Susan Chipchase

Ulcer-free survival following management of foot ulcers in diabetes.

Aims  Measures of healing rate may not give a complete indication of the effectiveness of overall management of diabetic foot ulcers. Apart from healing and speed of healing, the outcomes of greatest importance to the patient are avoidance of any amputation and remaining free from any recurrence. We have documented the number of patients presenting with diabetic foot ulcers who become ulcer free and examined the value of documenting ulcer‐free survival.

Factors associated with carer strain in carers of people with multiple sclerosis

Purpose : To examine the factors associated with strain in carers of people with multiple sclerosis (MS). Method : People with MS were recruited from an MS management clinic. Demographic information, memory, executive function, attention/concentration, mood, disability and health of the person with MS, the carers opinion of the care-recipients memory and disability, and the carers mood were recorded. A postal questionnaire to identify factors associated with carer strain was sent to carers. A further questionnaire was sent to carers to examine the association between memory problems in people with MS and carer strain. Results : Problems with everyday memory and activities of daily living were found to be associated with carer strain. Strained carers perceived strain to be a consequence of the memory problems (p<0.01). Aspects of the memory problems related to carer strain were the amount of time a carer could spend alone (p = 0.01), the carers mood and less sympathetic feelings towards the person with MS (p<0.05). Strained carers had more desire for other people to help the person with MS deal with the memory problems by themselves than carers who were not under strain (p = 0.03). Conclusion : Carer strain was associated with memory problems experienced by people with MS.PURPOSE To examine the factors associated with strain in carers of people with multiple sclerosis (MS). METHOD People with MS were recruited from an MS management clinic. Demographic information, memory, executive function, attention/concentration, mood, disability and health of the person with MS, the carers opinion of the care-recipients memory and disability, and the carers mood were recorded. A postal questionnaire to identify factors associated with carer strain was sent to carers. A further questionnaire was sent to carers to examine the association between memory problems in people with MS and carer strain. RESULTS Problems with everyday memory and activities of daily living were found to be associated with carer strain. Strained carers perceived strain to be a consequence of the memory problems (p < 0.01). Aspects of the memory problems related to carer strain were the amount of time a carer could spend alone (p = 0.01), the carers mood and less sympathetic feelings towards the person with MS (p < 0.05). Strained carers had more desire for other people to help the person with MS deal with the memory problems by themselves than carers who were not under strain (p = 0.03). CONCLUSION Carer strain was associated with memory problems experienced by people with MS.

Measuring fatigue in people with Multiple Sclerosis

Objective: To compare methods of assessing fatigue. Design: Cross sectional. Setting: Community. Subjects: Forty Multile Sclerosis (MS) patients and 20 healthy controls. Main outcome measures: Fatigue questionnaires, SDSA dot cancellation test, finger tapping test, TEA Lottery. Results: The MS patients had significantly higher levels of fatigue than the controls on the Task Induced Fatigue Scale, Fatigue Severity Scale and Fatigue Impact Scale. The Task Induced Fatigue Scale completed whilst imagining oneself driving and the Fatigue Assessment Instrument did not differentiate between MS patients and controls. Finger tapping differentiated between MS patients and controls but there was no significant difference between MS patients and controls on visual and auditory concentration tests. A factor analysis indicated that questionnaire measures of fatigue were inter-related but independent of objective test performance. Conclusions: Questionnaire measures can be used to assess fatigue in people with MS. The FSS differentiated MS patients from controls and is relatively short. It was therefore recommended for clinical use.

General practitioners’ experiences and perceptions of benzodiazepine prescribing: systematic review and meta-synthesis

BackgroundBenzodiazepines are often prescribed long-term inappropriately. We aimed to systematically review and meta-synthesise qualitative studies exploring clinicians’ experiences and perceptions of benzodiazepine prescribing to build an explanatory model of processes underlying current prescribing practices.MethodsWe searched seven electronic databases for qualitative studies in Western primary care settings published in a European language between January 1990 and August 2011 analysing GP or practice nurse experiences of benzodiazepine prescribing. We assessed study quality using the Critical Appraisal Skills Programme Checklist. We analysed findings using thematic synthesis.ResultsWe included eight studies from seven countries published between 1993 and 2010. Benzodiazepine prescribing decisions are complex, uncomfortable, and demanding, taken within the constraints of daily general practice. Different GPs varied in the extent to which they were willing to prescribe benzodiazepines, and individual GPs’ approaches also varied. GPs were ambivalent in their attitude towards prescribing benzodiazepines and inconsistently applied management strategies for their use. This was due to the changing context of prescribing, differing perceptions of the role and responsibility of the GP, variation in GPs’ attitudes to benzodiazepines, perceived lack of alternative treatment options, GPs’ perception of patient expectations and the doctor-patient relationship. GPs faced different challenges in managing initiation, continuation and withdrawal of benzodiazepines.ConclusionWe have developed a model which could be used to inform future interventions to improve adherence to benzodiazepine prescribing guidance and improve prescribing through education and training of professionals on benzodiazepine use and withdrawal, greater provision of alternatives to drugs, reflective practice, and better communication with patients.

Heel ulcers don't heal in diabetes. Or do they?

Aim  To obtain information on outcome of heel ulcers in diabetes.

Trade-offs in visual attention and the enhancement of memory specificity for positive and negative emotional stimuli

Emotional influences on memory can lead to trade-offs in memory for gist or detail and trade-offs in memory for central or peripheral aspects of an event. Attentional narrowing has often been proposed as a theoretical explanation for this pattern of findings with negative emotion. These trade-offs have been less extensively investigated with positive emotion. In three experiments, we investigate memory for specific visual details of positive and negative stimuli, examine central–peripheral trade-offs in memory, and assess the hypothesis that attentional narrowing contributes to emotional enhancement of memory specificity. We found that memory for details was enhanced by negative and positive emotion. Central–peripheral trade-offs were found in memory for negative emotional stimuli but not in memory for positive emotional stimuli. These trade-offs with negative emotion were associated with attentional narrowing at the time of encoding, as measured by eye movements. There were no attentional effects at the time of encoding found with positive emotional stimuli. Evidence was found for the attentional narrowing hypothesis of memory specificity and central–peripheral trade-offs in memory for negative emotional events. Alternative explanations for the positive emotional enhancement of memory specificity are required.

A Systematic Review and Meta-Synthesis of Patients’ Experiences and Perceptions of Seeking and Using Benzodiazepines and Z-Drugs: Towards Safer Prescribing

BackgroundBenzodiazepines and Z-drugs are used to treat complaints like insomnia, anxiety and pain. These drugs are recommended for short-term use only, but many studies report long-term use, particularly in older people.ObjectiveThe aim of this study was to identify and synthesise qualitative studies exploring patients’ experiences and perceptions of receiving benzodiazepines and Z-drugs, and through this identify factors which perpetuate use of these drugs, and strategies for achieving safer prescribing.MethodsA systematic search of six databases for qualitative studies exploring patients’ experiences and perceptions of primary care benzodiazepine and z-drug prescribing published between January 2000 and April 2014 in a European language, and conducted in Europe, the United States, Australia or New Zealand. Reference lists of included papers were also searched. Study quality was assessed using the Critical Appraisal Skills Programme qualitative checklist. Findings were synthesised using thematic synthesis.ResultsNine papers were included and seven analytical themes were identified relating to patients’ experiences and perceptions and, within that, strategies for safer prescribing of benzodiazepines and Z-drugs: (1) patients’ negative perceptions of insomnia and its impact, (2) failed self-care strategies, (3) triggers to medical help-seeking, (4) attitudes towards treatment options and service provision, (5) varying patterns of use, (6) withdrawal, (7) reasons for initial or ongoing use.ConclusionsInappropriate use and prescribing of benzodiazepines and Z-drugs is perpetuated by psychological dependence, absence of support and patients’ denial/lack of knowledge of side effects. Education strategies, increased availability of alternatives, and targeted extended dialogue with patients could support safer prescribing.

Understanding emotionally relevant situations in primary dental practice. 2. Reported effects of emotionally charged situations

Background and aims Dentistry is widely reported to be a stressful profession. There is a limited body of research relating to the coping strategies used by dentists whilst in clinical situations. This study aims to use qualitative methods to explore the full extent of the coping strategies associated with stressful events in primary dental practice.Method Semi-structured interviews were conducted with 20 dentists within a 50 mile radius of Lincoln. A thematic analysis was conducted on verbatim transcriptions thereby identifying six themes and 35 codes.Results Participants described both problem-focused and emotion-focused strategies. The strategies used had a variety of outcomes in the context of use. Most dentists denied that their emotions affected their decision-making, but then proceeded to describe how they were influential.Discussion and conclusion Dentists use a wide variety of coping strategies some of which are maladaptive. Training in the development and recognition of appropriate coping decisions would be appropriate as they would, potentially, improve practitioner decision-making and well-being.