Roy Powell

Assessing communication skills of GP registrars: a comparison of patient and GP examiner ratings

General practice.

Patient Partnership in Care: A new instrument for measuring patient–professional partnership in the treatment of long-term conditions

Abstract The Patient Partnership in Care (PPiC) questionnaire was designed to measure the ability of health professionals to work in partnership with patients with long-term conditions (LTCs) to support and motivate self-management. It is a generic, 16-item questionnaire, contained on two sides of A4, incorporating space for two written comments. In a baseline survey, 97 clinicians gathered responses from 1,660 patients with LTCs in eight centres across the UK. The questionnaire was found to have face validity, construct validity, good internal consistency and sensitivity to change. It consists of two, unidimensional subscales covering patient–clinician partnership and the patients confidence to manage their LTC (Cronbachs alpha 0.977 and 0.877 respectively). Health professionals who participated in three four-hour training sessions focusing on skills that support patients with self-management showed a significantly improved score in both subscales (with moderate effect sizes: –0.56 for both subscales). These health professionals administered the PPiC to their patients before and after the training. Regression analysis showed that patient confidence was strongly predicted by their partnership score. This suggests that the intervention of relevant training and reflection on the initial results of the PPiC can promote clinician skill development and increase the confidence of patients regarding self-management of LTCs.

Do metronomes improve the quality of life in people with Parkinson’s disease? A pragmatic, single-blind, randomized cross-over trial:

Objective: To evaluate the effect of acoustic cueing using metronomes on the quality of life of people with moderate to severe Parkinson’s disease. Study design: Pragmatic, single-blind, randomized cross-over trial. Participants: Forty-two people aged 50—85 years, in Hoehn and Yahr stage II—IV and on stable medication. Eight were lost to follow-up. Intervention: Participants were randomized using concealed allocation to either an early group (n = 21) to receive an electronic metronome without therapy but limited support (5—10 minutes instruction and on-demand telephone assistance) for four weeks, or a late group (n = 21) to receive the same intervention at 10 weeks. In both groups the beat frequency was initially set to be comfortable for walking. Outcomes measures: Primary and secondary outcomes were measured at baseline, 4, 10 and 14 weeks using the Parkinson’s Disease Questionnaire 39 (PDQ-39), the Short Form 36 version 2 (SF-36 version 2) and a falls diary. Results: There were positive effects in six domains of the SF-36 version 2 and eight domains of the PDQ-39, although only one mean difference was clinically important: the role limitation (emotional) domain of SF-36 version 2 (a mean difference of 3.77, 95% confidence interval (CI), —2.68 to 10.22), a secondary outcome. None of these changes were statistically significant. There were no statistically significant differences in falls rates over the study period. Ten participants (24%) wanted to continue with their metronomes at the end of the study. Conclusion: To demonstrate metronomes are beneficial on the role limitation domain of the SF-36 version 2 in people with moderate to severe Parkinson’s disease a sample size of 600 would be required.

The impact of patient survey feedback in general practice: The influence of practice size

Abstract In two successive years, 2,012 practices surveyed over 400,000 patients per year in the UK using the Improving Practice Questionnaire (IPQ). In the second survey, of the 27 questionnaire items, a statistically significant improvement was seen in scores for 12 items, while scores were maintained for 13 items and significantly decreased for only two items, namely satisfaction with opening hours and contacting the practice by telephone. Scores for perceived practitioner capability were maintained regardless of practice size, showing a continued high level of satisfaction of over 80 per cent in this area. These scores could still be improved, particularly for considering the patient as a person and taking into account their personal situation in deciding possible treatments. Scores for the capacity of the practice to deliver a high-quality service with regard to supporting services and access were inversely correlated with practice size. Improvement in these scores indicated that listening to patients through the IPQ on more than one occasion can enable practices to significantly improve patient services, but larger practices need to work harder at it. Waiting time in the practice was the lowest scoring item but the efficiency of telephone systems was also poorly rated. There needs to be greater opportunity for patients to speak to practitioners on the phone and also to see the practitioner of their choice, particularly in large practices.

Does treatment by a specialist physiotherapist change pain and function in young adults with symptoms from femoroacetabular impingement? A pilot project for a randomised controlled trial

AIM Femoroacetabular impingement (FAI) is recognised as a source of hip pain but the effect of conservative treatment remains untested. This pilot study aimed to inform and evaluate the methods required to conduct a substantive trial comparing the effect of treatment by a physiotherapist versus routine care on the symptoms of FAI. DESIGN A parallel group, pilot randomised controlled trial (RCT). SETTING A single NHS acute hospital trust, Devon, England. PARTICIPANTS 30 adults with symptomatic FAI were recruited. 23 (77%) completed the study. INTERVENTIONS Intervention was 3 months of treatment by a specialist physiotherapist. The control group received routine care. MAIN OUTCOMES Change in pain and function was measured using a Visual Analogue Scale, Non Arthritic Hip Score (NAHS), Lower Extremity Functional Score (LEFS) and Hip Outcome Score. RESULTS Participants in the intervention arm undertook a personalised exercise programme to improve pelvic and femoral control plus advice on posture, activity pacing and pain relief. The mean change in NAHS for the intervention group was 12.7 (95% CI 4.7 to 20.7) and 1.8 (95% CI -5.3 to 9.0) in the control group; Median change in LEFS was 11.5 (95% CI 5.0 to 26.0) versus -1.0 (95% CI -7.0 to 4.0). This improvement in LEFS was beyond minimal clinically important difference in the intervention group. Pain scores improved marginally in both groups. CONCLUSIONS Methodological strengths and weaknesses were successfully identified for a substantive study. Further research is needed to evaluate the relative influence of structural and neuromuscular features on symptoms of FAI and the role of conservative treatment.

Pilot randomised controlled trial of protective socks against usual care to reduce skin tears in high risk people “STOPCUTS”: study protocol

BackgroundSkin tears are traumatic injuries occurring mostly on the extremities due to shearing and friction forces that separate the epidermis and the dermis from underlying tissues. They are common and occur mostly in older adults and those taking medications that compromise skin integrity. Pretibial skin tears can develop into leg ulcers, which require lengthy, expensive treatment to heal. Traumatic injuries are the second most common type of wounds after pressure ulcers in care homes and are the commonest reason for older adults to require the attention of a community nurse. Common causes of skin tear injuries are bumping into furniture and other obstacles, using mobility aids, transfer to/from wheelchairs, getting in and out of bed and falls. No effective preventative measures currently exist but knee-length, protective socks are now available that contain impact-resistant Kevlar fibres (of the type used in stab-proof vests) and cushioning layers underneath.Methods/designIn this pilot parallel group, randomised controlled trial, 90 people at risk of skin-tear injury will be randomised with equal allocation to receive the intervention or usual care. They will be recruited from care homes and from the community via general practices and a research volunteer database. Pilot outcomes include recruitment, eligibility, attrition, ascertainment of injuries and completion of outcome measures. Acceptability of the intervention and of study participation will be explored using semi-structured interviews. The proposed primary outcome for the future definitive trial is skin tear-free days. Secondary outcomes are skin tear severity, health status, specific skin-tears quality of life, capability and fear of falling, measured at baseline and the end of the study and in the event of a skin tear.DiscussionThe results of this study will be used to inform the development and design of a future randomised controlled trial to assess the effectiveness and cost-effectiveness of a unique and innovative approach to skin tear prevention.Approval was granted by the NRES - Cornwall and Plymouth Research Ethics Committee (13/SW/013). Dissemination will include publication of quantitative and qualitative findings, and experience of public involvement in peer-reviewed journals.Trial registrationCurrent Controlled Trials: ISRCTN96565376

Diagnosis of type 2 diabetes in primary care

Little is known about the impact of case-finding and protocol-driven screening at a practice level on the increasing prevalence of type 2 diabetes. This cross-sectional study investigated the diagnostic process in 154 patients with diabetes in a single practice with protocol-led screening for diabetes. A large proportion (87%) were diagnosed in primary care and of the 116 (86.6%) patients with type 2 diabetes the majority (58.6%) were also asymptomatic at the time of diagnosis. The commonest reason for screening was the presence of hypertension. Br J Diabetes Vasc Dis 2003;3:342‐4

Exploring NursEs lived Experience of Discussions about Sexual health, with kidney patients in Devon (NEEDS)

The aim of the study is to gain a better understanding about the complexities of discussing sexuality with patients.

The diagnostic accuracy of multiparametric magnetic resonance imaging before biopsy in the detection of prostate cancer

To determine the extent to which clinically significant prostate cancer (csPCa) can be detected in a routine National Health Service setting in men with no previous biopsy, when multiparametric magnetic resonance imaging (mpMRI) is introduced into the diagnostic pathway.

Pilot randomised controlled trial of protective socks against usual care to reduce skin tears in high risk people: ‘stopcuts’

Skin tears are traumatic injuries occurring mostly on the extremities due to shearing and friction forces that separate the epidermis and the dermis from underlying tissues. They are common in older adults - especially those who have taken long-term steroids - and are caused by falls, mobility aids and knocks from obstacles. Traumatic injuries are the second most common type of wounds in care homes and are the commonest reason for community nurse involvement. Pretibial skin tears can develop into leg ulcers, which require lengthy, expensive treatment. No effective prevention exists. We are trialling knee-length, protective socks that contain cut, tear and abrasion-resistant Kevlar fibres and cushioning layers. In this pilot parallel group, randomised controlled trial, 90 people at risk of skin-tear injury were recruited in Devon from care homes and the community and were randomised to wear the intervention socks or usual clothing for 4 months. The aim of the pilot was to inform the design of a definitive trial (that recruitment, randomisation, treatment and follow-up ran smoothly). 395 patients were approached and 90 were consented (54 in care homes and 36 community). Median age of participants was 85 years. 31 skin tear injuries occurred in 18 (20%) of the 90 participants over a period of 112 days. There were 21 injuries among 10 (21.74%) patients in the control group (n=46) and 10 injuries among 8 (18.18%) patients in the socks group (n=44). Only two in this group were definitely wearing their intervention socks at the time of their injury.