David Wellsted

David Wellsted
University of Hertfordshire | UH · Health Reserach Methods Unit

Professor

About

189
Publications
23,234
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Introduction
Skills and Expertise

Publications

Publications (189)
Article
Background Needling is a key step in haemodialysis. Research suggests needling experience is sub-optimal; however, no validated measure exists to inform improvements. We addressed this by developing the Needling Patient Reported Experience Measure (NPREM). Methods We used mixed methods and co-production. All participants were adults with working f...
Article
Full-text available
Background Depression and anxiety are commonly experienced by people with chronic kidney disease (CKD). This study aimed to evaluate person- and service-level factors associated with depression and anxiety symptoms. We sought to also understand utilisation of mental health treatments and preferences for future psychological support. Methods An onl...
Article
Full-text available
Objectives The aim of this study was to conduct a pilot evaluation of a novel six‐week school‐based intervention (‘Haven Schools’) on young people's psychological wellbeing. Methods One hundred and forty‐one students (ages 12–16 years) from 11 schools in England attended up to six sessions of the intervention at their school during the day. Psycho...
Article
Background Prevalence of depression is increasing in young people. Behaviour change interventions providing benefits equal to or greater than talking therapies or pharmacological alternatives are needed. Exercise could be beneficial for young people with depression, but we lack robust trials of its effectiveness. Objective To test whether an exerc...
Article
Full-text available
Background It is unknown whether there are differences in maximal oxygen uptake (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${V}$$\end{document}O2max) response when...
Article
Background For many patients, cannulation (‘needling’) is essential for haemodialysis. It is associated with anxiety and fear and contributes to the overall burden of treatment. Limited research exists on patient experience of needling and how this might vary by individual and clinical characteristics. Objectives To explore and identify key aspect...
Article
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Background Communicating risk is a key component of shared decision-making and is vital for the management of advanced chronic kidney disease (CKD). Despite this, there is little evidence to suggest how best to communicate health risk information to people living with CKD. The aim of this review was to identify and understand the nature of evidence...
Article
Background and Aims Most people on haemodialysis rely on having reliable access to their vascular system, often via surgically created arteriovenous fistula or graft. At the beginning of each dialysis session, needles must be inserted. While ‘needling’ is a key step, an annual UK survey shows that needling is one of the lowest scoring areas of repo...
Article
Patients with obsessive compulsive disorder (OCD) randomised to sertraline, manualised cognitive behavioural therapy (CBT), or combination (sertraline + CBT), underwent cognitive assessment. Cognitive testing was conducted at baseline and at week 16. The stop signal reaction time task (SSRT) was used to evaluate motor impulsivity and attentional fl...
Article
Background People with severe learning disabilities and complex needs are more likely to experience delayed discharge from hospital; however, there is little research into their experience in hospital and as they move out as part of the Transforming Care Programme. Methods Six family members of people with complex needs who had moved out of hospit...
Article
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Background People with intellectual disabilities may experience frailty earlier than the general population. This scoping review aimed to investigate how frailty is defined, assessed, and managed in adults with an intellectual disability; factors associated with frailty; and the potential impact of COVID-19 on frailty identification and management....
Article
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Background People with learning disabilities experience health and social inequalities, and research that could improve health services may not be implemented in real‐life settings. Building stakeholder networks that can share and implement research findings may address this. This paper presents a framework for building a stakeholder network that m...
Article
Background Depression is common in people with chronic kidney disease, yet little is known about how depression is identified and managed as part of routine kidney care. Objectives The primary objective was to survey all UK adult kidney centres to understand how depression is identified and managed. A secondary objective was to broadly describe th...
Preprint
Full-text available
Background Dependence on alcohol and other substances contributes significantly to poor health globally. Deaths associated with substance misuse have increased since the COVID-19 pandemic period and providing effective support for recovery is critical. The pandemic required an unprecedented change to recovery services for substance misuse, from in-...
Article
Full-text available
Introduction In March 2020, a pandemic state was declared due to SARS-COV-2 (COVID-19). Patients with kidney disease, especially those on replacement therapies, proved more susceptible to severe infection. This rapid literature review aims to help understand how the pandemic impacted patient experience of kidney care. Methods It was conducted in a...
Poster
Notwithstanding the small sample size, stimulating the OFC and SMA with a short course of tDCS significantly improved attentional flexibility but not motor impulsivity in patients with OCD. The effect of tDCS on attentional inflexibility is remarkable because this cognitive phenotype is not known to improve with standard evidence based treatments...
Article
Full-text available
Background Services for patients with kidney disease underwent radical adaptations in response to the COVID-19 pandemic. We undertook an online national survey of UK kidney centres to understand the nature, range, and degree of variation in these changes and to explore factors contributing to differing practice. Methods The survey was designed by...
Article
Full-text available
Background and objective It is crucial to make early differentiation between coronavirus disease 2019 (COVID-19) and seasonal influenza infections at the time of a patient's presentation to the emergency department (ED). In light of this, this study aimed to identify key epidemiological, initial laboratory, and radiological differences that would e...
Technical Report
Full-text available
The Youth Endowment Fund (YEF) is a charity with a mission that matters. We exist to prevent children and young people becoming involved in violence. We do this by finding out what works and building a movement to put this knowledge into practice. Children and young people at risk of becoming involved in violence deserve services that give them the...
Technical Report
Full-text available
The Youth Endowment Fund (YEF) is a charity with a mission that matters. We exist to prevent children and young people from becoming involved in violence. We do this by finding out what works and building a movement to put this knowledge into practice. Children and young people at risk of becoming involved in violence deserve services that give the...
Technical Report
Full-text available
The Youth Endowment Fund (YEF) is a charity with a mission that matters. We exist to prevent children and young people becoming involved in violence. We do this by finding out what works and building a movement to put this knowledge into practice. Children and young people at risk of becoming involved in violence deserve services that give them the...
Technical Report
Full-text available
The Youth Endowment Fund (YEF) is a charity with a mission that matters. We exist to prevent children and young people becoming involved in violence. We do this by finding out what works and building a movement to put this knowledge into practice. Children and young people at risk of becoming involved in violence deserve services that give them the...
Article
Full-text available
Background Depression is common amongst patients receiving haemodialysis (HD). Assessment and intervention when faced with language and cultural barriers is challenging. To support clinician decisions, we conducted a cross-sectional study to assess the use of culturally adapted and translated versions of commonly-used depression screening questionn...
Article
Background: Transcranial direct current stimulation (tDCS) is a non-invasive form of neurostimulation with potential for development as a self-administered intervention. It has shown promise as a safe and effective treatment for obsessive compulsive disorder (OCD) in a small number of studies. The two most favourable stimulation targets appear to...
Article
Full-text available
The objective of this study was to determine whether the variability in exercise tolerance and physiological responses is lower when exercise is prescribed relative to physiological thresholds (THR) compared to traditional intensity anchors (TRAD). Ten individuals completed a series of maximal exercise tests and a series of moderate (MOD), heavy (H...
Article
Full-text available
Background Older people with end-stage kidney disease (ESKD) are vulnerable to frailty, which impacts on clinical and experiential outcomes. With kidney transplantation in older people increasing, a better understanding of patient experiences is necessary for guiding decision making. The Kidney Transplantation in Older People (KTOP):impact of frail...
Article
Full-text available
Background Depression is prevalent across the spectrum of Chronic Kidney Disease and associated with poorer outcomes. There is limited evidence regarding the most effective interventions and care pathways for depression in Chronic Kidney Disease. Objectives To investigate how depression is identified and managed in adults with Chronic Kidney Dis...
Article
Objective: this systematic review and meta-analysis assessed the efficacy of exercise in reducing OCD symptoms. Methods: we searched PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, Scopus and grey literature until March 2022. The study was preregistered at Prospero (CRD42021283931). We included randomised controlled and pre-post...
Article
Full-text available
Background: Kidney transplantation in older people has increased, however older transplant recipients experience mixed outcomes that invariably impacts on their quality of life. The increased vulnerability of older end stage kidney disease patients to frailty and cognitive impairment, may partially explain the differences in outcomes observed. The...
Article
Full-text available
Background Substance misuse is a significant global health concern. In the UK, the prevalence of substance misuse has increased over the past decade and the number of alcohol and drug related deaths are increasing. Individuals with substance dependency issues are entitled to access treatment services. However, the COVID-19 pandemic created signific...
Article
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Introduction Despite promising results from several randomized controlled trials (RCTs) and meta-analyses, the efficacy of r-TMS as a treatment for OCD remains controversial, at least in part owing to inconsistency in the trial methodologies and heterogeneity in the trial outcomes. This meta-analysis attempts to explain some of this heterogeneity b...
Article
Full-text available
Funding Acknowledgements Type of funding sources: None. Background Prior studies mainly in healthy volunteers and patients with stable coronary artery disease (CAD) indicate circadian variation in spontaneous fibrinolytic activity. This is predominantly attributable to changes plasminogen activator inhibitor-1 (PAI-1) levels peaking between midnig...
Article
Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): This study is funded by Bayer PLC, 400 South Oak Way, Green Park, Reading, Berkshire, RG2 6AD. Background Impaired endogenous fibrinolysis is novel biomarker that can identify patients with ACS at increased cardiovascular risk. The addition of very low dose...
Preprint
Full-text available
Background Kidney transplantation in older people has increased, however older transplant recipients experience mixed outcomes that invariably impacts on their quality of life. The increased vulnerability of older end stage kidney disease patients to frailty and cognitive impairment may partially explain the differences in outcomes observed. The Ki...
Article
Full-text available
Obesity is a global epidemic affecting all age groups, populations and income levels across continents. The causes of obesity are complex and are routed in health behaviours, environmental factors, government policy and the cultural and built environment. Consequently, a Whole System Approach (WSA) which considers the many causes of obesity and shi...
Article
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Background People living with a long-term condition, such as chronic kidney disease (CKD), often suffer from multiple symptoms simultaneously, making symptom management challenging. This study aimed to identify symptom clusters in adults with CKD across treatment groups and investigate their association with people’s ability to perform their usual...
Article
Full-text available
Background Patient experience is a recognised aspect of quality of care for people with chronic kidney disease (CKD), but current patient-reported experience measures (PREMs) only focus on dialysis care. We developed and validated the Kidney PREM to assess patients’ experience with renal services in secondary care for any CKD stage or treatment (tr...
Article
Full-text available
Background Obsessive–compulsive disorder (OCD) is a neuropsychiatric disorder which often proves refractory to current treatment approaches. Transcranial direct current stimulation (tDCS), a noninvasive form of neurostimulation, with potential for development as a self-administered intervention, has shown potential as a safe and efficacious treatme...
Article
Full-text available
Background The needs of children in care are a government priority, yet the evidence base for effective interventions to support the emotional wellbeing of children in care is lacking. Research suggests that supporting the carer-child relationship, by promoting the carer’s reflective parenting, may be an effective approach to improving the wellbein...
Article
The aim of the audit was to assess the change in key health markers in people with, or at risk of, diabetes who attended X‐PERT structured diabetes education. Data from X‐PERT programmes are entered into a central database. Twelve‐month changes in anthropometric and clinical variables – and diabetes medication usage – are reported for programmes ru...
Article
p>Background: Re-establishing societal norms in the wake of the COVID-19 pandemic will be important for restoring public mental health and psychosocial wellbeing as well as economic recovery. We investigated the impact on post-pandemic adjustment of a history of mental disorder, with particular reference to obsessive-compulsive (OC) symptoms or tra...
Article
Twice-weekly hemodialysis, as part of incremental initiation, has reported benefits including preservation of residual kidney function (RKF). To explore this, we initiated a randomized controlled feasibility trial examining 55 incident hemodialysis patients with urea clearance of 3ml/min/1.73m² or more across four centers in the United Kingdom rand...
Article
Full-text available
Muscular dystrophy is a terminal muscle-wasting condition, whereby families face continuous challenges as their child's health deteriorates. This research explored accounts of parenthood following bereavement of their child to muscular dystrophy. Narrative inquiry was used to analyse interviews with four couples. Findings suggest an importance in n...
Article
Background Re-establishing societal norms in the wake of the COVID-19 pandemic will be important for restoring public mental health and psychosocial wellbeing as well as economic recovery. We investigated the impact on post-pandemic adjustment of a history of mental disorder, with particular reference to obsessive-compulsive (OC) symptoms or traits...
Article
Full-text available
Aims Obsessive Compulsive Disorder is a disabling and difficult-to-treat condition, new treatment options are needed to improve health outcomes. Transcranial Direct Current Stimulation, a non-invasive form of neurostimulation, has shown positive results in a small number of studies as a safe and potentially efficacious treatment for OCD. There neve...
Article
Full-text available
Objectives To examine the relative importance of patient and centre level factors in determining self-reported experience of care in patients with advanced kidney disease treated by maintenance haemodialysis (HD). Design Analysis of data from a cross sectional national survey; the UK Renal Registry (UKRR) national Kidney patient-reported experienc...
Preprint
Full-text available
Background: The needs of children in care are a government priority, yet the evidence-base for effective interventions to support the emotional wellbeing of children in care is still lacking. Research suggests that supporting the carer-child relationship, by promoting the carer’s reflective parenting, may be an effective approach to improving the w...
Preprint
Background: Depression is common amongst patients receiving haemodialysis (HD). Assessment and intervention when faced with language and cultural barriers is challenging. To support clinician decisions, we assessed the use of culturally adapted and translated versions of commonly-used depression screening questionnaires with South Asian patients re...
Article
Full-text available
Research enables us to attempt to understand the incomprehensible. In doing so, we collaborate with others – facilitating a context to communicate. Our dialogues gather up the complexity of what it means to have lived particular lives or to have had particular experiences over time. Ultimately, research aids our connection to others and leads us to...
Article
Full-text available
Background Prevalence of depression is increasing in young people, and there is a need to develop and evaluate behavioural interventions which may provide benefits equal to or greater than talking therapies or pharmacological alternatives. Exercise could be beneficial for young people living with depression, but robust, large-scale trials of effect...
Article
Full-text available
Introduction Preserving residual kidney function (RKF) may be beneficial to patients on haemodialysis (HD) and it has been proposed that commencing dialysis incrementally rather than three times a week may preserve RKF. In Incremental HD, target dose includes a contribution from RKF, which is added to HD dose, allowing individualisation of the HD p...
Article
Full-text available
Background and Aims Incremental HD is a method of individualising haemodialysis (HD) dose according to level of residual renal function(RRF) such that as RRF reduces, HD dose is upwardly adjusted. Retrospective data suggest potential benefit of this approach in preserving RRF, a key predictor of survival for dialysis patients. Method A randomised,...
Article
Background: Depression is common in patients on haemodialysis and associated with adverse outcomes. Antidepressant use is widespread though evidence of efficacy is limited. Objectives: To study antidepressant management practices in patients on haemodialysis with reference to NICE guidelines on management of depression in adults with chronic phy...
Article
Full-text available
Impaired endogenous fibrinolysis is novel biomarker that can identify patients with ACS at increased cardiovascular risk. The addition of Very Low Dose Rivaroxaban (VLDR) to dual antiplatelet therapy has been shown to reduce cardiovascular events but at a cost of increased bleeding and is therefore not suitable for all-comers. Targeted additional p...
Conference Paper
Introduction COPD exacerbations impose a major burden on patients and the NHS. They are often treated empirically with antibiotics and steroids, despite a large proportion being viral induced or non-infective. We hypothesised that incorporation of R-POCTc within our integrated hospital at home service would improve quality of patient care by ensuri...
Article
Full-text available
“What dreams may come when we have shuffled off this mortal coil?” This question, posed by Shakespeare’s Hamlet, kept coming to mind for James whilst he completed his doctorate research project that looked at the ways in which bereaved couples storied their experiences of parenting a child with muscular dystrophy. What seemed imperative to this exp...
Article
Full-text available
Background: There is a lack of well-designed randomized controlled trials (RCTs) to investigate the efficacy of psychological therapies for children in foster care with emotional and behavioural difficulties. Mentalization-based therapy (MBT) focuses on supporting the carer-child relationship by promoting reflective capacity. This study examined t...
Article
Full-text available
Aims Approximately 20% of ischaemic stroke patients exhibit spontaneous arterial recanalization, attributable to endogenous fibrinolysis, which strongly relates to improved functional outcome. The impact of oral anticoagulants on endogenous fibrinolysis is unknown. Our aim was to test the hypothesis that apixaban enhances endogenous fibrinolysis in...
Article
Full-text available
Background: In England and Wales, the single-informant Strengths and Difficulties Questionnaire (SDQ) is used to assess and monitor looked-after children’s (LAC) mental health; and some targeted Child and Adolescent Mental Health Services (CAMHS) include a minimum SDQ score in their acceptance criteria. However, its ability to identify LAC who nee...
Article
Full-text available
Objectives End-stage kidney disease disproportionately affects people of South Asian origin. This study aimed to uncover the lived experiences of this group of patients on centre-based haemodialysis (HD), the most prevalent dialysis modality. Design The study utilised a qualitative focus group methodology. Seven focus groups were conducted across...
Article
Full-text available
Introduction In a society that perpetuates the strive for a perfect appearance, a fit body has become synonymous with success, but simultaneously hard to achieve. This represents a fertile ground for the development of Exercise Addiction (EA) alongside other disorders, such as Body Dysmorphic Disorder (BDD). This study aims to explore the diffusion...
Article
Full-text available
Introduction: Conventional haemodialysis (HD) involves treatment times of around 4 hours thrice weekly, taking no account of residual kidney function (RKF). In incremental HD the frequency and duration of dialysis sessions are individualized according to RKF. There are no studies comparing these approaches. We utilized data from a recent multicente...
Article
Although used routinely to reduce thrombotic events in patients with coronary disease, the effects of P2Y12 inhibitors on thrombus stability and endogenous fibrinolysis are largely unknown. Blood taken from patients pre- and post-aspirin (n = 20) and on aspirin alone and on dual antiplatelet therapy comprising aspirin plus clopidogrel (n = 20), tic...
Article
Aims The endogenous fibrinolytic system serves to prevent lasting thrombotic occlusion and infarction following initiation of coronary thrombosis. We aimed to determine whether impaired endogenous fibrinolysis can identify patients with ST-segment elevation myocardial infarction (STEMI) who remain at high cardiovascular risk despite dual antiplatel...
Article
Background: Initiating twice-weekly haemodialysis (2×HD) in patients who retain significant residual kidney function (RKF) may have benefits. We aimed to determine differences between patients initiated on twice- and thrice-weekly regimes, with respect to loss of kidney function, survival and other safety parameters. Methods: We conducted a sing...
Poster
In 2015, the University of Hertfordshire was approached by The Muscle Help Foundation to evaluate the impact of the Muscle Dream experiences they offer to young people with a diagnosis of Muscular Dystrophy (and other muscle wasting conditions) and their families. Here we report on the findings of the research.
Article
Objectives/Hypothesis To examine the effects of dairy versus nondairy diets on self‐reported levels of nasopharyngeal mucus secretion. Study Design Prospective, randomized, double‐blinded controlled study. Methods Twenty‐six men and 82 consecutive women over the age of 15 years attending the otolaryngology department at East and North Hertfordshi...
Article
Full-text available
Established treatments for obsessive compulsive disorder (OCD) include cognitive behaviour therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication. Combined treatment may outperform monotherapy, but few studies have investigated this. A total of 49 community-based adults with OCD were randomly assigned to CBT, SSRI, or SSRI+CBT....