46 research outputs found
Independent Evaluation of the Marie Curie Cancer Care Delivering Choice Programme in Somerset and North Somerset
An exploration of barriers and facilitators to older adults’ participation in higher impact physical activity and bone health:a qualitative study
Consequences of ‘conversations not had’:insights into failures in communication affecting delays in hospital discharge for older people living with frailty
Dementia priority setting partnership with the James Lind Alliance: using patient and public involvement and the evidence base to inform the research agenda.
BACKGROUND: The James Lind Alliance (JLA) created an approach to elicit the views of those under-represented in research priority exercises. Building on this, the JLA Dementia Priority Setting Partnership was set up as an independent and evidence-based project to identify and prioritise unanswered questions ('uncertainties') about prevention, diagnosis, treatment and care relating to dementia. METHODS: A survey was widely disseminated to stakeholders with an interest in the needs of the older population. Thematic analysis was used to identify themes from the large amount of questions collected from which research questions were developed using PICO framework (Population, Intervention, Comparator, Outcome). Each question was checked against an extensive evidence base of high-quality systematic reviews to verify whether they were true uncertainties. FINDINGS: One thousand five hundred and sixty-three questionnaires were received, from people with dementia, carers/relatives, and health and care professionals; 85 uncertainties were identified from other sources. Questions were refined and formatted iteratively into 146 unique uncertainties. An interim prioritisation process involving diverse organisations identified the top 25 ranked questions. At a final face-to-face prioritisation workshop, 18 people representing the above constituencies arrived by consensus at the top 10 priority questions. The impact of patient and public involvement on the priorities is discussed. INTERPRETATION: The long (146 questions) and top 10 lists of dementia research priorities provide a focus for researchers, funders and commissioners. They highlight a need for more research into care for people with dementia and carers, and a need for high-quality effectiveness trials in all aspects of dementia research.This work was funded by the Alzheimer’s Society, UK (grant number RG66301) and supported by the National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough. No funding source had a role in the preparation of this paper, or the decision to submit it for publication.This is the final published version of the article. It was originally published in Age and Ageing (Age and Ageing 2015; 44: 985–993 doi: 10.1093/ageing/afv143). The final version is available at http://dx.doi.org/10.1093/ageing/afv14
Can Paramedics Use Frax to Identify Patients at Greatest Risk of Future Fracture Among Those Who Fall?:A Feasibility Study
Measuring spirometry in a lung cancer screening cohort highlights possible underdiagnosis and misdiagnosis of Chronic Obstructive Pulmonary Disease
Introduction:
Chronic Obstructive Pulmonary Disease (COPD) is underdiagnosed, and measurement of spirometry
alongside low-dose computed tomography (LDCT) screening for lung cancer is one strategy to
increase earlier diagnosis of this disease. //
Methods:
Ever-smokers at high risk of lung cancer were invited to the Yorkshire Lung Screening Trial for a Lung
Health Check (LHC) comprising LDCT screening, pre-bronchodilator spirometry and smoking
cessation service. In this cross-sectional study we present data on participant demographics,
respiratory symptoms, lung function, emphysema on imaging and both self-reported and primary
care diagnoses of COPD. Multivariable logistic regression analysis identified factors associated with
possible underdiagnosis and misdiagnosis of COPD in this population, with airflow obstruction (AO)
defined as FEV1/FVC ratio <0.70. //
Results:
Of 3,920 LHC attendees undergoing spirometry, 17% had undiagnosed AO with respiratory
symptoms, representing potentially undiagnosed COPD. Compared to those with a primary care
COPD code, this population had milder symptoms, better lung function, and were more likely to be
current smokers (p≤0.001 for all comparisons). Of 836 attendees with a primary care COPD code
who underwent spirometry, 19% did not have AO, potentially representing misdiagnosed COPD,
although symptom burden was high. //
Discussion:
Spirometry offered alongside LDCT screening can potentially identify cases of undiagnosed and
misdiagnosed COPD. Future research should assess the downstream impact of these findings to
determine if any meaningful changes to treatment and outcomes occurs, and also to assess the
impact on co-delivering spirometry on other parameters of LDCT screening performance such as
participation and adherence. Additionally, work is needed to better understand the aetiology of
respiratory symptoms in those with misdiagnosed COPD, to ensure this highly symptomatic group
receive evidence-based interventions
Objectively assessed physical activity and subsequent health service use of UK adults aged 70 and over: A four to five year follow up study
Objectives: To examine the associations between volume and intensity of older peoples' physical activity, with their subsequent health service usage over the following four to five years. Study Design: A prospective cohort design using baseline participant characteristics, objectively assessed physical activity and lower limb function provided by Project OPAL (Older People and Active Living). OPAL-PLUS provided data on numbers of primary care consultations, prescriptions, unplanned hospital admissions, and secondary care referrals, extracted from medical records for up to five years following the baseline OPAL data collection. Participants and Data Collection: OPAL participants were a diverse sample of 240 older adults with a mean age of 78 years. They were recruited from 12 General Practitioner surgeries from low, middle, and high areas of deprivation in a city in the West of England. Primary care consultations, secondary care referrals, unplanned hospital admissions, number of prescriptions and new disease diagnoses were assessed for 213 (104 females) of the original 240 OPAL participants who had either consented to participate in OPAL-PLUS or already died during the follow-up period. Results: In regression modelling, adjusted for socio-economic variables, existing disease, weight status, minutes of moderate-to-vigorous physical activity (MVPA) per day predicted subsequent numbers of prescriptions. Steps taken per day and MVPA also predicted unplanned hospital admissions, although the strength of the effect was reduced when further adjustment was made for lower limb function. Conclusions: Community-based programs are needed which are successful in engaging older adults in their late 70s and 80s in more walking, MVPA and activity that helps them avoid loss of physical function. There is a potential for cost savings to health services through reduced reliance on prescriptions and fewer unplanned hospital admissions. © 2014 Simmonds et al
What works in ‘real life’ to facilitate home deaths and fewer hospital admissions for those at end of life?: results from a realist evaluation of new palliative care services in two English counties
Short‐term psychosocial outcomes of adding a non‐contrast abdominal computed tomography (CT) scan to the thoracic CT within lung cancer screening
Objectives
To evaluate psychological, social, and financial outcomes amongst individuals undergoing a non-contrast abdominal computed tomography (CT) scan to screen for kidney cancer and other abdominal malignancies alongside the thoracic CT within lung cancer screening.
Subjects and Methods
The Yorkshire Kidney Screening Trial (YKST) is a feasibility study of adding a non-contrast abdominal CT scan to the thoracic CT within lung cancer screening. A total of 500 participants within the YKST, comprising all who had an abnormal CT scan and a random sample of one-third of those with a normal scan between 14/03/2022 and 24/08/2022 were sent a questionnaire at 3 and 6 months. Outcomes included the Psychological Consequences Questionnaire (PCQ), the short-form of the Spielberger State–Trait Anxiety Inventory, and the EuroQoL five Dimensions five Levels scale (EQ-5D-5L). Data were analysed using regression adjusting for participant age, sex, socioeconomic status, education, baseline quality of life (EQ-5D-5L), and ethnicity.
Results
A total of 380 (76%) participants returned questionnaires at 3 months and 328 (66%) at 6 months. There was no difference in any outcomes between participants with a normal scan and those with abnormal scans requiring no further action. Individuals requiring initial further investigations or referral had higher scores on the negative PCQ than those with normal scans at 3 months (standardised mean difference 0.28 sd, 95% confidence interval 0.01–0.54; P = 0.044). The difference was greater in those with anxiety or depression at baseline. No differences were seen at 6 months.
Conclusion
Screening for kidney cancer and other abdominal malignancies using abdominal CT alongside the thoracic CT within lung cancer screening is unlikely to cause significant lasting psychosocial or financial harm to participants with incidental findings