Noelle Robertson

The association between depression and health‐related quality of life in people with type 2 diabetes: a systematic literature review

The relationships between co‐morbid depression in people with diabetes and adverse outcomes including poor HbA1c control, adherence to medication and mortality have been examined and confirmed. However, as the awareness of the decrement to health‐related quality of life (HRQOL) in people with diabetes and its clinical consequences grows, investigators have become increasingly interested in measuring HRQOL in clinical trials. Given that the psychological factors such as depression may contribute to diminished HRQOL, the present review sought to summarize the association between these variables in people with type 2 diabetes. Articles for a systematic review were obtained via a search performed using MEDLINE, EMBASE and PsycINFO (1980–2007).

Coping with caring for someone with dementia: Reviewing the literature about men

As the demographics of the population change, men are assuming increasingly important roles as caregivers, despite caregiving often being perceived as a feminine activity. Research to date has described sex differences in caregiving and psychological outcomes. However, there appears to be little understanding of varying ways men may cope with the strains of caregiving. To this end, a systematic literature search was carried out to determine what is known about men coping with caring for someone with dementia. The search process elicited 93 articles, reviewed and categorised by their content. The majority of articles reported research and interventions with little detailed analysis of gender as a mediating variable for coping. Four articles reported finding no sex-differences in coping and burden. Of the nine articles that reported exclusively on men caregivers, only one generated quantitative data within an explicit framework of stress, appraisal and coping. Conclusions suggest that future research requires refinement and sophistication to address the role of gender in mediating appraisals of strain and coping responses to familial dementia care. The limitations of gender difference research and self-report methodologies are discussed along with their implications for interventions and suggestions for future research.

Psychological morbidity and illness appraisals of patients with cardiac and non-cardiac chest pain attending a rapid access chest pain clinic: a longitudinal cohort study

Objectives: To assess the psychological morbidity and illness beliefs in newly referred patients with chest pain, and to compare the psychological morbidity of patients with pain of cardiac origin with that of patients with pain of non-cardiac origin. Design: Longitudinal cohort study. Setting: Rapid Access Chest Pain Clinic in a tertiary referral centre in Leicester, United Kingdom. Participants: 246 patients with acute, undifferentiated, chest pain followed up 1 week and 2 months subsequent to clinic attendance. Main outcome measures: Levels of affective disturbance, health anxiety and illness perception. Results: Levels of anxiety before clinic attendance exceeded community norms but did not differentiate the two groups. However, after clinic attendance levels of anxiety for those with a non-cardiac diagnosis significantly exceeded those of patients whose pain was of cardiac origin and remained above community norms 2 months hence. Non-cardiac patients viewed their condition as significantly less controllable and less understandable than those whose pain was cardiac in origin. Levels of depression for those with cardiac pain also significantly increased to above community norms after clinic attendance. Conclusions: Clinical levels of psychological morbidity are evident in the immediate and long-term aftermath of a visit to a Rapid Access Chest Pain Clinic, despite early access and provision of reassurance. More structured interventions appear necessary to deal with both distress and illness beliefs that may influence future healthcare use.

Cluster randomized controlled trial of the effectiveness of audit and feedback and educational outreach on improving nursing practice and patient outcomes.

Background:Current understanding of implementation methods is limited, and research has focused on changing doctors’ behaviors. Aim:Our aim was to evaluate the impact of audit and feedback and educational outreach in improving nursing practice and patient outcomes. Methods:Using a factorial design, cluster randomized controlled trial, we evaluated 194 community nurses in 157 family practices and 1078 patients with diagnosis of urinary incontinence (UI) for nurses compliance with evidence-linked review criteria for the assessment and management of UI and impact on psychologic and social well-being and symptoms. In the outreach arms, nurses’ self-reported barriers informed development of tailored strategies. Results:In comparison with educational materials alone, the implementation methods tested did not improve care at 6 months follow-up. Moderate rates of improvement (10–17% of patients) in performance for the assessment of UI and greater rates of improvement (20–30% of patients) for the management of care were found but effects were similar across arms. Improvement in patient outcomes was more consistently positive for educational outreach than for audit and feedback but differences were not significant. Adjustment for caseload size, severity or duration of UI and patients’ age did not alter results. Conclusions:Printed educational materials alone may be as effective as audit and feedback and educational outreach in improving nurses’ performance and outcomes of care for people with UI. Greater understanding of the underlying processes in improving performance within multidisciplinary teams through further, theory-driven studies with “no intervention” control groups and longer follow-up are needed.

Mindfulness, functioning and catastrophizing after multidisciplinary pain management for chronic low back pain.

Summary Relationships between self‐reports of mindfulness, catastrophizing, disability and depression were explored before and after a multidisciplinary cognitive‐behavioural intervention for chronic pain. Abstract We examined mindfulness in people with chronic low back pain who were attending a multidisciplinary pain management programme. Participants completed questionnaires at baseline (n = 116) and after a 3‐month cognitive‐behaviourally informed multidisciplinary intervention (n = 87). Self‐reported mindfulness was measured before and after the intervention, and relationships were explored between mindfulness, disability, affect and pain catastrophizing. Mindfulness increased following participation in the intervention, and greater mindfulness was predictive of lower levels of disability, anxiety, depression and catastrophizing, even when pain severity was controlled. Mediator analyses suggested that the relationship between mindfulness and disability was mediated by catastrophizing. It is possible that cognitive‐behavioural interventions and processes can affect both catastrophizing and mindfulness.

Men caring for wives or partners with dementia: Masculinity, strain and gain

Over the last three decades, demographic changes in the developed world have meant more older men find themselves in caregiving roles. Little research has been undertaken with male caregivers in dementia care. Although there is general consensus that men construe care differently to women, gender has seldom been treated as an independent variable that can inform supportive interventions. This study, underpinned by an assumption of the benefits of mens differential response to managing illness, sought to explore how facets of masculinity might relate to male caregivers’ appraisals of strain and gain in dementia care. Seventy men, currently caring for a partner with dementia, completed questionnaires exploring their gender identity (Personal Attributes Questionnaire), gender role conflict (Gender Role Conflict Scale), and appraisals of carer strain and gain (Brief Zarit Burden Interview and Caregiving Satisfaction Scale). They were also asked to provide demographic information and, since caregiver strain is significantly affected by a care-receivers cognitive and behavioural difficulties, to complete the revised Memory and Behaviour Problems Checklist. Carers’ age and duration of caregiving was broadly representative of previous studies. A series of regression analyses revealed contrasting findings to previous studies. Gender identity did not appear important in carers evaluations of strain or gain, and only the ‘restrictive affectionate behaviour between men’ subscale of gender role conflict had explanatory power in analyses with all strain and gain variables. Findings are discussed with regard to response bias and defended masculinity. Consideration is made about how men can successfully access services.

Psychological adjustment to lower limb amputation amongst prosthesis users

Purpose. Clinical reports indicate that many lower limb amputees experience problems with psychological adjustment. Although depressive responses to amputation have been well investigated, there has been insufficient attention to other aspects of adjustment. This study aimed to determine the prevalence of psychological morbidity in an amputee population and identify variables associated with increased distress. Particular attention was given to cognitive models of emotion which postulate a key role for self-consciousness and appearance-related beliefs. Method. A cross-sectional survey of 67 adult lower limb prosthesis users who had experienced amputation within the last five years. Outcome measures were the Psychosocial Adjustment Scale of the Trinity Amputation and Prosthesis Experience Scales, the Hospital Anxiety and Depression Scale, the Self Consciousness Scale and the Appearance Schemas Inventory. Results. Using conservative cut-off scores the prevalence of anxiety and depression was 29.9 and 13.4%, respectively. Appearance-related beliefs were associated with both distress and psychosocial adjustment difficulties. Public but not private self-consciousness was associated with distress and psychosocial adjustment difficulties. Conclusions. Clinicians need to monitor amputees for distress over a longer time period than the initial post-operative phase. It is particularly important to assess for anxiety. Interventions that target appearance-related beliefs may be of benefit to this population.

The role of patient appraisal and coping in predicting distress in IVF

This study aimed to develop a theoretical understanding of the factors predicting psychological morbidity in patients planning IVF treatments, using Leventhal et al.s Self Regulation Model. Fifty patients attending assisted conception units completed a demographic questionnaire, the Illness Perception Questionnaire—Revised, the Brief COPE and the Hospital Anxiety and Depression Scale. Results showed that mean anxiety and depression scores did not fall into the clinically significant range, although 42% of patients did score in the clinical range for anxiety. Hierarchical multiple regressions, examining the relationships between illness perceptions, coping and distress, revealed that both illness perceptions and coping strategies predicted anxiety and depression. Implications of the research are presented with suggestions for clinical interventions.

We are not worthy--understanding why patients decline pulmonary rehabilitation following an acute exacerbation of COPD.

Abstract Purpose: To explore how patients who refuse referral to Pulmonary Rehabilitation (PR) appraise acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD), in the context of having considered and declined PR. Method: Six participants recently hospitalized with an acute exacerbation COPD who refused a referral to PR subsequent to hospital discharge participated in in-depth interviews. Transcripts were subjected to Interpretative Phenomenological Analysis (IPA). Results: Three conceptual themes emerged comprising: “Construction of the self”, reflecting the impact of the acute exacerbation on personal identity; “Relinquishing control”, describing participants” struggle to maintain agency following an acute event; and “Engagement with others”, embodying participants’ sensitivity and responsiveness to interactions with others. Conclusions: Prominent in theses participants’ narratives are self-conscious cognitions which appear founded in shame and stigmatization. These cognitions seem to reflect challenges to self-worth and appear associated with reduced help-seeking and isolation. Perceived personal culpability for COPD appears to sensitize participants’ towards their interactions with health care professionals, construed as critical and judgmental which may increase avoidant behaviors, such as refusal of PR. When introducing PR, professionals should be aware of such sensitivities and facilitate open discussion which offers, time, compassion and understanding as a means of facilitating uptake. Implications for Rehabilitation Patients who decline referral to Pulmonary Rehabilitation report self-conscious cognitions (i.e. shame, guilt, fear of others evaluation) associated with lowered self-worth and reduced help-seeking. When introducing Pulmonary Rehabilitation health care professionals need to be mindful of patients’ sensitivities to being shamed which stem from perceived culpability for COPD. Professionals should facilitate an open discussion with patients which offers, time, compassion and understanding as a means of facilitating Pulmonary Rehabilitation uptake. Compassion focused interventions which encourage trust and safety may promote active partnership working and facilitate engagement in Pulmonary Rehabilitation.

The National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Leicestershire, Northamptonshire and Rutland (LNR) : a programme protocol.

BackgroundIn October 2008, the National Institute for Health Research launched nine new research projects to develop and investigate methods of translating research evidence into practice. Given the title Collaborations for Leadership in Applied Health Research and Care (CLAHRC), all involve collaboration between one or more universities and the local health service, but they are adopting different approaches to achieve translation.MethodsThe translation and implementation programme of this CLAHRC has been built around a pragmatic framework for undertaking research to address live concerns in the delivery of care, in partnership with the managers, practitioners, and patients of the provider organisations of the CLAHRC. Focused on long-term conditions, the constituent research themes are prevention, early detection, self-management, rehabilitation, and implementation. Individual studies have various designs, and include both randomised trials of new ways to deliver care and qualitative studies of, for example, means of identifying barriers to research translation. A mix of methods will be used to evaluate the CLAHRC as a whole, including use of public health indicators, social research methods, and health economics.DiscussionThis paper describes one of the nine collaborations, that of Leicestershire, Northamptonshire, and Rutland. Drawing a distinction between translation as an organising principle for healthcare providers and implementation as a discrete activity, this collaboration is built on a substantial programme of applied research intended to create both research generation and research use capacity in provider organisations. The collaboration in Leicestershire, Northamptonshire, and Rutland has potential to provide evidence on how partnerships between practitioners, patients, and researchers can improve the transfer of evidence into practice.