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Publication History View all

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    Alimentary Pharmacology & Therapeutics 10/2011; 34(8):1030; author reply 1031.
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    ABSTRACT: Unconventional locations outwith general medical practice may prove opportunities for screening. The aim was to determine the resource implications and economics of a screening service using random capillary blood glucose (rCBG) tests to detect raised blood glucose levels in the "at risk" population attending high street optometry practices. A screening service was implemented in optometry practices in North East England: the cost of the service and the implication of different screening strategies was estimated. The cost of a screening test was £5.53-£11.20, depending on the screening strategy employed and who carried out the testing. Refining the screening strategy to target those ≥40 years with BMI of ≥25 kg/m(2) and/or family history of diabetes resulted in a cost per case referred to the GP of £14.38-£26.36. Implementing this strategy in half of optometric practices in England would have the potential to identify up to 150,000 new cases of diabetes and prediabetes a year. Optometry practices provide an effective way of identifying people who would benefit from further investigation for diabetes. Effectiveness could be improved further by improving cooperation and communication between optometrists and medical practitioners.
    Health Policy 08/2011; 102(2-3):193-9.
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    ABSTRACT: Unconventional settings, outside general medical practice, are an underutilised resource in the attempt to identify the large numbers of people with undiagnosed diabetes worldwide. The study investigated the feasibility of using optometry practices (opticians) as a setting for a diabetes screening service. Adults attending high street optometry practices in northern England who self-reported at least one risk factor for diabetes were offered a random capillary blood glucose (rCBG) test. Those with raised rCBG levels were asked to visit their GP for further investigations. Of 1909 adults attending practices for sight tests, 1303 (68.2%) reported risk factors for diabetes, of whom 1002 (76.9%) had rCBG measurements taken. Of these, 318 (31.7%) were found to have a rCBG level of ≥6.1 mmol/l, a level where further investigations are recommended by Diabetes UK; 1.6% of previously undiagnosed individuals were diagnosed with diabetes or pre-diabetes as a result of the service. Refining the number of risk factors for inclusion would have reduced those requiring screening by half and still have identified nearly 70% of the new cases of diabetes and pre-diabetes. Screening in optometric practices provides an efficient opportunity to screen at-risk individuals who do not present to conventional medical services, and is acceptable and appropriate. Optometrists represent a skilled worldwide resource that could provide a screening service. This service could be transferable to other settings.
    British Journal of General Practice 07/2011; 61(588):436-42.
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    ABSTRACT: Diabetes is a leading cause of blindness in the working age population. While optometrists have an established role in screening people with known diabetes for eye disease, their role in screening for diabetes has not been evaluated. For diabetes screening in optometry practices to be successful it must be acceptable to both optometrists and to the public. The purpose of this study was to determine acceptability to people attending optometry practices of using random capillary blood glucose (rCBG) tests to detect raised blood glucose levels in optometry practices. A screening service offering people with risk factors or symptoms of diabetes rCBG tests was piloted in five high street opticians' practices in North East England. One thousand and two people used the screening service during a 20 week period. Each was given a questionnaire to complete and return following a rCBG test. Nine hundred and thirty-nine questionnaires were returned (return rate 93.7%). The mean age of participants was 54.5 years, 63.3% were female and 75.0% had not been screened for diabetes previously. 99.1% agreed or strongly agreed that the location was convenient for them and 98.0% would recommend others to use the screening service. 83.8% of the participants would not have gone elsewhere to have any tests done and 148 (16.2%) responded that they would have sought a test elsewhere; 14.2% at the GP, 0.8% at a pharmacy and 0.5% elsewhere. Only 3.2% reported that the test procedure was uncomfortable.   To those attending opticians' practices, screening using rCBG tests is acceptable in terms of convenience and test comfort, and they would recommend the test to others. Screening in optometry practices provides an opportunity to identify people at risk of diabetes in a hitherto unutilised setting.
    Ophthalmic and Physiological Optics 03/2011; 31(4):367-74.
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    ABSTRACT: Upper gastrointestinal symptoms impose a substantial illness burden and management costs. Understanding perceptions and reasons for seeking healthcare is a prerequisite for meeting patients' needs effectively. To review systematically findings on consultation frequencies for gastro-oesophageal reflux disease (GERD) and dyspepsia and patients' reasons for consultation. Systematic literature searches. Reported consultation rates ranged from 5.4% to 56% for GERD and from 26% to 70% for dyspepsia. Consultation for GERD was associated with increased symptom severity and frequency, interference with social activities, sleep disturbance, lack of timetabled work, higher levels of comorbidity, depression, anxiety, phobia, somatization and obsessionality. Some consulted because of fears that their symptoms represented serious disease; others avoided consultation because of this. Inconsistent associations were seen with medication use. Patients were less likely to consult if they felt that their doctor would trivialize their symptoms. Few factors were consistently associated with dyspepsia consultation. However, lower socio-economic status and Helicobacter pylori infection were associated with increased consultation. Patients' perceptions of their condition, comorbid factors and external reasons such as work and social factors are related to consultation rates for GERD. Awareness of these factors can guide the clinician towards a more effective strategy than one based on drug therapy alone.
    Alimentary Pharmacology & Therapeutics 09/2009; 30(4):331-42.
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    ABSTRACT: Depressive symptoms are common in primary care, yet considerable professional controversy exists about appropriate management including the effectiveness of treatments. In addition, avoiding prescribing antidepressants at least initially is recommended. Views of patients themselves should therefore be particularly important in agreeing management strategies. To examine lay beliefs about depressive symptoms in primary care. A total of 23 semi-structured interviews were conducted with patients scoring positively for depression on the Hospital Anxiety and Depression Score in a primary care setting. Differentiating 'depression' from understandable reactions to adversity was difficult for patients. The wide range of consequences discussed included adverse effects on others, difficulties coping with feeling out of control and loss of self-identity. Negative images of depression, such as depression being a 20th century phenomenon, were pervasive. Views about medication varied. Various management strategies described included strategies of detachment, engagement in activities and 'blotting out' symptoms. Patients' views about depressive symptoms are significantly different from conventional medical views. A 'disease management approach' fits uncomfortably with patients' experiences. Acknowledging feelings of loss of control and loss of self-identity in consultations may be useful. The wide employment of techniques patients use to control their disorders, such as support from others, engagement in activities and working at relationships, may be useful to encourage in consultations as alternatives to the use of antidepressant medication.
    Family Practice 10/2007; 24(4):358-64.
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    ABSTRACT: As the extension of nursing into roles previously within the domain of medicine and the demand for evidence based practice continue to increase, the quality of decision making becomes imperative. Making accurate decisions is essential, both for the practitioner and for the patient, especially in the provision of critical care outreach (CCOR), to improve outcomes of care. With changes in health care delivery and increased accountability for practitioners' decisions, it is important to understand more about how clinical decisions are made and what factors influence them in order to inform practice. The previous paper outlined the theoretical background of clinical decision making and the knowledge that underpins practice in CCOR. In this paper, the authors, a Nurse Consultant in CCOR and a research fellow, examine the process of a practitioner's decision making in the practice of CCOR, through a collaborative reflective account of a case study. From this, recommendations are made about the future development of CCOR practitioners and services.
    Intensive and Critical Care Nursing 05/2007; 23(2):104-14.
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    ABSTRACT: Since the publication of 'Comprehensive Critical Care' (2000) critical care outreach (CCOR) services have been developed to meet the needs of patients through critical care provision 'without walls'. Now embedded nationally, CCOR is a central part of health care delivery in the National Health Service (NHS). To date, approximately 75% of hospitals in England have introduced and developed the service according, at least to some extent, to local needs and resources. While this has resulted in a somewhat inconsistent approach to the development and configuration of these services, a number of common elements remain. Arguably, effective clinical decision-making by CCOR practitioners is fundamental to efficient patient care management and the success of these services. In its examination of CCOR service provision this, the first of two papers, addresses the theoretical background of clinical decision making and the knowledge that underpins practice in CCOR. In the second paper, through collaborative reflection and analysis of a case study, the authors bring these together in a process that illuminates the realities of clinical decision making for CCOR practitioners. From this, recommendations are made about the future development of CCOR practitioners and services.
    Intensive and Critical Care Nursing 03/2007; 23(1):15-22.
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    ABSTRACT: With reference to her own study of children with long-term conditions, Helen Close considers whether photography as a research method can be both valuable and ethical.
    Nurse researcher 02/2007; 15(1):27-36.
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    ABSTRACT: Uncertainty about the likelihood of a particular child coming to harm is a chief concern for parents making decisions about the MMR vaccine, but little attention has been given to the ways that parents cope with this uncertainty. Social science frameworks may help practitioners to understand parental decision making and its implications for community practice. In focus groups and interviews involving 87 parents, three distinct strategies for dealing with uncertainty emerged: reducing complexity through trust, compromise strategies that embrace ambivalence and identifying vulnerable groups. Community practitioners should seek to understand how parents may be using these strategies in order to appropriately tailor their information provision and foster trusting relationships in the communities they serve.
    Community practitioner: the journal of the Community Practitioners' & Health Visitors' Association 12/2006; 79(11):354-7.
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