three months' follow-up. Similarly, evidence from two studies indicated that written emotional disclosure found uncertain effect on forced vital capacity (FVC) (standardised mean difference (SMD) -0.02, 95% CI -0.30 to 0.26; low-quality evidence) and asthma symptoms (SMD -0.22, 95% CI -0.52 to 0.09; low-quality evidence) but may result in improved asthma control at ≤ three months' follow-up (SMD 0.29, 95% CI 0.01 to 0.58; low-quality evidence). We were unable to pool the data for other outcomes. Results from individual trials did not reveal a significant benefit of written emotional disclosure for quality of life, medication use, healthcare utilisation or psychological well-being. Evidence from one trial suggests a significant reduction in beta agonist use (MD -1.62, 95% CI -2.62 to -0.62; low-quality evidence) at ≤ three months' follow-up in the disclosure group compared with controls. The review did not address any adverse effects of emotional writing.

Authors' Conclusions: Evidence was insufficient to show whether written emotional disclosure compared with writing about non-emotional topics had an effect on the outcomes included in this review. Evidence is insufficient to allow any conclusions as to the role of disclosure in quality of life, psychological well-being, medication use and healthcare utilisation. The evidence presented in this review is generally of low quality. Better designed studies with standardised reporting of outcome measurement instruments are required to determine the effectiveness of written emotional disclosure in the management of asthma.
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http://dx.doi.org/10.1002/14651858.CD007676.pub2DOI Listing
May 2014

Development and reliability of a system to classify the eating and drinking ability of people with cerebral palsy.

Dev Med Child Neurol 2014 Mar 18;56(3):245-51. Epub 2013 Dec 18.

Chailey Heritage Clinical Services, Sussex Community NHS Trust, Lewes, UK.

Aim: The aim of this study was to develop a valid classification system to describe eating and drinking ability in people with cerebral palsy (CP), and to test its reliability.

Method: The Eating and Drinking Ability Classification System (EDACS) was developed in four stages in consultation with individuals with CP, parents, and health professionals: Stage 1, drafting informed by literature and clinical experience; Stage 2, modification by nominal groups; Stage 3, refinement in an international Delphi survey; and Stage 4, testing of agreement and reliability between classifications made by speech and language therapists (SaLTs), and between SaLTs and parents.

Results: Seven nominal groups involved 56 participants; 95 people participated in two rounds of the Delphi survey. Using the version of EDACS produced from this process, SaLTs in pairs classified 100 children. The rate of absolute agreement was 78% (kappa=0.72; intraclass correlation coefficient [ICC]=0.93; 95% confidence interval [CI] 0.90-0.95). Any disagreement was only by one level, with one exception. SaLTs and parents classified 48 children. The rate of absolute agreement was 58% (kappa=0.45, ICC=0.86; 95% CI 0.76-0.92). Parents either agreed with SaLTs or rated their children as more able by one level.

Interpretation: The EDACS provides a valid and reliable system for classifying eating and drinking performance of people with CP, for use in both clinical and research contexts.
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http://dx.doi.org/10.1111/dmcn.12352DOI Listing
March 2014

Patient involvement in the development of asthma-specific patient-reported outcome measures: a systematic review.

J Allergy Clin Immunol 2013 Dec 31;132(6):1434-6. Epub 2013 Aug 31.

Norwich Medical School, University of East Anglia, Brighton, United Kingdom.

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http://dx.doi.org/10.1016/j.jaci.2013.05.047DOI Listing
December 2013

Patients' expectations of private osteopathic care in the UK: a national survey of patients.

BMC Complement Altern Med 2013 May 31;13:122. Epub 2013 May 31.

Clinical Research centre for Health Professions, University of Brighton, Aldro Building, 49 Darley Road, BN20 7UR, Eastbourne, UK.

Background: Patients' expectations of osteopathic care have been little researched. The aim of this study was to quantify the most important expectations of patients in private UK osteopathic practices, and the extent to which those expectations were met or unmet.

Methods: The study involved development and application of a questionnaire about patients' expectations of osteopathic care. The questionnaire drew on an extensive review of the literature and the findings of a prior qualitative study involving focus groups exploring the expectations of osteopathic patients. A questionnaire survey of osteopathic patients in the UK was then conducted. Patients were recruited from a random sample of 800 registered osteopaths in private practice across the UK. Patients were asked to complete the questionnaire which asked about 51 aspects of expectation, and post it to the researchers for analysis.The main outcome measures were the patients-perceived level of expectation as assessed by the percentage of positive responses for each aspect of expectation, and unmet expectation as computed from the proportion responding that their expectation "did not happen".

Results: 1649 sets of patient data were included in the analysis. Thirty five (69%) of the 51 aspects of expectation were prevalent, with listening, respect and information-giving ranking highest. Only 11 expectations were unmet, the most often unmet were to be made aware that there was a complaints procedure, to find it difficult to pay for osteopathic treatment, and perceiving a lack of communication between the osteopath and their GP.

Conclusions: The findings reflected the complexity of providing osteopathic care and meeting patients' expectations. The results provided a generally positive message about private osteopathic practice. The study identified certain gaps between expectations and delivery of care, which can be used to improve the quality of care. The questionnaire is a resource for future research.
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http://dx.doi.org/10.1186/1472-6882-13-122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3679882PMC
May 2013

Separating emotions from consequences in muscle disease: comparing beneficial and unhelpful illness schemata to inform intervention development.

J Psychosom Res 2013 Apr 9;74(4):320-6. Epub 2012 Oct 9.

Department of Health Psychology, Institute of Psychiatry, King's College London, 5th Floor Bermondsey Wing, Guy's Hospital, London, UK.

Objective: Muscle diseases are currently untreatable and people with muscle disease experience reduced quality of life (QoL) and low mood. Patient's illness perceptions explain large proportions of the variance in QoL and mood, even after considering the impact of disease severity. Therefore a psychological intervention which helps patients modify their illness perceptions may improve QoL and mood even as the disease progresses. However, it is unknown which profile of illness perceptions (illness schema) an intervention should seek to promote. We aimed to fully describe and compare the illness schemata of clusters associated with better and worse outcomes.

Method: Following a cluster analysis of 217 people with muscle disease, a between-cluster comparison of QoL and mood identified the clusters associated with better and worse outcomes. Functional impairment was compared between-clusters to indicate if this could account for observed differences. Inter-correlations between the illness perceptions held within each cluster were examined across the clusters.

Results: Three stable clusters holding distinct illness schemata emerged. One cluster was characterised by greater functional impairment, worse QoL and mood than the other two clusters. The other two clusters did not differ in functional impairment but differed significantly in QoL and mood. The cluster associated with better outcomes was characterised by realistic views of timeline, greater coherence, reduced emotional representation and identity, and a lack of association between emotional representation and consequences.

Conclusion: Detailed comparison of beneficial and unhelpful illness schemata, taking into account disease-specific concerns, can help inform both the content and composition of an intervention.
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http://dx.doi.org/10.1016/j.jpsychores.2012.09.012DOI Listing
April 2013

Change in anxiety following successful and unsuccessful attempts at smoking cessation: cohort study.

Br J Psychiatry 2013 Jan;202(1):62-7

Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK.

Background: Despite a lack of empirical evidence, many smokers and health professionals believe that tobacco smoking reduces anxiety, which may deter smoking cessation.

Aims: The study aim was to assess whether successful smoking cessation or relapse to smoking after a quit attempt are associated with changes in anxiety.

Method: A total of 491 smokers attending National Health Service smoking cessation clinics in England were followed up 6 months after enrolment in a trial of pharmacogenetic tailoring of nicotine replacement therapy (ISRCTN14352545).

Results: There was a points difference of 11.8 (95% CI 7.7-16.0) in anxiety score 6 months after cessation between people who relapsed to smoking and people who attained abstinence. This reflected a three-point increase in anxiety from baseline for participants who relapsed and a nine-point decrease for participants who abstained. The increase in anxiety in those who relapsed was largest for those with a current diagnosis of psychiatric disorder and whose main reason for smoking was to cope with stress. The decrease in anxiety on abstinence was larger for these groups also.

Conclusions: People who achieve abstinence experience a marked reduction in anxiety whereas those who fail to quit experience a modest increase in the long term. These data contradict the assumption that smoking is a stress reliever, but suggest that failure of a quit attempt may generate anxiety.
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http://dx.doi.org/10.1192/bjp.bp.112.114389DOI Listing
January 2013

A short measure of quality of life in older age: the performance of the brief Older People's Quality of Life questionnaire (OPQOL-brief).

Arch Gerontol Geriatr 2013 Jan-Feb;56(1):181-7. Epub 2012 Sep 19.

Faculty of Health Sciences, University of Southampton, Highfield Campus, Southampton SO171BJ, United Kingdom.

Promoting quality of life in older age is an internationally recognized priority, requiring valid measurement. We present a short version of the established Older People's Quality of Life questionnaire (OPQOL-brief). The full OPQOL-35 was original in being developed from the perspectives of older people, assessed conceptually, and validated with a population sample using gold-standard psychometric assessment. The OPQOL-brief was also developed by asking older people to prioritize the most important items from the OPQOL-35, next assessed psychometrically with a population sample, and also statistically against the discarded 22 items. The aim was to assess the psychometric properties of the short, 13-item version of the OPQOL (OPQOL-brief), and to compare the performance of included and discarded items. The method was a national population survey of people aged 65+ living at home. The measures were OPQOL-brief, WHOQOL-QOL and CASP-19. The OPQOL-brief was found to be a highly reliable and valid, short measure of quality of life in older age. The OPQOL-brief is of value in assessment of interventions where a rigorously tested, short measure is required. The grounded development of the instrument is consistent with international policy emphasis on user involvement in shaping policy and research.
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http://dx.doi.org/10.1016/j.archger.2012.08.012DOI Listing
May 2013

Validity of two common asthma-specific quality of life questionnaires: Juniper mini asthma quality of life questionnaire and Sydney asthma quality of life questionnaire.

Health Qual Life Outcomes 2012 Aug 20;10:97. Epub 2012 Aug 20.

Division of Public Health and Primary Care, Brighton and Sussex Medical School, Brighton, UK.

Background: This study explored the psychometric properties (internal consistency, construct validity, discriminative ability) of the Juniper Mini Asthma Quality of Life Questionnaire (Mini AQLQ-J) and the Sydney Asthma Quality of Life Questionnaire (AQLQ-S).

Methods: One hundred fourty-six adults (18-45 years) with asthma requiring regular inhaled corticosteroids were recruited to a trial of written emotional disclosure. Correlational analyses were performed to understand the relationship of the two measures with each other, with symptoms, lung function, asthma control, asthma bother and generic quality of life. Median quality of life scores were compared according to gender, health care usage and levels of asthma severity.

Results: AQLQ-J and AQLQ-S total scores correlated strongly with each other (rho = -0.80) and moderately with the EuroQol Current Health Status Scale (AQLQ-J: rho = 0.35; AQLQ-S: rho = -0.40). Domain score correlations between AQLQ-J and AQLQ-S were mostly moderate (0.50 < rho < 0.80).Both QoL measures were significantly correlated with symptom score. Correlations with the symptom score asthma module (AQLQ-J: rho = -0.69; AQLQ-S: rho = 0.50) were stronger compared with the total symptom score and the symptom score rhinitis module (AQLQ-J: rho = -0.41; AQLQ-S: rho =0.31).Neither QoL measure was significantly correlated with FEV1, % predicted at the total or the domain level.Total scores of both measures were significantly correlated with subjective asthma control (AQLQ-J: rho = 0.68; AQLQ-S: rho = -0.61) and asthma bother (AQLQ-J: rho = -0.73; AQLQ-M: rho = 0.73).Total AQLQ-J score and total AQLQ-S score were significantly associated with perceived asthma severity (AQLQ-J: p=0.004, AQLQ-S: p=0.002) and having visited a GP in the past four months (AQLQ-J: p=0.003, AQLQ-S: p=0.002).

Conclusions: This study provides further evidence for the validity of the AQLQ-J and the AQLQ-S in a British population of adult patients with asthma managed in primary care. Correlations with lung function parameters were weak or absent. Correlations with generic quality of life were moderate, those with asthma symptoms, asthma control and asthma bother were strong. Both measures are able to discriminate between levels of asthma severity and health care usage.
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http://dx.doi.org/10.1186/1477-7525-10-97DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3478207PMC
August 2012

Distinct work-related, clinical and psychological factors predict return to work following treatment in four different cancer types.

Psychooncology 2013 Mar 21;22(3):659-67. Epub 2012 Mar 21.

Department of Psychology, King's College London, London, UK.

Objective: Many factors influence return to work (RTW) following cancer treatment. However specific factors affecting RTW across different cancer types are unclear. This study examined the role of clinical, sociodemographic, work and psychological factors in RTW following treatment for breast, gynaecological, head and neck, and urological cancer.

Methods: A 12-month prospective questionnaire study was conducted with 290 patients. Cox regression analyses were conducted to calculate hazard ratios (HR) for time to RTW.

Results: Between 89-94% of cancer survivors returned to work. Breast cancer survivors took the longest to return (median 30 weeks), and urology cancer survivors returned the soonest (median 5 weeks). Earlier return among breast cancer survivors was predicted by a greater sense of control over their cancer at work (HR 1.2; 95% CI: 1.09-1.37) and by full-time work (HR 2.1; CI: 1.24-3.4). Predictive of a longer return among gynaecological cancer survivors was a belief that cancer treatment may impair ability to work (HR 0.75; CI: 0.62-0.91). Among urological cancer survivors constipation was predictive of longer RTW (HR 0.99; CI: 0.97-1.00), whereas undertaking flexible working was predictive of returning sooner (HR 1.70; CI: 1.07-2.7). Head and neck cancer survivors who perceived greater negative consequences of their cancer took longer to return (HR 0.27; CI: 0.11-0.68). Those reporting better physical functioning returned sooner (HR1.04; CI: 1.01-1.08).

Conclusion: A different profile of predictive factors emerged for the four cancer types. In addition to optimal symptom management and workplace adaptations, the findings suggest that eliciting and challenging specific cancer and treatment-related perceptions may facilitate RTW.
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http://dx.doi.org/10.1002/pon.3049DOI Listing
March 2013

A pilot study to compare the views of traditionally trained and CAM-trained therapists using the clinical exemplar of the management of neck/upper limb pain to assess barriers to effective integration of approaches.

Complement Ther Med 2012 Feb-Apr;20(1-2):38-44. Epub 2011 Nov 29.

University of Sussex, Falmer, Brighton, UK.

Background: In the UK, patients frequently choose complementary (CAM) therapies, particularly for chronic painful musculoskeletal conditions. It is widely agreed that better integration of complementary and traditional healthcare is desirable. We piloted the Benefits and Risks of Treatment Questionnaire to compare the views of different healthcare practitioners about traditional and alternative approaches in one clinical scenario in order to assess barriers to effective integration.

Methods: A cross-sectional survey of healthcare practitioners (primary care practitioners, physiotherapists, pharmacists, osteopaths, chiropractors and acupuncturists) in the UK. The views of all healthcare providers were compared using the exemplar of neck, shoulder and upper arm pain to explore the perceived risks and benefits of different types of therapeutic intervention using a mathematical cluster approach.

Results: 448/1254 (36%) useable replies were received representing all six professions. A mean of 14.9 years of experience was reported by participants. The cluster analyses revealed distinct clusters of opinion of benefit: primary care physicians, physiotherapists and pharmacists were significantly more likely to rate a cluster including: anti-inflammatory drugs, steroid injections, steroids, physiotherapy, paracetamol and antidepressants as beneficial for neck, shoulder and upper arm pain. In contrast, osteopaths and chiropractors, but not physiotherapists were significantly more likely to rate a cluster including chiropractic, osteopathy and physiotherapy as beneficial.

Conclusion: The Beliefs about Risks and Benefits of Treatments Questionnaire can be applied using a postal approach and achieves similar response rates to other surveys amongst healthcare practitioners. Despite widespread agreement that increased integration of traditional and alternative approaches is desirable, the results of this study suggest that experienced practitioners show the strongest belief in the benefit of approaches closest to their own training and background and the most wariness of risk to those therapies furthest from their background.
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http://dx.doi.org/10.1016/j.ctim.2011.10.004DOI Listing
July 2012

Why does genetic causal information alter perceived treatment effectiveness? An analogue study.

Br J Health Psychol 2012 May 6;17(2):294-313. Epub 2011 Jul 6.

Department of Primary Care & Public Health Sciences, King's College London, UK.

Objectives: When a health problem is perceived as having a genetic cause, this appears to increase the perceived effectiveness of pharmacological treatments and reduce perceived effectiveness of non-pharmacological treatments. Potential mediators of this effect include causal attributions, perceived severity, and perceived control over the health problem. This study aimed to use experimental methods to establish which beliefs mediate the effect of genetic causal information on perceived effectiveness of treatments.

Design: A 4(cause: environmental, family history, genetic test, family history & genetic test)×2(severity: higher or low) between-subjects design using vignettes about heart disease risk, obesity or depression.

Methods: A total of 647 adults, randomly assigned to read one of the experimental vignettes, were interviewed. Key outcomes were perceived effectiveness of medication and of non-pharmacological treatments. Potential mediators of perceived severity, perceived controllability, and causal attributions were also assessed.

Results: For heart disease risk, genetic causes reduced perceived effectiveness of non-pharmacological treatments (an effect mediated by causal attributions and perceived control) but did not influence perceived medication effectiveness. For obesity, neither severity nor cause influenced the perceived effectiveness of either treatment. For depression, genetic causes only increased perceived effectiveness of medication for more severe depression, an effect mediated by perceived control.

Conclusions: The impact of genetic causal information on perceived effectiveness of treatments varies with type of health problem. When genetic causal information influences perceived treatment effectiveness, it does so by altering causal attributions and perceived controllability. However, these effects are small and unlikely to translate into clinically meaningful differences in health-enhancing behaviours.
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http://dx.doi.org/10.1111/j.2044-8287.2011.02038.xDOI Listing
May 2012

Critical conditions for ferric chloride-induced flocculation of freshwater algae.

Biotechnol Bioeng 2012 Feb 9;109(2):493-501. Epub 2011 Sep 9.

Engineering Sciences Center, Sandia National Laboratories, PO Box 5800, Albuquerque, New Mexico 87185, USA.

The effects of algae concentration, ferric chloride dose, and pH on the flocculation efficiency of the freshwater algae Chlorella zofingiensis can be understood by considering the nature of the electrostatic charges on the algae and precipitate surfaces. Two critical conditions are identified which, when met, result in flocculation efficiencies in excess of 90% for freshwater algae. First, a minimum concentration of ferric chloride is required to overcome the electrostatic stabilization of the algae and promote bridging of algae cells by hydroxide precipitates. At low algae concentrations, the minimum amount of ferric chloride required increases linearly with algae concentration, characteristic of flocculation primarily through electrostatic bridging by hydroxide precipitates. At higher algae concentrations, the minimum required concentration of ferric chloride for flocculation is independent of algae concentration, suggesting a change in the primary flocculation mechanism from bridging to sweep flocculation. Second, the algae must have a negative surface charge. Experiments and surface complexation modeling show that the surface charge of C. zofingiensis is negative above a pH of 4.0 ± 0.3 which agrees well with the minimum pH required for effective flocculation. These critical flocculation criteria can be extended to other freshwater algae to design effective flocculation systems.
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http://dx.doi.org/10.1002/bit.23319DOI Listing
February 2012

A pilot clinical trial to evaluate a novel time-to-positivity assay to measure the effectiveness of antibiotic therapy for septic patients in intensive care.

J Crit Care 2012 Jun 19;27(3):320.e1-5. Epub 2011 Aug 19.

Department of Microbiology & Infectious Diseases, Brighton & Sussex University Hospitals Trust, Brighton & Sussex Medical School, Brighton, UK.

Purpose: The purpose of the study was to investigate whether a novel assay of antibiotic efficacy could predict clinical outcome measures in septic patients in the intensive care unit (ICU).

Methods: A prospective, noninterventional clinical study was performed involving 48 adult patients with sepsis in a single adult general ICU, with measurement of the time-to-positivity (Tpos) at 2 time points (Tpos1, Tpos2).

Results: The mean length of stay for all patients was 14.1 days (range, 2-98; median, 10 days). There was no significant difference between the Tpos1-adequate and the Tpos1-inadequate patients in day 1 Sequential Organ Failure Assessment or Acute Physiology and Chronic Health Evaluation II scores. However, there were a significant difference for the length of stay in ICU, with median stay in the Tpos1-adequate group of 7.8 days compared with 14.4 days in the Tpos1-inadequate group (Mann-Whitney U test, P = .028), and a significant difference in the length of stay in hospital, with a median stay in the Tpos1-adequate group of 13 days compared with 31 days in the Tpos1-inadequate group (P = .001). There was no statistical association between Tpos1 and 28-day survival (P > .05). The Tpos2 data added no further information.

Conclusions: This pilot study provides preliminary evidence that measurement of Tpos1 24 hours after the initiation of antibiotic therapy is associated with ICU length of stay and might be of value as a surrogate marker of antibiotic activity.
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http://dx.doi.org/10.1016/j.jcrc.2011.06.009DOI Listing
June 2012

Impact of informed-choice invitations on diabetes screening knowledge, attitude and intentions: an analogue study.

BMC Public Health 2010 Dec 17;10:768. Epub 2010 Dec 17.

Psychology Department at Guy's, Health Psychology Section, 5th Floor Bermondsey Wing, Guy's Campus, London SE1 9RT, UK.

Background: Despite concerns that facilitating informed choice would decrease diabetes screening uptake, 'informed choice' invitations that increased knowledge did not affect attendance (the DICISION trial). We explored possible reasons using data from an experimental analogue study undertaken to develop the invitations. We tested a model of the impact on knowledge, attitude and intentions of a diabetes screening invitation designed to facilitate informed choices.

Methods: 417 men and women aged 40-69 recruited from town centres in the UK were randomised to receive either an invitation for diabetes screening designed to facilitate informed choice or a standard type of invitation. Knowledge of the invitation, attitude towards diabetes screening, and intention to attend for diabetes screening were assessed two weeks later.

Results: Attitude was a strong predictor of screening intentions (β = .64, p = .001). Knowledge added to the model but was a weak predictor of intentions (β = .13, p = .005). However, invitation type did not predict attitudes towards screening but did predict knowledge (β = -.45, p = .001), which mediated a small effect of invitation type on intention (indirect β = -.06, p = .017).

Conclusions: These findings may explain why information about the benefits and harms of screening did not reduce diabetes screening attendance in the DICISION trial.
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http://dx.doi.org/10.1186/1471-2458-10-768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3019193PMC
December 2010

Cognitive impairment and 7-year mortality in dialysis patients.

Am J Kidney Dis 2010 Oct 25;56(4):693-703. Epub 2010 Aug 25.

Department of Psychology, National University of Singapore, Singapore.

Background: Although dementia has predicted mortality in large dialysis cohorts, little is known about the relationship between less pronounced cognitive deficits and mortality in patients with end-stage renal disease. This study assessed whether cognitive impairment without dementia was an independent predictor of 7-year survival in dialysis patients after controlling for other risk factors.

Study Design: Prospective single-cohort study.

Setting & Participants: 145 prevalent dialysis patients from 2 units in London, UK, were followed up for 64.3 ± 27.4 months and censored at the time of change to a different treatment.

Predictors: Cognitive impairment, defined as performance 1 standard deviation less than normative values on 2 or more cognitive tests within a neurocognitive battery assessing attention/concentration, memory, and psychomotor function domains. Depression, quality-of-life, and clinical measures also were obtained.

Outcomes & Measurements: All-cause mortality was the primary outcome. Cox proportional hazard models were used to assess the contribution of demographics and clinical and psychological measures and cognitive impairment to mortality.

Results: 98 (67.6%) patients were cognitively impaired at baseline. At follow-up, 56 (38.6%) patients had died, 29 of cardiac causes. Unadjusted Kaplan-Meier analysis showed higher mortality in cognitively impaired patients, in whom 7-year survival was 49% versus 83.2% in those with no cognitive impairment (P < 0.001). Mortality risk associated with cognitive impairment remained significant in adjusted analysis controlling for sociodemographic, clinical, and psychological factors (adjusted HR, 2.53; 95% CI, 1.03-6.22; P = 0.04).

Limitations: Small sample size and number of events.

Conclusions: Cognitive impairment is an independent predictor of mortality in dialysis patients. Although the implications of early recognition and treatment of cognitive impairment for clinical outcomes are unclear, these results suggest that patient management protocols should attempt to ensure prevention of cognitive decline in addition to managing coexisting medical conditions.
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http://dx.doi.org/10.1053/j.ajkd.2010.07.003DOI Listing
October 2010

High adherence and concordance within a clinical trial of antihypertensives.

Chronic Illn 2010 Dec 7;6(4):243-51. Epub 2010 Jul 7.

Centre for Behavioural Medicine, The School of Pharmacy, University of London, Mezzanine Floor, BMA House, Tavistock Square, London WC1H 9JP, UK.

Objectives: To explore hypertensive patients' beliefs about their condition and its treatment and their adherence within the context of a clinical trial. To assess the degree of concordance between patients' beliefs about hypertension and the medical model of the condition.

Methods: This was a questionnaire-based study, involving 230 patients participating in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), a randomized controlled trial comparing two pharmaceutical approaches to the management of hypertension. A comparison group of 106 hypertensive patients who were screened for ASCOT but did not meet the entry criteria was also recruited. Outcome measures were beliefs about hypertension and antihypertensive medication, and adherence to medication (self-report and tablet count).

Results: Adherence to medication was higher than anticipated, with 45% participants reporting complete adherence over the 18-month study and a further 40% only rare non-adherence. Patients' beliefs about their condition and treatment were generally concordant with the medical model of hypertension. High concordance was associated with high medication adherence (p<0.001).

Discussion: Clinical trial volunteers may have beliefs that are unusually concordant with the medical model of hypertension and may demonstrate atypically high adherence. This has implications for the transferability of trial findings to the general hypertensive population.
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http://dx.doi.org/10.1177/1742395310369018DOI Listing
December 2010

Time orientation and health-related behaviour: measurement in general population samples.

Psychol Health 2009 Mar;24(3):333-50

Department of Psychology, King's College London, London, UK.

Research on health behaviour and time orientation has been hindered by a lack of consensus about appropriate measurement. Study 1 assessed the reliability of the Consideration of Future Consequences Scale (CFC) and the Zimbardo Time Perspective Inventory (ZTPI) in a general population sample (n = 300). Although more reliable, the CFC was less readable. Study 2 assessed the validity of a shortened ZTPI, measuring future and present orientation, and the full CFC. The measures had good discrimination to distinguish interpersonal differences. Construct validity of present, but not future, orientation as measured by the ZTPI, was evidenced by its mediation of the association between socioeconomic status and expectations of participating in diabetes screening. The CFC mediated this relationship more weakly. Further investigation of present orientation in understanding health-related behaviour is warranted.
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http://dx.doi.org/10.1080/08870440701813030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657323PMC
March 2009
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