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Biomedical subjects

Helen Moore

Publications and source records attributed to Helen Moore.

16 recordsLinked to original sources
PubMed2006

Conducting randomised controlled trials in primary care: lessons from an obesity management trial.

BACKGROUND: A UK trial ending in 2002 reported that a training intervention to improve the management of obesity in primary care had no impact. Process analysis showed that the intervention was taken up by very few of the practitioners in the participating practices. AIM: The aim of the current study was to explore both the reasons behind low levels of implementation and the context in which the trial was delivered. DESIGN: In-depth qualitative interviews. SETTING: General practices in the North East of England. METHOD: Interviews with 13 practitioners (GPs and practice nurses) and 10 patients, representing seven of the eight intervention practices in the largest centre of the original trial. RESULTS: While patients were clear that they had participated in a trial few of those interviewed had any recollection of the intervention. Most staff were positive about the training, resources to use with patients and the weight management model, but not all training needs were met. High initial expectations of the trial gave way to disillusionment, exacerbated by significant misunderstanding by some practice staff of their role in implementation. CONCLUSIONS: Frustration among practitioners managing obesity in primary care combined with unrealistic expectations of and misunderstanding about an intervention designed to improve care in the field, appeared to have resulted in disillusionment with and consequent disengagement from the trial.

Attitude of Health Personnel↗
PubMed2005

Laying foundations for health: food provision for under 5s in day care.

This study investigated the food offered to children under 5 years of age in UK day care, the influence of the childcare providers on a child's diet and their attitudes towards this role. A postal survey of a randomised quota sample of childcare providers enquired after the range of food on offer and explored attitudes towards the role of food in health and the role of promoting health. Themes emerging from these data were explored by in-depth interviews with a sample of 18 childcare providers and 7 Local Authority Early Years Service staff. We received 194 (56%) responses to 345 copies of the questionnaire. Half (46%) of nurseries and 23% of childminders provided a fruit or vegetable with the main meal 5 days a week. Only 14% of nurseries and 21% of childminders provided a dairy food (i.e. calcium-rich) at the main meal every day. Almost all the childcare providers saw themselves as responsible for promoting healthy diet, but it was rare for them to have had any formal training in nutrition, while current dietary guidance was perceived as too vague to be useful. The study also highlighted tensions on the issue of food provision between those delivering childcare and parents; further research should explore the parents' perspectives. Nursery staff and childminders should have access to carefully designed advice on nutritionally appropriate food and drink services for under-fives.

Attitude↗
PubMed2004

A mathematical model for chronic myelogenous leukemia (CML) and T cell interaction.

In this paper, we propose and analyse a mathematical model for chronic myelogenous leukemia (CML), a cancer of the blood. We model the interaction between naive T cells, effector T cells, and CML cancer cells in the body, using a system of ordinary differential equations which gives rates of change of the three cell populations. One of the difficulties in modeling CML is the scarcity of experimental data which can be used to estimate parameters values. To compensate for the resulting uncertainties, we use Latin hypercube sampling (LHS) on large ranges of possible parameter values in our analysis. A major goal of this work is the determination of parameters which play a critical role in remission or clearance of the cancer in the model. Our analysis examines 12 parameters, and identifies two of these, the growth and death rates of CML, as critical to the outcome of the system. Our results indicate that the most promising research avenues for treatments of CML should be those that affect these two significant parameters (CML growth and death rates), while altering the other parameters should have little effect on the outcome.

Cell Death↗
PubMed2003

Improving management of obesity in primary care: cluster randomised trial.

OBJECTIVE: To evaluate a training programme intended to improve the management of obesity, delivered to general practice teams. DESIGN: Cluster randomised trial. SETTING: Northern and Yorkshire region of England. PARTICIPANTS: 44 general practices invited consecutively attending obese adults to participate; 843 patients attended for collection of baseline data and were subsequently randomised. INTERVENTION: 4.5 hour training programme promoting an obesity management model. MAIN OUTCOME MEASURES: Difference in weight between patients in intervention and control groups at 12 months (main outcome measure) and at 3 months and 18 months; change in practitioners' knowledge and behaviour in obesity management consultations. RESULTS: Twelve months after training the patients in the intervention group were 1 (95% confidence interval--1.9 to 3.9) kg heavier than controls (P = 0.5). Some evidence indicated that practitioners' knowledge had improved. Some aspects of the management model, including recording weight, target weight, and dietary targets, occurred more frequently in intervention practices after the training, but in absolute terms levels of implementation were low. CONCLUSION: A training package promoting a brief, prescriptive approach to the treatment of obesity through lifestyle modification, intended to be incorporated into routine clinical practice, did not ultimately affect the weight of this motivated and at risk cohort of patients.

Adolescent↗
PubMed2003

Prognostic significance of quantitative analysis of WT1 gene transcripts by competitive reverse transcription polymerase chain reaction in acute leukaemia.

We have developed a sensitive, competitive, nested reverse transcription polymerase chain reaction (RT-PCR) titration assay that quantifies the number of Wilm's tumour (WT1) gene transcripts in bone marrow (BM) and peripheral blood (PB), coupled with a competitive RT-PCR protocol for the ABL gene as control. We studied BM/PB samples from 107 acute myeloid leukaemia (AML) patients and 22 acute lymphoblastic leukaemia (ALL) patients at presentation and detected the WT1 gene in > 90% of patients by a qualitative assay. Quantitative analysis of WT1 transcript at presentation in 66 patients (52 AML, 14 ALL) correlated significantly with remission rate, disease-free survival (DFS) and overall survival (OS) (P = 0.003). WT1 levels were normalized to 105ABL transcripts. Within good and standard cytogenetic risk groups, high WT1 levels correlated with poorer outcome. Serial quantification was performed in 35 patients (28 AML, seven ALL); those with less than 103 copies of WT1 after induction and second consolidation chemotherapy had significantly better DFS and OS. Fourteen patients have relapsed with a median complete remission duration of 12 (range 4-49) months. We detected a rise in WT1 levels in nine out of 14 patients, 2-4 months before the onset of haematological relapse, whereas in the remaining five patients, WT1 levels remained persistently high during the disease course. WT1 levels were lower in PB than in BM, but mirrored changes in the BM samples and were equally informative. We suggest that WT1 is a useful molecular target to monitor minimal residual disease in acute leukaemia, especially in cases without a specific fusion gene.

Adolescent↗
PubMed2003

Searching the evidence: the clinically-effective nutritionist.

As a clinically-effective nutritionist faced with needing to find the answer to a clinical question quickly it is necessary to search the best evidence efficiently. The requirements are to: (1) avoid having lots of papers to read; (2) be able to access this information at one's place of work; (3) restrict reading to trials and systematic reviews of trials. If a decision has to be made while on the ward, the best resource is probably an easy-to-use book, Clinical Evidence. This resource is also available on-line, but there may not be access to the Internet on the ward. If a little more time is available, and access to the Internet, the following plan is suggested: (1) work out what the question is and highlight the search terms; (2) using the best search engine available, search MEDLiNE from 1990 for titles and abstracts of papers containing the search terms, this is the search strategy (limit the search by publication type by requesting randomised controlled trials only, English language only and human only); (3) if more or less than approximately ten hits are obtained, alter the limits of the search (not the search strategy); (4) read the abstract, or full paper where available, of the relevant hits and appraise this evidence.

Dietetics↗
PubMed2003

A cluster randomised trial to evaluate a nutrition training programme.

BACKGROUND: The need for training to equip primary care staff with the knowledge and skills to provide dietary advice to the public has been acknowledged. Little is known about the effectiveness of such training at improving the dietary counselling skills of multidisciplinary practice teams. AIM: To evaluate the effectiveness of a nutrition training programme, delivered to primary care teams by a dietitian. DESIGN OF STUDY: A paired-cluster randomised trial. SETTING: Twelve general practices in Sunderland, in the United Kingdom. METHOD: A nutrition training programme, aimed at improving the quality of dietary consultations, was developed and delivered to six primary care teams by a dietitian. Main outcome measures were patients' recall of seven key consulting behaviours. Data were collected from patients in intervention and control practices, pre- and post-intervention. Change in knowledge and attitude of practitioners was also measured. RESULTS: All 12 practices completed the trial. Data were collected from 251 patients pre-intervention and 228 patients post-intervention. Of the seven consulting behaviours targeted in the training, only the proportion of consultations where written information (diet sheets) was provided to patients was significantly higher (13% higher, 95% confidence interval [CI = 4 to 21, P = 0.004) in the intervention practices post-training. Some evidence of improved practitioner knowledge and attitude was detected. CONCLUSION: This evaluation of a nutrition training intervention detected only a limited impact on the behaviour, knowledge, and attitudes of primary care practitioners in dietary consultations.

Adult↗
PubMed2002

Nutrition interventions by primary care staff: a survey of involvement, knowledge and attitude.

OBJECTIVE: To undertake a survey to investigate the quality and format of nutrition health promotion in UK primary care. Data from both primary care practitioners - i.e. level of nutritional knowledge and attitude towards nutrition interventions - and patients - i.e. the format and quality of dietary consultations - are presented. DESIGN: A self-completion questionnaire was used to assess nutritional knowledge and attitude of primary care staff towards nutrition interventions. Data regarding the format and quality of the dietary consultation were collected from patients using a screening question and follow-up questionnaire. SETTING: Twelve general practices in a city in north-east England. SUBJECTS: One hundred and nine primary care staff, and 2400 consecutive patients recruited from the 12 practices. RESULTS: Seventy-seven per cent of primary care staff completed the questionnaire. Sixty-five per cent of the knowledge questions were answered correctly by most practitioners. Questions containing complex nutritional terminology were answered poorly. Most practitioners believed primary care teams have an essential role in giving dietary advice. Thirteen per cent of patients reported that they had discussed diet. Of these, 40% were asked to make dietary changes; 20% discussed how they cooked or prepared food; and 33% were asked to make a follow-up appointment. CONCLUSION: Encouraging signs included good levels of nutritional knowledge and belief amongst staff that they should be involved in nutrition interventions. Patients reported that they understood and felt able to achieve the dietary changes suggested. Less encouraging were little evidence of discussion about the practical aspects of food and fairly low rates of follow-up being arranged.

Attitude of Health Personnel↗