Yvonne Birks

Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care

Abstract Objective To assess whether supplementation with calcium and cholecaliferol (vitamin D3) reduces the risk of fracture in women with one or more risk factors for fracture of the hip. Design Pragmatic open randomised controlled trial. Setting Practice nurse led clinics in primary care. Participants 3314 women aged 70 and over with one or more risk factors for hip fracture: any previous fracture, low body weight (< 58 kg), smoker, family history of hip fracture, or fair or poor self reported health. Intervention Daily oral supplementation using 1000 mg calcium with 800 IU cholecaliferol and information leaflet on dietary calcium intake and prevention of falls, or leaflet only (control group). Main outcome measures Primary outcome measure was all clinical fractures and secondary outcome measures were adherence to treatment, falls, and quality of life (measured with the SF-12). Results 69% of the women who completed the follow-up questionnaire at 24 months were still taking supplements (55% with inclusion of randomised participants known to be alive). After a median follow-up of 25 months (range 18 to 42 months), clinical fracture rates were lower than expected in both groups but did not significantly differ for all clinical fractures (odds ratio for fracture in supplemented group 1.01, 95% confidence interval 0.71 to 1.43). The odds ratio for hip fracture was 0.75 (0.31 to 1.78). The odds of a woman having a fall at six and 12 months was 0.99 and 0.98, respectively. Quality of life did not significantly differ between the groups. Conclusion We found no evidence that calcium and vitamin D supplementation reduces the risk of clinical fractures in women with one or more risk factors for hip fracture. Registration ISRCTN26118436, controlled trials registry.

Systematic review of information and support interventions for caregivers of people with dementia.

BackgroundDementia is an important health and social care problem and is one of the main causes of disability in later life. The number of families affected by dementia will dramatically increase over the next five decades. Despite the implications for health and social care services in the future, the overwhelming majority of care for people with dementia takes place away from health care settings. Providing informal care for someone with dementia can be psychologically, physically and financially expensive and a range of health service interventions aimed at supporting and providing information to these carers has developed to help carers meet these demands. This review examines whether information and support interventions improve the quality of life of people caring for someone with dementia.MethodsA systematic review examining evidence from randomised controlled trials in which technology, individualised or group-based interventions built around the provision of support and/or information were evaluated.ResultsForty-four studies were included in the review. Controlling for the quality of the evidence, we found statistically significant evidence that group-based supportive interventions impact positively on psychological morbidity. However, whilst the improvement was unlikely to be due to chance, the clinical significance of this finding should be interpreted tentatively, due to the difficulties in interpreting the standardised mean difference as a measure of effect and the complex aetiology of depression. No evidence was found for the effectiveness of any other form of intervention on a range of physical and psychological health outcomes.ConclusionThere is little evidence that interventions aimed at supporting and/or providing information to carers of people with dementia are uniformly effective. There is a pressing need to ensure that supportive interventions at the development stage are accompanied by good quality randomised evaluations in which outcomes that are important to clinicians and carers are measured.

Emotional intelligence and perceived stress in healthcare students: a multi-institutional, multi-professional survey

BackgroundEmotional intelligence (EI) is increasingly discussed as having a potential role in medicine, nursing, and other healthcare disciplines, both for personal mental health and professional practice. Stress has been identified as being high for students in healthcare courses. This study investigated whether EI and stress differed among students in four health professions (dental, nursing, graduate mental health workers, medical) and whether there was evidence that EI might serve as a buffer for stress.MethodThe Schutte Emotional Intelligence and the Perceived Stress scale instruments were administered to four groups of healthcare students in their first year of study in both the autumn and summer terms of the 2005-6 academic year. The groups were undergraduate dental, nursing and medical students, and postgraduate mental health workers.ResultsNo significant differences were found between males and females nor among professional groups for the EI measure. Dental students reported significantly higher stress than medical students. EI was found to be only moderately stable in test-retest scores. Some evidence was found for EI as a possible factor in mediating stress. Students in different health profession courses did not show significant differences in Emotional Intelligence.ConclusionWhile stress and EI showed a moderate relationship, results of this study do not allow the direction of relationship to be determined. The limitations and further research questions raised in this study are discussed along with the need for refinement of the EI construct and measures, particularly if Emotional Intelligence were to be considered as a possible selection criterion, as has been suggested by some authors.

Scoping Review and Approach to Appraisal of Interventions Intended to Involve Patients in Patient Safety

Objective To review the literature on the involvement of patients in efforts to promote their own or others’ safety while using health care services. Method A total of 1933 reports were identified as potentially relevant and 745 of these were included in the review (437 descriptions of interventions, 299 comment or opinion pieces and 42 discussions or studies of patients’ willingness and ability to adopt safety-promoting behaviours). Results The rate of publication on these topics has increased, especially in the USA and UK. However, there is scant evidence of the impact of patient involvement initiatives on safety outcomes and there has been little exploration of patients’ willingness and ability to adopt particular safety-oriented behaviours. We identified three broad routes by which patients’ actions might contribute to their safety by helping to make sure that: their treatment is appropriate for them (informing the management plan); treatment is given as planned and according to appropriate protocols (monitoring and ensuring safe delivery of treatment); and problems and risks within health care systems are identified and reduced (informing systems improvements). Conclusions An approach for appraising interventions intended to promote patient involvement in patient safety should involve: identification of the routes by which interventions assume patients’ actions might contribute to their safety; identification of the conditions that would need to be met for patients to behave and contribute as the interventions (implicitly) assume; examination of the extent to which the intervention supports fulfilment of those conditions; and consideration of the potential negative effects of the intervention.

Effect of physicians’ gender on communication and consultation length: a systematic review and meta-analysis

Objective Physician gender may be a source of differences in communication between physicians and their patients, which may in turn contribute to patient satisfaction and other outcomes. Our aim was to review systematically research on gender differences in the length, style and content of communication with patients. Methods Seven electronic databases were searched from inception to September 2010 with no language restrictions (included MEDLINE; PsychINFO; EMBASE; CINAHL; Health Management Information Consortium; Web of Science; and ASSIA). ‘Grey’ literature was also searched. Data extraction and quality assessment was carried out in accordance with Cochrane Collaboration guidelines by at least two reviewers. The review uses mainly narrative synthesis due to the heterogeneous nature of the studies, with only data on consultation length being pooled in a random effects generic inverse variance meta-analysis. Results Searches yielded 6412 articles, of which 33 studies fulfilled the inclusion criteria. Studies were heterogenous and of mixed quality. Conflicting results are reported for many communication variables. There is some evidence that female physicians adopt a more partnership building style and spend on average 2.24 min longer with patients per consultation (95% CI 0.62–3.86) than their male colleagues. Conclusions Greater patient engagement by female doctors may reflect a more patient-centred approach, but their longer consultation times will limit the number of consultations they can provide. This has implications for planning and managing services.

Randomized controlled trials of interventions to change maladaptive illness beliefs in people with coronary heart disease: systematic review

AIM This paper is a report of a systematic review of randomized controlled trials of interventions to change maladaptive illness beliefs in people with coronary heart disease, and was conducted to determine whether such interventions were effective in changing maladaptive beliefs, and to assess any consequent change in coping and outcome. BACKGROUND An increasing body of evidence suggests that faulty beliefs can lead to maladaptive behaviours and, in turn, to poor outcomes. However, the effectiveness of interventions to change such faulty illness beliefs in people with coronary heart disease is unknown. DATA SOURCES Multiple data bases were searched using a systematic search strategy. In addition, reference lists of included papers were checked and key authors in the field contacted. REVIEW METHODS The systematic review included randomized controlled trials with adults of any age with a diagnosis of coronary heart disease and an intervention aimed at changing cardiac beliefs. The primary outcome measured was change in beliefs about coronary heart disease. RESULTS Thirteen trials met the inclusion criteria. Owing to the heterogeneity of these studies, quantitative synthesis was not practicable. Descriptive synthesis of the results suggested that cognitive behavioural and counselling/education interventions can be effective in changing beliefs. The effects of changing beliefs on behavioural, functional and psychological outcomes remain unclear. CONCLUSION While some interventions may be effective in changing beliefs in people with coronary heart disease, the effect of these changes on outcome is not clear. Further high quality research is required before firmer guidance can be given to clinicians on the most effective method to dispel cardiac misconceptions.

Exploring health‐related experiences of children and young people with congenital heart disease

Objective  To determine the health‐related experiences of children with congenital heart disease.

A validation study of the Cardiac Depression Scale (CDS) in a UK population

OBJECTIVES This study was designed to validate the Cardiac Depression Scale (CDS) in a UK cardiac population. METHOD A battery of questionnaires (the Medical Outcomes Study Short-Form 36 [SF-36] Health Survey, the Beck Depression Inventory [BDI], the Hospital Anxiety and Depression Scale [HADS] and the Cardiac Depression Scale [CDS]) was mailed to 487 individuals with coronary heart disease (CHD) recruited from cardiac support groups. The process was repeated on a subsample of 80 participants four-six weeks later for the purpose of test-retest analysis. RESULTS The response rate from the first administration was 81% and from the test-retest subsample 54%. Factor analysis revealed a one-factor solution with a high internal reliability (Cronbachs alpha = 0.93) and an acceptable test-retest reliability (0.79). Concurrent validation against the SF-36, BDI and HADS demonstrated strong correlations. CONCLUSIONS The CDS is both a reliable and sensitive instrument for measuring depression in cardiac patients.

The development of a new measure of quality of life for children with congenital cardiac disease.

The purpose of the study was to develop a questionnaire measuring health-related R1 quality of life for children and adolescents with congenital heart disease, the ConQol, that would have both clinical and research applications. We describe here the process of construction of a questionnaire, the piloting and the development of a weighted scoring system, and data on the psychometric performance of the measure in a sample of 640 children and young people recruited via 6 regional centres for paediatric cardiology from across the United Kingdom. The ConQol has two versions, one designed for children aged from 8 to 11 years, and the other for young people aged from 12 to 16 years. Initial findings suggest that it is a valid and reliable instrument, is acceptable to respondents, and is simple to administer in both a research and clinical context.

A comparison of randomised controlled trials in health and education

Health care and educational trials face similar methodological challenges. Methodological reviews of health care trials have shown that a significant proportion have methodological flaws. Whether or not educational trials have a similar proportion of poor-quality trials is unknown. The authors undertook a methodological comparison between health care and educational trials published since 1990. The authors aimed (1) to assess whether the quality of trial reports in education and health care are similar; and (2) to assess whether trial reporting quality is improving. The characteristics of a sample of trials, published since 1990, were taken from health and educational journals. Trials were assessed using the following quality criteria: rationale for sample size; concealment of allocation; blinded follow-up; use of confidence intervals; adequate sample size. Ninety-six placebo drug trials and 54 non-drug trials published in major general journals were identified. These were compared with 54 trials in specialist health journals and 84 trials in educational journals. No educational trial used concealed allocation or reported the rationale for sample size calculation and only one trial used confidence intervals. There was a trend for the reporting of health care trials to improve with time, whilst the reporting quality of educational trials declined. The authors concluded that poor quality of trial reporting is more prevalent in educational journals than in health care journals.