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Biomedical subjects

Elaine McColl

Publications and source records attributed to Elaine McColl.

9 recordsLinked to original sources
PubMed2007

Development of a series of patient information leaflets for constipation using a range of cognitive interview techniques: LIFELAX.

BACKGROUND: The aim of the LIFELAX randomised controlled trial (diet and lifestyle vs. laxatives in the management of chronic constipation) is to develop and evaluate a cost effective intervention to promote diet and lifestyle in the treatment and management of chronic constipation for older people in Primary Care. Constipation affects the quality of life in around 20% of older people in the community. In the 65 years plus population, a significant proportion of men and women both living in institutions (81% and 75% respectively) and free living (30% and 37% respectively) use laxatives. Approximately 42 million pounds is spent each year on prescribed laxatives in England in addition to laxatives purchased over the counter. Although bowel problems are often multifactorial, diet and lifestyle have an extremely important role in their management. This paper describes one aspect of the main study, the development and piloting of the Patient information leaflets (PILs). METHODS: Following review of the literature and interviews with practitioners and patients, 8 PILs were designed on: constipation, activity, bowel health, fruit and vegetables, fibre, fluid, alternative therapies and laxatives. To check the patient's understanding of terms used in the PILS and the clarity and accessibility of the information understanding, cognitive interviews (CI) were used with nine patients (selected from 3 GP surgeries), aged > or = 55 years, who had received > or = 3 prescriptions of laxatives over 12 months. Interviews were recorded and transcribed. RESULTS: Changes made following the CI process included the lay-out, words used (e.g. 'exercise' was changed to 'activity', 'gut motility' changed to 'bowel movement') and descriptions and examples were adapted to be more appropriate for the target population. CONCLUSION: Pilot testing with CIs resulted in improvements in the PILs, which emphasises the need to pilot PILs with the target population before use. The techniques employed are relatively inexpensive and could be routinely used when preparing literature for research or clinical use including those intended for use with healthcare professionals and patients.

Aged↗
PubMed2005

Predictors of quality of life in ulcerative colitis: the importance of symptoms and illness representations.

BACKGROUND: Establishing predictors of quality of life (QoL) in individuals with inflammatory bowel disease could help to identify those patients who are most likely to experience poor QoL and to target therapeutic interventions appropriately. We aimed to investigate how disease-specific QoL depends on demographic, diseaserelated, and physiological markers of disease activity, cognitive representations of illness, and perceived general health status. METHODS: A total of 111 individuals completed the Inflammatory Bowel Disease Questionnaire (IBDQ), the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Illness Perception Questionnaire (IPQ). The extent of disease was determined from records, and disease activity was determined by a symptom index. Bivariate analyses and multivariate regression models were used to identify predictors of disease-specific QoL. RESULTS: Bivariate analyses showed that symptom-related disease activity, elements of illness representation measured by the IPQ, and elements of physical and mental health measured by the SF-36 were the only variables that were strongly or moderately correlated with disease-specific QoL. Multivariate regression modeling showed that disease activity was the major explanatory variable for each of the 4 domains and for the total score on the IBDQ. CONCLUSION: This study highlights the strong relationship between individuals' symptoms and all domains of their health-related QoL, but shows little association with age, gender, physiological markers of disease activity, or anatomic disease extent. Perceptions of the condition were relatively weak predictors of self-reported QoL. The best strategy for improving QoL among individuals with ulcerative colitis may be to find ways to reduce their symptoms.

Adult↗
PubMed2005

Assessing symptoms in gastroesophageal reflux disease: how well do clinicians' assessments agree with those of their patients?

OBJECTIVES: This study aimed to determine the extent of agreement between clinicians and patients regarding assessments of reflux symptom severity in patients with gastroesophageal reflux disease. METHODS: Data were analyzed from four randomized clinical trials involving 2,674 patients treated with esomeprazole, omeprazole, ranitidine, or placebo. The extent of agreement was determined for symptom severity before and after 4-8 wk of treatment, and for the absence of symptoms after treatment. Agreement was further analyzed by determining weighted kappa values, which were interpreted according to the criteria of Landis and Koch. RESULTS: Before treatment, clinician-patient agreement regarding symptom severity in the four studies was slight to moderate (kappa: 0.17-0.53); 48-52% of assessments agreed for heartburn, 24-35% for epigastric pain, 36-43% for regurgitation, and 63% agreed for dysphagia. Poor agreement reflected clinician underestimation of symptom severity relative to patient ratings in three studies and clinician overestimation in one study. Agreement regarding symptom severity improved following treatment, and was fair to substantial (kappa: 0.31-0.73); 58-78% of assessments agreed for heartburn, 42-60% for epigastric pain, 66-76% for regurgitation, and 86% agreed for dysphagia. After treatment, agreement was greatest for patients reporting absence of symptoms and decreased with increasing severity of symptoms. CONCLUSIONS: The agreement between clinicians and patients in their assessments of the severity of reflux symptoms is poor, particularly before treatment and for more severe symptoms. Improvements in clinician-patient communication may help to bridge this gap, and greater reliance on patient assessments may be appropriate.

Abdominal Pain↗
PubMed2003

Practice based, longitudinal, qualitative interview study of computerised evidence based guidelines in primary care.

OBJECTIVE: To understand the factors influencing the adoption of a computerised clinical decision support system for two chronic diseases in general practice. DESIGN: Practice based, longitudinal, qualitative interview study. SETTING: Five general practices in north east England. PARTICIPANTS: 13 respondents (two practice managers, three nurses, and eight general practitioners) gave a total of 19 semistructured interviews. 40 people in practices included in the randomised controlled trial (34 doctors, three nurses) and interview study (three doctors, one previously interviewed) gave feedback. RESULTS: Negative comments about the decision support system significantly outweighed the positive or neutral comments. Three main areas of concern among clinicians emerged: timing of the guideline trigger, ease of use of the system, and helpfulness of the content. Respondents did not feel that the system fitted well within the general practice context. Experience of "on-demand" information sources, which were generally more positively viewed, informed the comments about the system. Some general practitioners suggested that nurses might find the guideline content more clinically useful and might be more prepared to use a computerised decision support system, but lack of feedback from nurses who had experienced the system limited the ability to assess this. CONCLUSIONS: Significant barriers exist to the use of complex clinical decision support systems for chronic disease by general practitioners. Key issues include the relevance and accuracy of messages and the flexibility to respond to other factors influencing decision making in primary care.

Attitude of Health Personnel↗
PubMed2003

The relationship of perceived control to outcomes in older women undergoing surgery for fractured neck of femur.

This paper examines the relationship between internal locus of control and recovery from surgery for fractured neck of femur in women over the age of 65 years, in order to inform strategies for nursing care. Structured interviews were carried out at 5 and 30 days postsurgery with 112 women (mean age 78.6 years) in five general hospitals in the North of England. Locus of control was assessed as a factor associated with the outcomes of physical disability (measured as dependence in activities of daily living) and psychological distress (measured using the Hospital Anxiety and Depression Scale). Internal locus of control was significantly related to less physical disability, but no association was found between locus of control and depression and anxiety at 30 days postsurgery when age, 5-day measures and other 30-day outcome measures were controlled. The findings suggest that nursing interventions that enhance perceived internal control by patients during rehabilitation may result in better physical outcomes. Further work is required to explore the relationship of control to psychological outcomes.

Activities of Daily Living↗
PubMed2003

From the generic to the condition-specific?: Instrument order effects in Quality of Life Assessment.

BACKGROUND: Generic and condition-specific measures of quality of life are often used in parallel. Despite extensive evidence of question ordering effects in the general survey literature, there is no consensus on which type of measure should be administered first and little previous conclusive research into instrument ordering effects. OBJECTIVES: To investigate the effects of instrument ordering on response rates, speed of response, and response patterns to questions on health-related quality of life. RESEARCH DESIGN: Subjects were randomized to two different versions of a self-completion questionnaire; in the first, condition-specific measures of quality of life preceded generic instruments; in the second version, the relative positions were reversed. SUBJECTS: Adults with asthma or angina from 62 family practices in northeast England. MEASURES: Instruments were the generic Medical Outcomes Study Short Form 36-item questionnaire, the EQ-5D, the Newcastle Asthma Symptoms Questionnaire, the Asthma Quality of Life Questionnaire, and the Seattle Angina Questionnaire. Effects were assessed in terms of questionnaire response rates, speed of response, item nonresponse rates, internal consistency, and domain scores on the quality of life measures. RESULTS: Instrument ordering had no effect on questionnaire response rates or response speed. Only condition affected item nonresponse rates. Some ordering effects in respect of quality of life scores were observed, but these were inconsistent within and between conditions, and none of the differences were clinically significant. CONCLUSIONS: There is little effect of instrument ordering on responses to self-completed measures of quality of life. Further research is required to test whether this finding extends to other methods of administration.

Adult↗
PubMed2002

Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial.

OBJECTIVE: To evaluate the use of a computerised support system for decision making for implementing evidence based clinical guidelines for the management of asthma and angina in adults in primary care. DESIGN: A before and after pragmatic cluster randomised controlled trial utilising a two by two incomplete block design. SETTING: 60 general practices in north east England. PARTICIPANTS: General practitioners and practice nurses in the study practices and their patients aged 18 or over with angina or asthma. MAIN OUTCOME MEASURES: Adherence to the guidelines, based on review of case notes and patient reported generic and condition specific outcome measures. RESULTS: The computerised decision support system had no significant effect on consultation rates, process of care measures (including prescribing), or any patient reported outcomes for either condition. Levels of use of the software were low. CONCLUSIONS: No effect was found of computerised evidence based guidelines on the management of asthma or angina in adults in primary care. This was probably due to low levels of use of the software, despite the system being optimised as far as was technically possible. Even if the technical problems of producing a system that fully supports the management of chronic disease were solved, there remains the challenge of integrating the systems into clinical encounters where busy practitioners manage patients with complex, multiple conditions.

Angina Pectoris↗