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    ABSTRACT: Objective: The increased prevalence of obesity has resulted in the current high popularity of dietary supplements marketed as weight reducing agents. The efficacy of most of these supplements is not established. The soluble fiber, glucomannan, is often recommended for weight loss. The aim of this systematic review is to evaluate the evidence for or against the efficacy of glucomannan in body weight reduction. Methods: Electronic searches were conducted in Medline, Embase, Amed, and The Cochrane Library. Hand searches of bibliography were also conducted. Outcomes of interest were body weight and body mass index. Studies involving only overweight and/or obese participants were included. Two reviewers independently determined the eligibility of studies and assessed the reporting quality of included randomized controlled trials (RCTs), using the CONSORT and PRISMA guidelines. Results: Eighteen trials were identified, and 9 were included. There was a variation in the reporting quality of the included RCTs. A meta-analysis (random effect model) of 8 RCTs revealed a nonstatistically significant difference in weight loss between glucomannan and placebo (mean difference [MD]: -0.22 kg; 95% confidence interval [CI], -0.62, 0.19; I(2) = 65%). Adverse events included abdominal discomfort, diarrhea, and constipation. Conclusion: The evidence from available RCTs does not show that glucomannan intake generates statistically significant weight loss. Future trials should be more rigorous and better reported.
    Journal of the American College of Nutrition 02/2014; 33(1):70-8.
  • Journal of clinical epidemiology 11/2013;
  • Journal of clinical epidemiology 11/2013;
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    ABSTRACT: Reports suggest approximately 21-23% of GPs in the UK have consulted with patients using email, but little is known about the nature of this use and what it means for clinicians and patients in general practice. To understand the use of email consultation in general practice by investigating the experiences of existing users and views of experts. A qualitative study conducted in 2010 using purposive sampling and semi-structured interviews in general practice and community settings in some London boroughs. A maximum variation sample of GPs and patients who had used email for consultation in general practice were recruited, as were policy and/or implementation experts. Interviews continued until saturation was achieved. In total 10 GPs, 14 patients, and six experts were interviewed. Consultation by email was often triggered by logistic or practical issues; motivators for ongoing use were the benefits, such as convenience, for GPs and patients. Both GPs and patients reported concerns about safety and lack of guidance about the 'rules of engagement' in email consultations, with GPs also concerned about workload. In response, both groups attempted to introduce their own rules, although this only went some way to addressing uncertainty. Long term, participants felt there was a need for regulation and guidance. Consultations by email in general practice occur in an unregulated and unstructured way. Current UK policy is to promote consultations by email, making it crucial to consider the responsibility and workload faced by clinicians, and the changes required to ensure safe use; not doing so may risk safety breaches and result in suboptimal care for patients.
    British Journal of General Practice 11/2013; 63(616):760-767.
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    ABSTRACT: Informal caregiving continues to be a crucial part of health and social care provision in the developed world, but the processes by which the identity of informal caregiver is conferred, or assumed, remain unclear. In this article we draw on data from a qualitative research study which examined the experiences of family members and friends of people with multiple sclerosis (pwMS) to explore how they interpret the label 'carer'. We conducted narrative interviews with forty people throughout the United Kingdom between June 2011 and January 2012. Participants were spouses, partners, parents, children, siblings or friends of people who have had multiple sclerosis between 6 months and fifty years. We carried out thematic analysis of the interviews, informed by identity theory. Identity theory illuminated variation in peoples' perceptions of themselves as carers, suggesting that self-identification with the role and label of carer is nuanced, shifting and variable. We propose a taxonomy of caring activity including emotional support, personal care, physical care, household tasks, advocacy and activism and describe four categories, with fluid and overlapping boundaries, in which the identity of carer was apparently embraced, enforced, absorbed or rejected. Variability and fluidity in self-identification as a carer are related to apparent expectations about whether one should assume a caring role. Those who were caring from the more tangential (and less taken for granted) relationship of sibling or ex-partner were among those who apparently embraced the role. Those who were expected to assume the caring role (typically spouses) were not always comfortable with doing so. It may be difficult to gain acknowledgement from family members and others that they occupy the role of carer if people resist the label as a bureaucratisation of their personal relationships.
    Social Science [?] Medicine 11/2013; 96:78-85.
  • Source
    British Journal of General Practice 10/2013; 63(615):553-4.
  • BMJ (online) 09/2013; 347:f5454.
  • The European journal of general practice 09/2013; 19(3):141-2.
  • British Journal of General Practice 09/2013; 63(614):461-2.
  • JAMA The Journal of the American Medical Association 08/2013; 310(7):749.
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BMJ (online) 01/2010; 340:c1900.
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