Dawn-Marie Walker

Neurocognitive outcome following fetal growth restriction

This review evaluates neurological and cognitive outcomes as they relate to fetal growth restriction. The aim is to clarify the relationship between poor fetal growth and abnormal brain development in order to understand the research directions required to untangle this complex issue.

The growth restriction intervention trial: Long-term outcomes in a randomized trial of timing of delivery in fetal growth restriction

OBJECTIVE The Growth Restriction Intervention Trial found little difference in overall mortality or 2-year outcomes associated with immediate or deferred delivery following signs of impaired fetal health in the presence of growth restriction when the obstetrician was unsure whether to deliver. Because early childhood assessments have limited predictive value, we reevaluated them. STUDY DESIGN Children were tested with standardized school-based evaluations of cognition, language, motor performance, and behavior. Analysis and interpretation were Bayesian. RESULTS Of 376 babies, 302 (80%) had known outcome: either dead or evaluated at age 6-13 years. Numbers of children dead, or with severe disability: 21 (14%) immediate and 25 (17%) deferred groups. Among survivors, the mean (SD) cognition scores were 95 (15) and 96 (14); motor scores were 8·9 (7·0) and 8·7 (6·7); and parent-assessed behavior scores were 10·5 (7·1) and 10·5 (6·9), respectively, for the 2 groups. CONCLUSION Clinically significant differences between immediate and deferred delivery were not found.

Systematic review and meta-analysis of interventions relevant for young offenders with mood disorders, anxiety disorders, or self-harm

Background Mood and anxiety disorders, and problems with self-harm are significant and serious issues that are common in young people in the Criminal Justice System. Aims To examine whether interventions relevant to young offenders with mood or anxiety disorders, or problems with self-harm are effective. Method Systematic review and meta-analysis of data from randomised controlled trials relevant to young offenders experiencing these problems. Results An exhaustive search of the worldwide literature (published and unpublished) yielded 10 studies suitable for inclusion in this review. Meta-analysis of data from three studies (with a total population of 171 individuals) revealed that group-based Cognitive Behaviour Therapy (CBT) may help to reduce symptoms of depression in young offenders. Conclusions These preliminary findings suggest that group-based CBT may be useful for young offenders with such mental health problems, but larger high quality RCTs are now needed to bolster the evidence-base.

A review of randomized controlled trials of medical record powered clinical decision support system to improve quality of diabetes care

BACKGROUND A gap between current diabetes care practice and recommended diabetes care standards has consistently been reported in the literature. Many IT-based interventions have been developed to improve adherence to the quality of care standards for chronic illness like diabetes. OBJECTIVE The widespread implementation of electronic medical/health records has catalyzed clinical decision support systems (CDSS) which may improve the quality of diabetes care. Therefore, the objective of the review is to evaluate the effectiveness of CDSS in improving quality of type II diabetes care. Moreover, the review aims to highlight the key indicators of quality improvement to assist policy makers in development of future diabetes care policies through the integration of information technology and system. SELECTION OF STUDY Setting inclusion criteria, a systematic literature search was conducted using Medline, Web of Science and Science Direct. Critical Appraisal Skills Programme (CASP) tools were used to evaluate the quality of studies. Eight randomized controlled trials (RCTs) were selected for the review. In the selected studies, seventeen clinical markers of diabetes care were discussed. Three quality of care indicators were given more importance in monitoring the progress of diabetes care, which is consistent with National Institute for Health and Care Excellence (NICE) guidelines. The presence of these indicators in the studies helped to determine which studies were selected for review. Clinical- and process-related improvements are compared between intervention group using CDSS and control group with usual care. Glycated hemoglobin (HbA1c), low density lipid cholesterol (LDL-C) and blood pressure (BP) were the quality of care indicators studied at the levels of process of care and clinical outcome. FINDINGS The review has found both inconsistent and variable results for quality of diabetes care measures. A significant improvement has been found in the process of care for all three measures of quality of diabetes care. However, weak to modest positive results are observed for the clinical measures of the diabetes care indicators. In addition to this, technology adoption of CDSS is found to be consistently low. CONCLUSION The review suggests the need to conduct further empirical research using the critical diabetes care indicators (HbA1c, LDL-C and BP) to ascertain if CDSS improves the quality of diabetes care. Research designs should be improved, especially with regard to baseline characteristics, sample size and study period. With respect to implementation of CDSS, rather than a sudden change of clinical work practice, there should instead be an incremental, gradual adoption of technology that minimizes the disruption in clinical workflow.

Attitudes of injecting male anabolic androgenic steroid users to media influence, health messages and gender constructs

Purpose – This study seeks to gain some understanding about the attitudes of anabolic‐androgenic steroid (AAS) users towards the media and whether their constructs of masculinity are influenced by this. It also aims to explore their attitudes towards health information.Design/methodology/approach – A self‐completion questionnaire containing 35 items of both open and closed questions was designed for the study. All participants were English‐speaking, injecting male steroid users, 16 years or older whose trigger for using was confidence and self‐esteem, and were registered clients at either of the two included UK needle exchange services.Findings – Participants and other AAS users were open about their use to each other, but not to people external to that sub‐culture. They denied media influence, although they thought that most men in the media with muscular bodies used AAS. They associate masculinity with strength and muscle. They seemed knowledgeable about the health implications of AAS, but would not tel...

Psychological therapy for people with tinnitus: a scoping review of treatment components

Background: Tinnitus is associated with depression and anxiety disorders, severely and adversely affecting the quality of life and functional health status for some people. With the dearth of clinical psychologists embedded in audiology services and the cessation of training for hearing therapists in the UK, it is left to audiologists to meet the psychological needs of many patients with tinnitus. However, there is no universally standardized training or manualized intervention specifically for audiologists across the whole UK public healthcare system and similar systems elsewhere across the world. Objectives: The primary aim of this scoping review was to catalog the components of psychological therapies for people with tinnitus, which have been used or tested by psychologists, so that they might inform the development of a standardized audiologist-delivered psychological intervention. Secondary aims of this article were to identify the types of psychological therapy for people with tinnitus, who were reported but not tested in any clinical trial, as well as the job roles of clinicians who delivered psychological therapy for people with tinnitus in the literature. Design: The authors searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL; LILACS; KoreaMed; IndMed; PakMediNet; CAB Abstracts; Web of Science; BIOSIS Previews; ISRCTN; ClinicalTrials.gov; IC-TRP; and Google Scholar. In addition, the authors searched the gray literature including conference abstracts, dissertations, and editorials. No records were excluded on the basis of controls used, outcomes reached, timing, setting, or study design (except for reviews—of the search results. Records were included in which a psychological therapy intervention was reported to address adults (⩽18 years) tinnitus-related distress. No restrictive criteria were placed upon the term tinnitus. Records were excluded in which the intervention included biofeedback, habituation, hypnosis, or relaxation as necessary parts of the treatment. Results: A total of 5043 records were retrieved of which 64 were retained. Twenty-five themes of components that have been included within a psychological therapy were identified, including tinnitus education, psychoeducation, evaluation treatment rationale, treatment planning, problem-solving behavioral intervention, thought identification, thought challenging, worry time, emotions, social comparison, interpersonal skills, self-concept, lifestyle advice, acceptance and defusion, mindfulness, attention, relaxation, sleep, sound enrichment, comorbidity, treatment reflection, relapse prevention, and common therapeutic skills. The most frequently reported psychological therapies were cognitive behavioral therapy, tinnitus education, and internet-delivered cognitive behavioral therapy. No records reported that an audiologist delivered any of these psychological therapies in the context of an empirical trial in which their role was clearly delineated from that of other clinicians. Conclusions: Scoping review methodology does not attempt to appraise the quality of evidence or synthesize the included records. Further research should therefore determine the relative importance of these different components of psychological therapies from the perspective of the patient and the clinician.

Can research development bursaries for patient and public involvement have a positive impact on grant applications? A UK-based, small-scale service evaluation.

Increasingly, research grant awarding bodies are regarding involvement at all stages of research, including prior to funding, as good practice. However, it is unclear how researchers should pay for this. Therefore, a pre‐funding bursary scheme was designed. Up to £500 could be requested for involvement to develop a grant application for which user involvement is a key requisite for the funding body concerned. As the bursary scheme had run for 2 years, an evaluation was conducted to ascertain whether the scheme was effective for incorporating early involvement and in developing the grant proposal.

National survey on management of weight reduction in PCOS women in the United Kingdom

OBJECTIVE To identify the most commonly used methods for weight reduction in women with polycystic ovarian syndrome (PCOS) utilized by obstetricians and gynaecologists in the United Kingdom (UK). STUDY DESIGN Permission was sought from the Royal College of Obstetricians and Gynaecologists (RCOG) to conduct an electronic survey of all consultants practising in the UK. The questionnaire was anonymous and an electronic link was sent via email to the 1140 consultants whose details were provided by the RCOG. A 27-item questionnaire was developed. The variables evaluated were first-line methods of weight reduction used, proportion of women with PCOS seen that were obese, whether the patients had tried other weight reduction methods before seeking help, the optimal dietary advice and optimal composition, the optimal duration and frequency of exercise suggested, BMI used for suggesting weight loss, percentage of women in whom weight loss worked, length of time allowed prior to suggesting another method, methods considered most effective by patients, use of metformin for weight loss, criteria used for prescribing metformin, first-line anti-obesity drugs preferred if any, second- and third-line methods used, referral to other specialists and criteria for referral for bariatric surgery. Responses were categorical and are reported as proportions. RESULTS One hundred and seven (9.4%) consultants responded to the questionnaire. One hundred and four (97%) provided advice on diet and 101 (94%) advice on exercise as their first-line strategy for weight management. Fifty-one (47.7%) stated that they provided specific information on an optimal dietary intake, 53 (49.9%) on the optimal dietary composition and 61 (57%) on the optimal duration and frequency of exercise per week. The commonest second-line methods used were anti-obesity drugs and metformin and the most popular third-line management options were anti-obesity drugs and bariatric surgery. CONCLUSIONS The results suggest that the information provided to women with PCOS on weight management is variable, and highlight the need for specific guidelines and further research on weight management in women with this condition.

Beliefs about Jinn, black magic and evil eye in Bangladesh: the effects of gender and level of education

The study was aimed to examine beliefs among 320 attendees of a large University Hospital in Dhaka about Jinn, black magic and evil eye among Muslims in Bangladesh, using a self-completed questionnaire. The majority believed in the existence of Jinn (72%) and in Jinn possession (61%). In contrast, a relatively smaller proportion believed in the existence of black magic and evil eye (50% and 44%, respectively). Women were more likely than men to believe in the existence of Jinn and to cite religious figures as the treating authority for diseases attributed to affliction by black magic. Participants with a higher educational attainment were less likely than those with lower attainment to believe in jinn possession; or to believe that Jinn, black magic, or evil eye could cause mental health problems. Mental health care practitioners need to be mindful of these beliefs to achieve the best outcome for their patients.

A systematic review and synthesis of outcome domains for use within forensic services for people with intellectual disabilities

Background There is limited empirical information on service-level outcome domains and indicators for the large number of people with intellectual disabilities being treated in forensic psychiatric hospitals. Aims This study identified and developed the domains that should be used to measure treatment outcomes for this population. Method A systematic review of the literature highlighted 60 studies which met eligibility criteria; they were synthesised using content analysis. The findings were refined within a consultation and consensus exercises with carers, patients and experts. Results The final framework encompassed three a priori superordinate domains: (a) effectiveness, (b) patient safety and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviours, reactive and restrictive interventions, quality of life and patient satisfaction. Conclusions To index recovery, services need to measure treatment outcomes using this framework. Declaration of interest None. Copyright and usage