A cluster randomised trial of a Needs Assessment Tool for adult Cancer patients and their carers (NAT-C) in primary care: A feasibility study.

BackgroundPeople with cancer often have unidentified symptoms and social care needs. The Needs Assessment Tool-Cancer (NAT-C) is a validated, structured method of assessing patient/carer concerns and prompting action, to address unmet need.AimsAssess feasibility and acceptability of a definitive two-armed cluster randomised trial of NAT-C in primary care by evaluating: recruitment of GP practices, patients and carers; most effective approach of ensuring NAT-C appointments, acceptability of study measures and follow-up.MethodsNon-blinded, feasibility study in four General Practices, with cluster randomisation to method of NAT-C appointment delivery, and process evaluation. Adults with active cancer were invited to participate with or without carer. Practices cluster randomised (1:1) to Arm I: promotion and use of NAT-C with a NAT-C trained clinician or Arm II: clinician of choice irrespective of training status. Participants completed study questionnaires at: baseline, 1, 3 and 6 months. Patients booked a 20 minute needs-assessment appointment post-baseline. Patients, carers and GP practice staff views regarding the study sought through interviews/focus groups. Quantitative data were analysed descriptively. Qualitative data were analysed thematically, informed by Normalisation Process Theory. Progression to a definitive trial was assessed against feasibility outcomes, relating to: recruitment rate, uptake and delivery of the NAT-C, data collection and quality.ResultsFive GP practices approached, four recruited and trained to use the NAT-C. Forty-seven participants and 17 carers recruited. At baseline, 34/47 (72%) participants reported at least one moderate-severe unmet need, confirming study rationale. 32/47 (68%) participants received a NAT-C-guided consultation, 19 of which on Arm I. Study attrition at one month (n = 44 (94%), n = 16 (94%)), three months (n = 38 (81%), n = 14 (82%)) and six months (n = 32 (68%), n = 10 (59%)). Fifteen patient interviews conducted across the whole study and one focus group at each GP practice. Participants supported a definitive study and found measures acceptable.ConclusionThe feasibility trial indicated that recruitment rate, intervention uptake and data collection were appropriate, with refinements, for a definitive multi-centre cluster randomised controlled trial. Feasibility outcomes informed the design of a 2-armed cluster randomised controlled trial to test the effectiveness and cost-effectiveness of the NAT-C compared with usual care

Pilot evaluation of the psychometric properties of a self-medication Risk Assessment Tool among elderly patients in a community setting

<p>Abstract</p> <p>Background</p> <p>Although community pharmacists in the United Kingdom are expected to assess elderly patients' needs for additional support in managing their medicines, there is limited data on potentially useful assessment tools. We sought to evaluate a 13-item assessment instrument among community dwelling elderly patients, 65 years and above. The instrument is composed of a cognitive risk sub-scale of 6 items and a physical risk sub-scale of 7 items.</p> <p>Findings</p> <p>The instrument was administered to elderly patients in a survey performed in a community to the west of Glasgow, Scotland. The survey recruited 37 participants, 31 from 4 community pharmacies and 6 patients whose medication management tasks were managed by the West Glasgow Community Health and Care Partnership (managed patients). Community pharmacists independently rated 29 of the 37 participants' comprehension of, and dexterity in handling their medicines. We assessed scale reliability, convergent validity and criterion validity. In sub-analyses, we assessed differences in scores between the managed patients and those recruited from the community pharmacies, and between multi-compartment compliance aid users and non-users. The instrument showed satisfactory internal consistency (Cronbach's alpha of 0.792 for 13-item scale). There was significant strong negative correlation between the cognitive risk sub-scores and community pharmacists' assessment of comprehension (ρ = -0.546, p = 0.0038); and physical risk sub-scores and community pharmacists' assessment of dexterity (ρ = -0.491, p = 0.0093). The Area Under the Receiver Operator Characteristic Curve (AUC ± SE; 95%CI) showed that the instrument had good discriminatory capacity (0.86 ± 0.07; 0.68, 0.96). The best cut-off (sensitivity, specificity) was ≥4 (65%, 100%). In the sub-analyses, managed patients had significantly higher cognitive risk sub-scores (6.5 versus 4.0, p = 0.0461) compared to non-managed patients. There was a significant difference in total risk score (4 versus 2, p = 0.0135) and cognitive risk sub-score (4 versus 1.5, p = 0.0029) between users and non-users of multi-compartment compliance aids.</p> <p>Conclusions</p> <p>This instrument shows potential for use in identifying elderly patients who may have problems managing their own medicines in the community setting. However, more robust validity and reliability assessments are needed prior to introduction of the tool into routine practice.</p

Strengthening Biblical Historicity vis-a`-vis Minimalism, 1992–2008 and Beyond. Part 2.3: Some Commonalities in Approaches to Writing Ancient Israel’s History

This series of articles covers scholarly works in English which can, at least potentially, be associated with a generally positive view of biblical historicity regarding periods preceding the Israelites’ return from exile. Part 2 covers works that treat the methodological issues at the center of the maximalist–minimalist debate. Parts 2.1 and 2.2 selectively survey the works of 24 non-minimalist scholars during two decades. In the absence of consensus, this article analyzes the works in Parts 2.1 and 2.2, tracing elements of approach that are held in common, at least among pluralities of non-minimalists (possible majorities are not noted). The first commonality of approach is that history is provisional, not final. The second is that history should become fully multidisciplinary. The third commonality is that historians should receive all historical evidence on an equal footing before examination and cross-examination. The fourth and last is that historians should become increasingly sensitive to cultural aspects and coding in ancient Near Eastern materials

New Creation instead of new Exodus : the innerbiblical exegesis and theological transformations of Isaiah 65:17–25

akzeptierte Manuskriptversio

A History of Prophecy in Israel

Kentxiii, 291 p.; 23 c

Interpretation: A Bible commentary for teaching and preaching : V.22.: Ezekiel

Louisvillex, 242 p.; 24 cm

Ezekiel : Interpretation, A Bible Commentary for teaching and preaching

Louisvillevi , 242 p. ; 23 c

Sage, Priest, Prophet : Religion and intellectual leadership in ancient Israel

Louisvillexi, 191 p.; 23 c

The Pentateuch : An Introduction to the first five books of the bible

Londonx, 273 p.; 23 c