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Biomedical subjects

Ffion Lloyd-Williams

Publications and source records attributed to Ffion Lloyd-Williams.

6 recordsLinked to original sources
PubMed2005

Patients' and nurses' views of nurse-led heart failure clinics in general practice: a qualitative study.

OBJECTIVES: To ascertain nurses' and patients' views and experiences of a nurse-led heart failure clinic provided in general practice. METHODS: The study was set in eight general practices in the North-West of England. Semi-structured interviews were devised and administered, with all the nurses providing the clinics and a purposive sample of patients attending the clinics. The interviews were tape-recorded and transcribed. Constant comparative analysis was used to identify key issues and themes. RESULTS: Nurses felt that the self-care advice provided had empowered patients to manage their condition. Explaining why a medication had been prescribed, and how it controlled heart failure, was felt to increase compliance. Although communication was deemed good, some patients were reticent about asking questions. Patients were knowledgeable about their prescribed heart failure medications, but some did not recall having discussed their medications. Also, medication inserts led some patients to question their prescription. Patients remained confused about the purpose and outcome of investigations. Furthermore, many patients suggested that they had problems adhering to or remembering the advice given. DISCUSSION: There are practical benefits to be obtained from attending a nurse-led heart failure clinic in primary care. However, patients and healthcare providers may have quite divergent views about such a service and its benefits, emphasizing the potential value of consumer involvement and feedback when developing and delivering such services.

England↗
PubMed2003

The effect of an intervention programme to improve health education leaflet uptake and distribution in community pharmacies.

The effect of an intervention programme to improve health education leaflet uptake in community pharmacies was conducted with a small convenience sample of 12 community pharmacies in North Staffordshire, UK. The intervention consisted of four different modes of leaflet provision. Modes 1 and 2 (without and with overt offer of advice from pharmacist respectively) relied upon the pharmacy client to actively obtain a leaflet, whereas Modes 3 and 4 (without and with offer of advice from pharmacist respectively) relied upon pharmacy staff to actively provide a leaflet. All 12 community pharmacies received 50 copies of a purposefully designed leaflet. The intervention extended over one calendar month. Data was collected during the intervention via monitoring forms completed by the pharmacist on a day to day basis, and interviews were conducted with the pharmacists at the end of the study. The overall uptake or distribution rate of leaflets was 64%. In both modes which offered advice (Modes 2 and 4), approximately one of every five leaflet recipients sought advice. The community pharmacists considered the intervention to be feasible, effective and enabled the utilisation of their skills.

Attitude of Health Personnel↗
PubMed2003

Why are patients in clinical trials of heart failure not like those we see in everyday practice?

BACKGROUND/OBJECTIVES: Evidence-based research has been criticized for not being relevant to the real world of patient care in the community, mainly because participants in research studies are dissimilar to those typically seen in every day practice. This article examines recruitment difficulties, and identifies the main reasons why patients with heart failure declined to participate in a research trial. METHODS: Postal survey of potential trial participants (n=667), at time of recruitment. Analysis of (1) clinical and sociodemographic characteristics of respondents and nonrespondents to survey, and decliners and consenters to participation in a randomized controlled trial. RESULTS: No significant differences were found between respondents and nonrespondents in respect to sociodemographic or clinical variables. Males (OR=1.58, CI=1.04-2.41), younger patients (OR=1.05, CI=1.03-1.08), and those prescribed an angiotensin converting enzyme (ACE) inhibitor (OR=1.68, CI=1.10-2.57) were significantly more likely to consent to participate. Main reasons for nonparticipation were perceptions of being too old, too unwell, or too busy. CONCLUSIONS: Explanations of the purpose of research need to counter against perceptions among participants and clarify the benefits and disadvantages of participating in an intervention study when unwell. Study design should recognize that many elderly patients have busy lives and caring responsibilities. Financial support for participation should be considered.

Aged↗
PubMed2002

Exercise training and heart failure: a systematic review of current evidence.

Chronic heart failure (CHEF) is a growing public health problem. Current guidelines provide detailed information regarding pharmacotherapy but little guidance about the value of exercise/cardiac rehabilitation programmes for individuals with this condition. To investigate the effects of exercise training upon CHF patients, a systematic literature review was carried out of trials (from 1966 to December 2000) which used as their main outcome measures the effects of exercise training upon: (a) physical performance; or (b) quality of life; or (c) morbidity/mortality. Databases searched include: MedLine; Science Citation Index; Social Sciences Citation Index; BIDS, Bandolier; Cochrane Database of Systematic Reviews (CDSR); NHS National Research Register (NRR); and Current Research in Britain (CRIB). Relevant bibliographic references from identified articles were also reviewed. Thirty-one trials were identified, comprising randomised controlled trials (RCTs) (14/31), randomised crossover trials (8/31), non-RCTs (2/31), and pre-test/post-test (7/31). Sample sizes were: 25 participants or fewer (20/31); 26 to 50 participants (7/31); 51 to 150 participants (4/31). Participants were predominantly younger with a mean age in 23/31 studies of 65 years or less, and male. Patients with comorbidities were often excluded. Positive effects were reported on physical performance (27/31), quality of life (11/16), mortality (1/31), and readmission rates (1/31). No cost-effectiveness analyses were identfied. We conclude that short-term physical exercise training in selected subgroups of patients with CHF has physiological benefits and positive effects on quality of life. This review highlights the continuing problem of clinical trials that include participants who are not representative of the general population of CHF patients seen in primary care. Further investigation of the utility and applicability of exercise training is essential.

Adult↗
PubMed2002

What do we know about socioeconomic status and congestive heart failure? A review of the literature.

OBJECTIVE: To examine and assess the available literature concerning the effects of socioeconomic status (SES) and congestive heart failure (CHF). STUDY DESIGN: We examined electronic databases, including: MEDLINE, EMBASE, Social Science Citation Index, Science citation index, the Cochrane Database, and Bandolier. We hand searched recent copies of appropriate journals and scrutinized lists of identified papers. The search terms we used included "heart failure," "cardiac failure," "ventricular dysfunction," "social class," "socioeconomic," "poverty," and "deprivation." Two reviewers independently examined and selected papers for inclusion. A standardized data collection form was used for data extraction. OUTCOMES MEASURED: We measured (1) prevalence; (2) differences in care (eg, use of diagnostic tests); (3) morbidity (eg, health care use); and (4) mortality. DATA SOURCES: We examined all English-language abstracts or papers concerning human research related to the subject of SES and CHF, including all clinical trials, reviews, discussion papers, and editorials. RESULTS: Only 8 clinical studies were identified that specifically examined aspects of the relationship between socioeconomic status and CHF. Key themes included increased hospitalization rates with increasing social deprivation; lower income inversely associated with being placed on a waiting list for transplantation; and that those of lower socioeconomic status had a greater severity of illness on admission. CONCLUSIONS: There is a paucity of generalizable high-quality research in this subject area. Crucial issues not addressed include the effects, if any, of socioeconomic status on the behaviors of health care providers. Further investigation, with a more holistic approach, is necessary to inform future intervention strategies aimed at reducing excess mortality from CHF.

Health Services↗