The Experiences of People Who Quit Khat and the Health Care Professionals Who Support them

Background: This study aimed to explore the barriers and enablers to quitting khat from the perspective of users and the barriers and enablers to supporting users to quit from the healthcare professional (HCP) perspective. Methods: A qualitative study using semi-structured interviews and the Theoretical Domains Framework (TDF) to collect and analyse data. Results: Overall 10 khat users and 3 professionals were interviewed. Beliefs about the consequences of continued use facilitated user’s decisions to quit. Social influences were a barrier and enabler. For professionals, the social influence of other colleagues and working together was key in enabling them to support clients. Social / professional role and identity was also an important enabler, as professionals saw supporting users to quit as an integral part of their role. A range of behaviour change techniques was identified as potential ways in which quit attempts could be more successful, from the user and professionals perspective. Conclusions: The study reveals the complexity of khat chewing and quitting from the perspective of khat users, such as the varied influence of family and friends. It also identifies the many barriers and enablers that professionals experience when supporting individuals to quit, such as working with other professionals. There is little evidence for the effectiveness of current quit khat services or little information outlining how they were developed. Current services would benefit from evaluating the effectiveness of the interventions using established methodology. Recommendations for practice in the field of substance misuse have been identified

Clinician and patients’ views about self-management support in arthritis: a cross-sectional UK survey

Objective The overall aims of the study are to (a) establish receipt and provision of self-management support for patients with inflammatory arthritis in the UK; and (b) establish if receipt of selfmanagement support is associated with patient’s knowledge, skills and confidence to selfmanage. Methods Questionnaire for patients and healthcare professionals were sent to members and associates of the National Rheumatoid Arthritis Society (NRAS). Patients completed the Patient Activation Measure (PAM), and questions about receipt of self-management support. Healthcare professionals completed the Clinician Support PAM and questions about provision of self-management support. Results A total of 886 patients and 117 healthcare professionals completed a questionnaire. Only 15% of patients had attended a structured self-management programme. Over half of patients reported having the skills, confidence and knowledge to self-manage and this was associated with receipt of self-management support embedded in routine care. All healthcare professionals felt that patients should be actively involved in their own care, however, 60% were unable to offer structured self-management support. Healthcare professionals reported engaging in more embedded self-management support than patients reported receiving in routine care

The impact of mobile monitoring technologies on glycosylated hemoglobin in diabetes: a systematic review

Background: A new development in the field of telehealth is the use of mobile health technologies (mhealth) to help patients record and track medical information. Mhealth appears particularly advantageous for conditions that require intense and ongoing monitoring, such as diabetes, and where people are of working age and not disabled. This review aims to evaluate the evidence for the effectiveness of mhealth interventions in diabetes management on glycosylated hemoglobin. Method: A comprehensive search strategy was developed and applied to eight electronic databases to identify studies that investigated the clinical effectiveness of mobile-based applications that allowed patients to record and send their blood glucose readings to a central server. The eligibility of 8543 papers was assessed against the selection criteria, and 24 papers were reviewed. All studies reviewed were assessed for quality using a standardized quality assessment tool. Results: Results for patients with type 1 and type 2 diabetes were examined separately. Study variability and poor reporting made comparison difficult, and most studies had important methodological weaknesses. Evidence on the effectiveness of mhealth interventions for diabetes was inconsistent for both types of diabetes and remains weak

Are diabetes self-management programmes for the general diabetes population effective for people with severe mental illness?: a systematic review.

Background: Diabetes self-management education programmes are effective in improving health outcomes in the general population with diabetes. However, it is not known if these programmes include people who also have a severe mental illness (SMI) and, if so, what their outcomes are. The aim of this review was to examine if evaluations of diabetes self-management education programmes included people with SMI, and if so, whether the interventions were beneficial for this population. Methods: The inclusion criteria for this systematic review, defined by PICOS criteria, were: Population - Adults with type 2 diabetes; Intervention - self-management education programme; Comparator – another active intervention or usual care; Outcomes of interest – inclusion of people with SMI and the clinical, behavioural and psychosocial outcomes in this population; Study design - randomised controlled trials. The following bibliographic databases were searched from January 2004 to April 2018: Cochrane Library, Medline, Embase, PsychINFO, Allied and Complimentary Medicine Database, Health Technology Assessment, NHS Economic Evaluations Database and CINAHL. Data were extracted on study characteristics, inclusion and exclusion criteria, participant and intervention characteristics, number of participants with SMI, and outcomes for people with SMI, if reported. Authors were contacted by email for missing data. Results: A total of 410 trials were included. At least 42% of trials did not recruit any participants with SMI. Only nine confirmed inclusion of participants with SMI, of which six provided data on the number recruited. These six trials recruited a total of 1009 participants, of whom 31 (3.1%) had SMI. It was not possible to assess intervention effectiveness for people with SMI as none of the trials reported outcomes for these participants. Conclusions: This systematic review confirms that people with SMI are often excluded from trials of diabetes self-management education, resulting in a lack of an evidence base on which to base treatment paths for this vulnerable population. It cannot be assumed that programmes developed for the general diabetes population meet the needs of people with SMI. Future research needs to examine if and how these programmes could be adapted for people with SMI or if new programmes are required

Erectile dysfunction and its detection in the health care setting: 10 years on

Erectile dysfunction is considered an early indicator of cardiovascular disease. Jackson highlighted the important role that General Practitioners and other health care professionals have in detecting erectile dysfunction and potentially preventing subsequent cardiovascular events.(1) Results from our audit suggest that erectile dysfunction detection remains poor

The development and evaluation of a self-monitoring and patient-initiated follow-up service for people with rheumatoid or psoriatic arthritis on methotrexate

This thesis describes the development and evaluation of a self-monitoring and patient-initiated follow-up service for people with rheumatoid arthritis (RA) or psoriatic arthritis (PsA) on methotrexate. Using a mixed methods approach including a randomised controlled trial (RCT) and qualitative semi-structured interviews. The overall aims of this thesis were to design an alternative model of care which could be delivered in rheumatology outpatients by clinical nurse specialists (CNS) in order to reduce the burden of established patients in clinic. This is followed by an evaluation of intervention effectiveness and safety, along with an exploration of the mechanisms of action and patient acceptability. One hundred patients from University College Hospital London (UCLH) with either RA or PsA on methotrexate were recruited into the trial and were followed for six consecutive blood tests. Patients randomised to the intervention group were required to monitor their symptoms, side effects and laboratory results and use this information to initiate care from the CNS. The results indicated that patients were able to accurately initiate a consultation with their nurse on approximately 75% of occasions. The intervention led to 55% fewer appointments with the CNS (p<0.0001) and 39% fewer GP appointments (p=0.07) compared to usual care, with tentative evidence to suggest cost savings. There were no significant differences in clinical or psychosocial well-being, including function, pain, quality of life and mood. Intervention participants were positive about the new model of care, valuing its efficiency and tailored approach. The service allowed patients to gain new knowledge and use this information along with the skills they obtained to take control of their health and arthritis. This model of care may, therefore, be a viable alternative for established RA and PsA patients on methotrexate in order to reduce healthcare utilisation without compromising clinical or psychosocial well-being

A patient-initiated DMARD selfmonitoring service for people with rheumatoid or psoriatic arthritis on methotrexate: a randomised controlled trial

Objective: To determine the effectiveness of a patient-initiated DMARD self-monitoring service for people with rheumatoid (RA) or psoriatic arthritis (PsA) on methotrexate. Methods: A two-arm, single centre, randomised controlled trial assessing superiority in relation to healthcare utilisation, clinical and psychosocial outcomes. Participants were 100 adults with either RA or PsA on a stable dose of methotrexate, randomly assigned to usual care or the patient-initiated service. Intervention participants were trained how to understand and interpret their blood tests and use this information to initiate care from their clinical nurse specialist (CNS). The primary outcome was the number of outpatient visits to the CNS during the trial period. Differences between groups were analysed using Poisson regression models. Secondary outcomes were collected at baseline and after the 3rd and 6th blood tests. Disease activity was measured using either the DAS28 or PsARC, pain and fatigue using a visual numeric scale and the HAQII, HADS and SF12 were completed to assess disability, mood and quality of life, respectively. Differences between groups over time on secondary outcomes were analysed using multi-level models. Results: The patient-initiated DMARD self-monitoring service was associated with 54.55% fewer visits to the CNS (p<0.0001), 6.80% fewer visits to the rheumatologist (p=0.23) and 38.80% fewer visits to the GP (p=0.07), compared with control participants. There was no association between trial arm and any of the clinical or psychosocial outcomes. Conclusions: The results suggest that a patient-initiated service that incorporates patients self-monitoring DMARD therapy can lead to significant reductions in healthcare utilisation, whilst maintaining clinical and psychosocial well-being

Psychosocial interventions for improving quality of life outcomes in adults undergoing strabismus surgery (Protocol)

This is the protocol for a review and there is no abstract. The objectives are as follows: To investigate the effects of psychosocial interventions versus no intervention on quality of life and psychosocial outcomes in adults undergoing strabismus surgery. The primary objective is to assess whether patients who have taken part in a sychosocial intervention prior to their strabismus surgery report significantly improved quality of life compared to those who receive standard care,i.e. strabismus surgery alone. The secondary outcome measures will include anxiety, depression, social anxiety and social avoidance, as well as degree of success in terms of surgical outcome

Opposing effects of final population density and stress on Escherichia coli mutation rate

Evolution depends on mutations. For an individual genotype, the rate at which mutations arise is known to increase with various stressors (stress-induced mutagenesis-SIM) and decrease at high final population density (density-associated mutation-rate plasticity-DAMP). We hypothesised that these two forms of mutation-rate plasticity would have opposing effects across a nutrient gradient. Here we test this hypothesis, culturing Escherichia coli in increasingly rich media. We distinguish an increase in mutation rate with added nutrients through SIM (dependent on error-prone polymerases Pol IV and Pol V) and an opposing effect of DAMP (dependent on MutT, which removes oxidised G nucleotides). The combination of DAMP and SIM results in a mutation rate minimum at intermediate nutrient levels (which can support 7 × 10  cells ml ). These findings demonstrate a strikingly close and nuanced relationship of ecological factors-stress and population density-with mutation, the fuel of all evolution

Hemodialysis Self-management Intervention Randomized Trial (HED-SMART): A Practical Low-Intensity Intervention to Improve Adherence and Clinical Markers in Patients Receiving Hemodialysis

Background: Poor adherence to treatment is common in hemodialysis patients. However, effective interventions for adherence in this population are lacking. Small studies of behavioral interventions have yielded improvements, but clinical effectiveness and long-term effects are unclear. Study Design: Multicenter parallel (1:1) design, blinded cluster-randomized controlled trial. Setting & Participants: Patients undergoing maintenance hemodialysis enrolled in 14 dialysis centers. Intervention: Dialysis shifts of eligible patients were randomly assigned to either an interactive and targeted self-management training program (HED-SMART; intervention; n = 134) or usual care (control; n = 101). HED-SMART, developed using the principles of problem solving and social learning theory, was delivered in a group format by health care professionals over 4 sessions. Outcomes & Measurements: Serum potassium and phosphate concentrations, interdialytic weight gains (IDWGs), self-reported adherence, and self-management skills at 1 week, 3 months, and 9 months postintervention. Results: 235 participants were enrolled in the study (response rate, 44.2%), and 82.1% completed the protocol. IDWG was significantly lowered across all 3 assessments relative to baseline (P < . 0.001) among patients randomly assigned to HED-SMART. In contrast, IDWG in controls showed no change except at 3 months, when it worsened significantly. Improvements in mineral markers were noted in the HED-SMART arm at 3 months (P < . 0.001) and in potassium concentrations (P < . 0.001) at 9 months. Phosphate concentrations improved in HED-SMART at 3 months (P = 0.03), but these effects were not maintained at 9 months postintervention. Significant differences between the arms were found for the secondary outcomes of self-reported adherence, self-management skills, and self-efficacy at all time points. Limitations: Low proportion of patients with diabetes. Conclusions: HED-SMART provides an effective and practical model for improving health in hemodialysis patients. The observed improvements in clinical markers and self-report adherence, if maintained at the longer follow-up, could significantly reduce end-stage renal disease-related complications. Given the feasibility of this kind of program, it has strong potential for supplementing usual care. Trial Registration: Registered at ISRCTN with study number ISRCTN31434033