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Dive into the research topics where M Bryans is active.

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Featured researches published by M Bryans.


BMJ | 2006

Effectiveness of educational interventions in improving detection and management of dementia in primary care: cluster randomised controlled study

Murna Downs; Stephen Turner; M Bryans; Jane Wilcock; John Keady; Enid Levin; Ronan E. O'Carroll; Kate Howie; Steve Iliffe

Abstract Objective To test the effectiveness of educational interventions in improving detection rates and management of dementia in primary care. Design Unblinded, cluster randomised, before and after controlled study. Setting General practices in the United Kingdom (central Scotland and London) between 1999 and 2002. Interventions Three educational interventions: an electronic tutorial carried on a CD Rom; decision support software built into the electronic medical record; and practice based workshops. Participants 36 practices participated in the study. Eight practices were randomly assigned to the electronic tutorial; eight to decision support software; 10 to practice based workshops; and 10 to control. Electronic and manual searches yielded 450 valid and usable medical records. Main outcome measures Rates of detection of dementia and the extent to which medical records showed evidence of improved concordance with guidelines regarding diagnosis and management. Results Decision support software (P = 0.01) and practice based workshops (P = 0.01) both significantly improved rates of detection compared with control. There were no significant differences by intervention in the measures of concordance with guidelines. Conclusions Decision support systems and practice based workshops are effective educational approaches in improving detection rates in dementia.


Dementia | 2002

Dementia Diagnosis and Management in Primary Care Developing and testing educational models

Steve Iliffe; Jane Wilcock; T Austin; Kate Walters; Greta Rait; Stephen Turner; M Bryans; Murna Downs

Dementia presents a challenge for primary care and the advent of new therapeutic options has highlighted the need to improve its detection so that early decisions about medication use can be made. Efforts at earlier diagnosis should be targeted at primary care as the gateway to specialist health and social services. There is, however, evidence that dementia remains under-detected and sub-optimally managed in general practice throughout the world. This article reviews the obstacles to early recognition of dementia and the factors causing sub-optimal management in the community, and discusses educational approaches to enhancing professional skills in the recognition of and response to dementia. Three educational interventions with different characteristics and methods of delivery are described.


Aging & Mental Health | 2009

Concordance with clinical practice guidelines for dementia in general practice

Jane Wilcock; Steve Iliffe; Stephen Turner; M Bryans; Ronan E. O'Carroll; John Keady; Enid Levin; Murna Downs

Background: Dementia is said to be under-recognized and sub-optimally managed in primary care, but there is little information about actual processes of diagnosis and clinical care. Aim: To determine general practitioners’ concordance with clinical guidelines on the diagnosis and management of patients with dementia. Design: Unblinded, cluster randomized pre-test–post-test controlled trial involving 35 practices in the UK. Methods: Patients with a diagnosis of probable or confirmed dementia were identified in practices, and permission sought from the older person and/or their carer to study the medical records of these patients. Medical records were reviewed using a data extraction tool designed for the study and based on published guidelines, and unweighted scores for diagnostic concordance and management concordance were calculated. Results: We reviewed 450 records of patients aged 75 and over with a diagnosis of dementia and found that: only 4% of cases were identified first in secondary care; two-thirds of those identified in primary care were referred immediately; about one-third identified had informant history and blood tests documented at the Index consultation and one-fifth underwent cognitive function testing. Discussion: The records analysed in this study came from a period before the Quality Outcomes Framework and show that the documentation in primary care of the diagnostic process in dementia syndromes is good, although there were significant gaps, particularly around depression case-finding. Information about management processes were less evident in the records.


Primary Health Care Research & Development | 2007

Methodological problems in dementia research in primary care: a case study of a randomized controlled trial

Jane Wilcock; M Bryans; Stephen Turner; Ronan E. O'Carroll; John Keady; Enid Levin; Steve Iliffe; Murna Downs

The emerging UK national research network in neurodegenerative diseases and dementias aims to promote large-scale community-based studies of therapeutic interventions, based in primary care. However, trials in primary care settings can be problematic, a common difficulty being the recruitment of a large enough sample. The article discusses recruitment issues in a multi-centre randomized controlled trial of differing educational approaches to improving dementia care in general practice. Sample size calculations based on community studies of prevalence may be misleading in intervention trials which may recruit practices with atypical demography. Recruitment rates for practitioners in this study were lower than expected. Professionals excluded themselves from the study mainly due to pressures of time and staff shortages, and we detected both ambivalent attitudes to primary care research and a perception that research into dementia care was not a high priority. Evaluation of the quality of care may be perceived as criticism of clinical practice, at a time when general practice is undergoing major administrative and contractual changes. Variations in Research Ethics Committee conditions for approval led to different methods of recruitment of patients and carers into the study, a factor which may have contributed to disparate levels of recruitment across study sites. Patient and carer levels of recruitment were lower than expected and were affected partly by carers’ time pressures and other family commitments, but largely by problems in identifying patients and carers in the practices. The development of research potential in primary care is at an early stage and studies reliant on patient recruitment in general practice must allow for multiple obstacles to enrollment. This is particularly relevant for studies of dementia care, where the prevalence of dementia in a demographically average population is low and the incidence very low, compared with other disabilities. Professionals may give dementia low priority in allocating practice time for research projects, and strategies to address this problem are needed.


Age and Ageing | 2004

General practitioners' knowledge, confidence and attitudes in the diagnosis and management of dementia

Stephen Turner; Steve Iliffe; Murna Downs; Jane Wilcock; M Bryans; Enid Levin; John Keady; Ronan E. O'Carroll


Dementia | 2006

Family carers' accounts of general practice contacts for their relatives with early signs of dementia

Murna Downs; Steven Ariss; Eryk Grant; John Keady; Stephen Turner; M Bryans; Jane Wilcock; Enid Levin; Ronan E. O'Carroll; Steve Iliffe


British journal of nursing | 2003

An exploratory survey into primary care nurses and dementia care

M Bryans; John Keady; S Turner; Jane Wilcock; Murna Downs; Steve Iliffe


Methods of Information in Medicine | 2002

Design and Implementation of a Computer Decision Support System for the Diagnosis and Management of Dementia Syndromes in Primary Care

Steve Iliffe; T Austin; Jane Wilcock; M Bryans; S Turner; Murna Downs


Education and Ageing , 17 (2/3) pp. 217-236. (2003) | 2003

The Development of an Evidence-based Curriculum for Dementia Care Training in General Practice

Jane Wilcock; Steve Iliffe; Kate Walters; Greta Rait; T Austin; S Turner; M Bryans; Murna Downs; Ronan E. O'Carroll; John Keady


Gerontology | 2001

An intervention to improve primary care practitioners' response to people with dementia and their families

Steve Iliffe; Murna Downs; S Turner; M Bryans; Jane Wilcock

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Jane Wilcock

University College London

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Murna Downs

University of Bradford

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Steve Iliffe

University College London

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S Turner

University of Dundee

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John Keady

University of Manchester

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Enid Levin

Social Care Institute for Excellence

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T Austin

University College London

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Greta Rait

University College London

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