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    ABSTRACT: To assess the effectiveness of telehealth interventions in the primary prevention of cardiovascular disease in adult patients in community settings. Systematic literature review, conducted in June 2013, of randomised controlled trials comparing the effectiveness of telehealth interventions to reduce overall cardiovascular disease (CVD) risk and/or to reduce multiple CVD risk factors compared with a non-telehealth control group. Study quality was assessed using the Cochrane Risk of Bias tool. Fixed and Random effects models were combined with a narrative synthesis for meta-analysis of included studies. Three of 13 included studies measured Framingham 10-year CVD risk scores, and meta-analysis showed no clear evidence of reduction in overall risk (SMD -0.37%, 95% CI -2.08, 1.33). There was weak evidence for a reduction in systolic blood pressure (SMD -1.22mmHg 95% CI -2.80, 0.35) and total cholesterol (SMD -0.07mmol/L 95% CI -0.19, 0.06). There was no change in High-Density Lipoprotein cholesterol or smoking rates. There is insufficient evidence to determine the effectiveness of telehealth interventions in reducing overall CVD risk. More studies are needed that consistently measure overall CVD risk, directly compare different telehealth interventions, and determine cost effectiveness of telehealth interventions for prevention of CVD.
    Preventive Medicine 04/2014; 64. DOI:10.1016/j.ypmed.2014.04.001

  • European Journal of Integrative Medicine 12/2013; 5(6):576–577. DOI:10.1016/j.eujim.2013.08.014
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    ABSTRACT: Demographic and policy changes appear to be increasing the complexity of consultations in general practice. To describe the number and types of problems discussed in general practice consultations, differences between problems raised by patients or doctors, and between problems discussed and recorded in medical records. Cross-sectional study based on video recordings of consultations in 22 general practices in Bristol and North Somerset. Consultations were examined between 30 representative GPs and adults making a pre-booked day-time appointment. The main outcome measures were number and types of problems and issues discussed; who raised each problem/issue; consultation duration; whether problems were recorded and coded. Of 318 eligible patients, 229 (72.0%) participated. On average, 2.5 (95% CI = 2.3 to 2.6) problems were discussed in each consultation, with 41% of consultations involving at least three problems. Seventy-two per cent (165/229) of consultations included problems in multiple disease areas. Mean consultation duration was 11.9 minutes (95% CI = 11.2 to 12.6). Most problems discussed were raised by patients, but 43% (99/229) of consultations included problems raised by doctors. Consultation duration increased by 2 minutes per additional problem. Of 562 problems discussed, 81% (n = 455) were recorded in notes, but only 37% (n = 206) were Read Coded. Consultations in general practice are complex encounters, dealing with multiple problems across a wide range of disease areas in a short time. Additional problems are dealt with very briefly. GPs, like patients, bring an agenda to consultations. There is systematic bias in the types of problems coded in electronic medical records databases.
    British Journal of General Practice 11/2013; 63(616):751-759. DOI:10.3399/bjgp13X674431
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    ABSTRACT: To compare the cost-effectiveness of PhysioDirect with usual physiotherapy care for patients with musculoskeletal problems. (1) Cost-consequences comparing cost to the National Health Service (NHS), to patients, and the value of lost productivity with a range of outcomes. (2) Cost-utility analysis comparing cost to the NHS with Quality-Adjusted Life Years (QALYs). Four physiotherapy services in England. Adults (18+) referred by their general practitioner or self-referred for physiotherapy. PhysioDirect involved telephone assessment and advice followed by face-to-face care if needed. Usual care patients were placed on a waiting list for face-to-face care. Primary clinical outcome: physical component summary from the SF-36v2 at 6 months. Also included in the cost-consequences: Measure Yourself Medical Outcomes Profile; a Global Improvement Score; response to treatment; patient satisfaction; waiting time. Outcome for the cost-utility analysis: QALYs. 2249 patients took part (1506 PhysioDirect; 743 usual care). (1) Cost-consequences: there was no evidence of a difference between the two groups in the cost of physiotherapy, other NHS services, personal costs or value of time off work. Outcomes were also similar. (2) Cost-utility analysis based on complete cases (n=1272). Total NHS costs, including the cost of physiotherapy were higher in the PhysioDirect group by £19.30 (95% CI -£37.60 to £76.19) and there was a QALY gain of 0.007 (95% CI -0.003 to 0.016). The incremental cost-effectiveness ratio was £2889 and the net monetary benefit at λ=£20 000 was £117 (95% CI -£86 to £310). PhysioDirect may be a cost-effective alternative to usual physiotherapy care, though only with careful management of staff time. Physiotherapists providing the service must be more fully occupied than was possible under trial conditions: consideration should be given to the scale of operation, opening times of the service and flexibility in the methods used to contact patients.
    BMJ Open 10/2013; 3(10):e003406. DOI:10.1136/bmjopen-2013-003406
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    ABSTRACT: The composite abuse scale (CAS) is a comprehensive tool used to measure intimate partner violence (IPV). The aim of the present study is to translate the CAS from English to Arabic. The translation of the CAS was conducted in four stages using a multi-method approach: 1) preliminary forward translation, 2) discussion with a panel of bilingual experts, 3) focus groups discussion, and 4) back-translation of the CAS. The discussion included a linguistic validation by a comparison of the Arabic translation with the original English by assessing conceptual and content equivalence. In all the stages of translation, there was an agreement to remove the question from the CAS that asked women about the use of objects in the vagina. Wording, format and order of the items were refined according to comments and suggestions made by the experts' panel and focus groups' members. The back-translated CAS showed similar wording and language of the original English version. The Arabic version of the CAS will help to measure the problem of IPV among Saudi women and possibly other Arabic-speaking women in future studies. This is important, particularly, in longitudinal studies or intervention studies among abused women and it allows a comparison of the results of studies from different cultures. However, further validations studies are needed to ensure accurate and equivalent Arabic translation of the CAS.
    PLoS ONE 09/2013; 8(9):e75244. DOI:10.1371/journal.pone.0075244

  • JAMA The Journal of the American Medical Association 08/2013; 310(5):479-80. DOI:10.1001/jama.2013.167453

  • British Journal of General Practice 08/2013; 63(613):426-7. DOI:10.3399/bjgp13X670750

  • Primary Health Care Research & Development 07/2013; 14(3):320-2. DOI:10.1017/S1463423613000224

  • Postgraduate medical journal 07/2013; 89(1053):369-70. DOI:10.1136/postgradmedj-2012-131336
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    ABSTRACT: Aim To map the availability and types of depression and anxiety groups, to examine men's experiences and perception of this support as well as the role of health professionals in accessing support. The best ways to support men with depression and anxiety in primary care are not well understood. Group-based interventions are sometimes offered but it is unknown whether this type of support is acceptable to men. Interviews with 17 men experiencing depression or anxiety. A further 12 interviews were conducted with staff who worked with depressed men (half of whom also experienced depression or anxiety themselves). There were detailed observations of four mental health groups and a mapping exercise of groups in a single English city (Bristol). Findings Some men attend groups for support with depression and anxiety. There was a strong theme of isolated men, some reluctant to discuss problems with their close family and friends but attending groups. Peer support, reduced stigma and opportunities for leadership were some of the identified benefits of groups. The different types of groups may relate to different potential member audiences. For example, unemployed men with greater mental health and support needs attended a professionally led group whereas men with milder mental health problems attended peer-led groups. Barriers to help seeking were commonly reported, many of which related to cultural norms about how men should behave. General practitioners played a key role in helping men to acknowledge their experiences of depression and anxiety, listening and providing information on the range of support options, including groups. Men with depression and anxiety do go to groups and appear to be well supported by them. Groups may potentially be low cost and offer additional advantages for some men. Health professionals could do more to identify and promote local groups.
    Primary Health Care Research & Development 06/2013; 15(03):1-15. DOI:10.1017/S1463423613000297
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