Effectiveness of psychological interventions to improve quality of life in people with long-term conditions : rapid systematic review of randomised controlled trials

Background: Long-term conditions may negatively impact multiple aspects of quality of life including physical functioning and mental wellbeing. The rapid systematic review aimed to examine the effectiveness of psychological interventions to improve quality of life in people with long-term conditions to inform future healthcare provision and research. Methods: EBSCOhost and OVID were used to search four databases (PsychInfo, PBSC, Medline and Embase). Relevant papers were systematically extracted by one researcher using the predefined inclusion/exclusion criteria based on titles, abstracts, and full texts. Randomized controlled trial psychological interventions conducted between 2006 and February 2016 to directly target and assess people with long-term conditions in order to improve quality of life were included. Interventions without long-term condition populations, psychological intervention and/or patient-assessed quality of life were excluded. Results: From 2223 citations identified, 6 satisfied the inclusion/exclusion criteria. All 6 studies significantly improved at least one quality of life outcome immediately post-intervention. Significant quality of life improvements were maintained at 12-months follow-up in one out of two studies for each of the short- (0–3 months), medium- (3–12 months), and long-term (≥ 12 months) study duration categories. Conclusions: All 6 psychological intervention studies significantly improved at least one quality of life outcome immediately post-intervention, with three out of six studies maintaining effects up to 12-months post-intervention. Future studies should seek to assess the efficacy of tailored psychological interventions using different formats, durations and facilitators to supplement healthcare provision and practice.Publisher PDFPeer reviewe

Exploring associations between perceived HCV status and injecting risk behaviors among recent initiates to injecting drug use in Glasgow

The aim of this study was to explore the influence of testing for hepatitis C virus (HCV) and perceived HCV status on injecting risk behavior. A cross-sectional, community-wide survey was undertaken at multiple sites throughout Greater Glasgow during 2001-2002. Four hundred ninety-seven injecting drug users (IDUs) consented to participate and were interviewed using a structured questionnaire to ascertain HCV test history and injecting risk behavior. The average age of participants was 27 years and the majority of the sample were male (70.4%). Participants had been injecting for an average duration of 2.5 years. Logistic regression analysis revealed no significant associations between having been tested and injecting risk behavior. After adjustment for potential confounding variables, HCV-negatives were significantly less likely to borrow needles/syringes and spoons or filters as compared with unawares and were significantly less likely to borrow spoons or filters as compared with HCV-positives. Due to the cross-sectional design of the study, it is uncertain whether this reduction in risk behavior could be attributed to perception of HCV status. Further research is recommended to consolidate the evidence for this relationship

How are emotional distress and reassurance expressed in medical consultations for people with long-term conditions who were unable to receive curative treatment? A pilot observational study with huntington’s disease and prostate cancer

Objective It is unclear whether how people with long-term conditions express distress, and how clinicians respond, influences perceptions of consultation outcomes. The pilot study examined emotional distress and reassurance in consultations with people whose long-term conditions (at the time of consultations) were treated using active surveillance or symptom management (as no curative treatment was suitable). Methods An observational pilot study was conducted involving consultations between people with long-term conditions and their respective clinician. Consultations between three clinicians (two Huntington’s Disease; one Prostate Cancer) and 22 people with long-term conditions (11 Huntington’s Disease; 11 Prostate Cancer) were audio-recorded. Participants also completed an expanded Consultation and Relational Empathy (CARE) Measure. Two researchers coded sessions using Verona Coding Definitions of Emotional Sequences (VR-CoDES/VR-CoDES-P). Code frequencies were calculated, t tests performed between conditions, and Pearson’s correlations performed for associations between CARE responses and clinician utterances. Results People with long-term conditions expressed emotional distress on average 4.45 times per session, averaging 1.09 Concern and 3.36 Cue utterances. Clinicians responded with more explicit (2.59) and space-providing (3.36), than non-explicit (1.86) and space-reducing (1.09), responses per session. Clinicians expressed spontaneous reassurance on average 5.18 times per session, averaging 3.77 Cognitive and 1.5 Affective reassurance utterances. Huntington’s Disease consultations featured significantly more 'Cues', 'Concerns' and 'Overall' 'Emotional Distress', and 'Cognitive' and 'Overall' ‘Reassurance'. Conclusion Emotional distress was expressed more using hints than explicit concern utterances. Clinicians predominantly explicitly explored distress rather than providing information/advice and provided advice using spontaneous cognitive reassurance. People with Huntington’s Disease expressed more concerns and received more reassurance, indicating different needs between conditions. Future research is required to explore emotional distress and reassurance in a larger sample of participants and long-term condition types, and how the practical implications of these findings may be used to enhance outcomes of consultations.Publisher PDFPeer reviewe

Methods for the Investigation of Spatial Clustering, With Epidemiological Applications

When analysing spatial data, it is often of interest to investigate whether or not the events under consideration show any tendency to form small aggregations, or clusters, that are unlikely to be the result of random variation. For example, the events might be the coordinates of the address at diagnosis of cases of a malignant disease, such as acute lymphoblastic leukaemia or non-Hodgkin's lymphoma. This thesis considers the usefulness of methods employing nonparametric kernel density estimation for the detection of clustering, as defined above, so that specific, and sometimes limiting, alternative hypotheses are not required, and the continuous spatial context of the problem is maintained. Two approaches, in particular, are considered; first, a generalisation of the Scan Statistic to two dimensions, with a correction for spatial heterogeneity under the null hypothesis, and secondly, a statistic measuring the squared difference between kernel estimates of the probability density functions of the principal events and a sample of controls. Chapter 1 establishes the background for this work, and identifies four different families of techniques that have been proposed, previously, for the study of clustering. Problems inherent in typical applications are discussed, and then used to motivate the approach taken subsequently. Chapter 2 describes the Scan Statistic for a one-dimensional problem, assuming that the distribution of events under the null hypothesis is uniform. A number of approximations to the statistic's distribution and methods of calculating critical values are compared, to enable significance testing to be carried out with minimum effort. A statistic based on the supremum of a kernel density estimate is also suggested, but an empirical study demonstrates that this has lower power than the Scan Statistic. Chapter 3 generalises the Scan Statistic to two dimensions and demonstrates empirically that existing bounds for the upper tail probability are not sufficiently sharp for significance testing purposes. As an aside, the chapter also describes a problem that can occur when a single pseudo-random number generator is used to produce parallel streams of uniform deviates. Chapter 4 investigates a method, suggested by Weinstock (1981), of correcting for a known, non-uniform null distribution when using the Scan Statistic in one dimension, and proposes that a kernel estimator replace the exact density, the estimate being calculated from a second set of (control) observations. The approach is generalised to two dimensions, and approximations are developed to simplify the computation required. However, simulation results indicate that the accuracy of these approximations is often poor, so an alternative implementation is suggested. For the case where two samples of observations are available, the events of interest and a group of control locations. Chapter 5 suggests the use of the integrated squared difference between the corresponding kernel density estimates as a measure of the departure of the events from null expectation. By exploiting its similarity to the integrated square error of a k.d.e., the statistic is shown to be asymptotically normal; the proof generalises a central limit theorem of Hall (1984) to the two-sample case. However, simulation results suggest that significance testing should use the bootstrap, since the exact distribution of the statistic appears to be noticeably skewed. A modified statistic, with the smoothing parameters of the two k.d.e.'s constrained to be equal and non-random, is also discussed, and shown, both asymptotically and empirically, to have greater power than the original. In Chapter 6, the two techniques are applied to the geographical distribution of cases of laryngeal cancer in South Lancashire for the period 1974 to 1983. The results are similar, for the most part, to a previous analysis of the data, described by Diggle (1990) and Diggle et al (1990). The differences in the two analyses appear to be attributable to the bias or variability of the k.d.e.'s required to calculate the integrated squared difference statistic, and the inaccuracy of the approximations used by the corrected Scan Statistic. Chapter 7 summarises the results obtained in the preceding sections, and considers the implications for further research of the observations made in Chapter 6 regarding the weaknesses of the two statistics. It also suggests extensions to the basic methodology presented here that would increase the range of problems to which the two methods could be applied

"It all needs to be a full jigsaw, not just bits" : exploration of healthcare professionals' beliefs towards supported self-management for long-term conditions

Background: Long-Term Conditions are physical health issues which profoundly impact physical and psychological outcomes and have reached epidemic worldwide levels. An increasing evidence-base has developed for utilizing Supported Self-Management to ensure Health, Social Care & Voluntary staff are knowledgeable, skilled, and experienced to enable patients to have the confidence and capability to self-manage their conditions. However, despite Health Psychology theories underpinning chronic care models demonstrating beliefs are crucially associated with intention and behaviour, staff beliefs towards Supported Self-Management have received little attention. Therefore, the study aimed to explore healthcare professionals’ beliefs towards Supported Self-Management for Long-Term Conditions using the Theory of Planned Behaviour. Methods:  A mixed-methods approach was conducted within a single UK local government authority region in 2 phases: (1) Qualitative focus group of existing Supported Self-Management project staff (N = 6); (2) Quantitative online questionnaire of general Long-Term Conditions staff (N = 58). Results:  (1) Eighty two utterances over 20 theme sub-codes demonstrated beliefs that Supported Self-Management improves healthcare outcomes, but requires enhancements to patient and senior stakeholder buy-in, healthcare culture-specific tailoring, and organizational policy and resources; (2) Mean scores indicated moderate-strength beliefs that Supported Self-Management achieves positive healthcare outcomes, but weak-strength intentions to implement Supported Self-Management and beliefs it is socially normative and perceived control over implementing it. Crucially, regression analyses demonstrated intentions to implement Supported Self-Management were only associated with beliefs that important others supported it and perceived control over, or by whether it was socially encouraged. Conclusions:  Healthcare professionals demonstrated positive attitudes towards Supported Self-Management improving healthcare outcomes. However, intentions towards implementing this approach were low with staff only slightly believing important others (including patients and clinicians) supported it and that they had control over using it. Future Supported Self-Management projects should seek to enhance intention (and consequently behaviour) through targeting beliefs that important others do indeed actually support this approach and that staff have control over implementing it, as well as enhancing social encouragement.Publisher PDFPeer reviewe

Improvement in Prediction of Coronary Heart Disease Risk over Conventional Risk Factors Using SNPs Identified in Genome-Wide Association Studies

We examined whether a panel of SNPs, systematically selected from genome-wide association studies (GWAS), could improve risk prediction of coronary heart disease (CHD), over-and-above conventional risk factors. These SNPs have already demonstrated reproducible associations with CHD; here we examined their use in long-term risk prediction.SNPs identified from meta-analyses of GWAS of CHD were tested in 840 men and women aged 55-75 from the Edinburgh Artery Study, a prospective, population-based study with 15 years of follow-up. Cox proportional hazards models were used to evaluate the addition of SNPs to conventional risk factors in prediction of CHD risk. CHD was classified as myocardial infarction (MI), coronary intervention (angioplasty, or coronary artery bypass surgery), angina and/or unspecified ischaemic heart disease as a cause of death; additional analyses were limited to MI or coronary intervention. Model performance was assessed by changes in discrimination and net reclassification improvement (NRI).There were significant improvements with addition of 27 SNPs to conventional risk factors for prediction of CHD (NRI of 54%, P<0.001; C-index 0.671 to 0.740, P = 0.001), as well as MI or coronary intervention, (NRI of 44%, P<0.001; C-index 0.717 to 0.750, P = 0.256). ROC curves showed that addition of SNPs better improved discrimination when the sensitivity of conventional risk factors was low for prediction of MI or coronary intervention.There was significant improvement in risk prediction of CHD over 15 years when SNPs identified from GWAS were added to conventional risk factors. This effect may be particularly useful for identifying individuals with a low prognostic index who are in fact at increased risk of disease than indicated by conventional risk factors alone

Acceptability of, and barriers and facilitators to, a pilot physical health service for people who inject drugs:A qualitative study with service users and providers

BACKGROUND: People who inject drugs may experience difficulty accessing or maintaining involvement with traditional healthcare services. This is associated with increased health inequalities and bio-psychosocial difficulties. Embedding physical healthcare services within community-based drug services may provide a practical and feasible approach to increase access and delivery of healthcare. This study explored the acceptability of, and barriers and facilitators to, embedding a pilot physical healthcare service within a community-based drug service in the United Kingdom (Bristol, England). METHODS: Semi-structured interviews were conducted with service users (people who inject drugs) (n = 13), and a focus group was conducted with service providers (n = 11: nine harm reduction workers, two nurses, one service manager). Topic guides included questions to explore barriers and facilitators to using and delivering the service (based on the COM-B Model), and acceptability of the service (using the Theoretical Framework of Acceptability). Transcripts were analysed using a combined deductive framework and inductive thematic analysis approach. RESULTS: The service was viewed as highly acceptable. Service users and providers were confident they could access and provide the service respectively, and perceived it to be effective. Barriers included competing priorities of service users (e.g. drug use) and the wider service (e.g. equipment), and the potential impact of the service being removed in future was viewed as a barrier to overall healthcare access. Both service users and providers viewed embedding the physical health service within an existing community-based drug service as facilitating accessible and holistic care which reduced stigma and discrimination. CONCLUSIONS: The current study demonstrated embedding a physical health service within an existing community-drug based and alcohol service was acceptable and beneficial. Future studies are required to demonstrate cost-effectiveness and ensure long-term sustainability, and to determine transferability of findings to other settings, organisations and countries

Total synthesis of (±)-aspidospermidine, (±)-aspidofractinine, (±)-limaspermidine, and (±)-vincadifformine via a cascade and common intermediate strategy

D.L.C. thanks EPSRC and GSK for a Ph.D. studentship.A concise strategy for the total synthesis of several Aspidosperma alkaloids is reported. A Suzuki–Miyaura cross-coupling provides access to a 2-vinyl indole that undergoes a Diels–Alder cascade reaction with butyn-2-one to deliver a pyrroloindoline intermediate. This undergoes cascade amidation, reduction, skeletal rearrangement, and intramolecular Michael addition to provide a common intermediate containing the full framework of the Aspidosperma alkaloids. The utility of this intermediate is shown in the synthesis of four different natural products.Publisher PDFPeer reviewe