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Ian Harvey

Publications and source records attributed to Ian Harvey.

At least 19 recordsLinked to original sources
PubMed2006

A pragmatic, unblinded randomised controlled trial comparing an occupational therapy-led lifestyle approach and routine GP care for panic disorder treatment in primary care.

BACKGROUND: Treated anxiety increased in the UK by over 30% since 1994. Medication and psychological treatment is most common, but outcomes are sometimes poor, with high relapse rates. Lifestyle has a potential role in treatment, but is not considered in clinical guidelines. Panic disorder is potentially influenced by lifestyle factors. METHODS: 16 week unblinded pragmatic randomised controlled trial in 15 East of England primary care practices (2 Primary Care Trusts). Participants met DSM-IV criteria for panic disorder with/without agoraphobia. Follow-up at 20 weeks and 10 months. Control arm, unrestricted routine GP care. Trial Arm, Occupational therapy-led lifestyle treatment comprising: lifestyle review of fluid intake, diet pattern, exercise, caffeine, alcohol and nicotine; negotiation of positive lifestyle changes; monitoring and review of impact of changes. PRIMARY OUTCOME MEASURE: Beck Anxiety Inventory. DATA ANALYSIS: Intention-to-treat analysis provided between-group comparisons using analysis of co-variance. Bonferroni method to adjust p-values. RESULTS: From 199 referrals, 36 GP care and 31 lifestyle arm patients completed to final follow-up. Significantly lower lifestyle arm BAI scores at 20 weeks (p<0.001), non-significant (p=0.167) at 10 months after Bonferroni correction. 63.6% lifestyle arm, and 40% GP arm patients (p=0.045) panic-free at 20 weeks; 67.7% and 48.5% (p=0.123) respectively at 10 months. LIMITATIONS: Final study size/power calls for caution in interpreting findings. CONCLUSIONS: A lifestyle approach may provide a clinically effective intervention at least as effective as routine GP care, with significant improvements in anxiety compared with routine GP care at the end of treatment. Further study is required before suggesting practice changes.

Adolescent↗
PubMed2006

The prevalence of problem drug misuse in a rural county of England.

Previous capture-recapture studies have estimated the prevalence of problem drug misuse in urban areas. This study estimates the prevalence in a rural county, Norfolk, using data from four sources: drug treatment agencies, probation, the arrest referral service, and police (drug-related crime with/without acquisitive crime). Careful consideration was given to methods of matching datasets and sensitivity analyses involved altering matching rules and postcode criteria. Whilst it is recognised that acquisitive crime is often related to drug use, this is the first capture-recapture study to incorporate acquisitive crime data. In further sensitivity analyses the proportion of acquisitive crime assumed to be drug-related was varied from 25-60%. The main analysis provided an estimated prevalence of problem drug use in Norfolk of 2.05% (95% confidence interval: 1.66%-2.56%) for ages 15-54 years, considerably higher than the 1.1% currently suggested for the UK. Sensitivity analyses based on varied matching and postcode criteria produced estimates ranging from 2.41%-3.37%, suggesting our estimate may be conservative. Sensitivity analyses assuming that 25-60% of acquisitive crimes were drug-related, produced estimates ranging from 2.02% to 5.73%, further supporting our main analysis. In conclusion, this study provides evidence that problem drug misuse is more prevalent in this rural population than previously thought.

Adolescent↗
PubMed2006

Crack/cocaine use in a rural county of England.

Crack/cocaine use is an increasing problem in the UK. This study is the first to ascertain the magnitude of the crack/cocaine problem in a rural county of the UK and to determine users' needs for treatment services. A questionnaire on drug dependence and risk behaviour was completed by 306 users of drug treatment services, and focus groups were conducted with 45 self-selected crack/cocaine users. It is estimated that 31% (95% C.I., 26% to 37%) of drug users in treatment services have moderate/severe dependence on crack/cocaine. Factors associated with severe crack/cocaine dependence are severe dependence on benzodiazepines, increasing number of drugs used, engaging in sex work and non-white ethnicity. Those with severe dependence have a higher prevalence of hepatitis B and C compared with those with moderate or no dependence. All focus group participants describe a frenzied drug life so when entering treatment they require additional support to give structure to their lives to prevent relapse. Current service provision appears not to provide help to crack/cocaine users. Given the lack of pharmacological treatment, programmes should incorporate a wide range of activities and interventions to provide structure to clients' lives. Learning from ex-users was perceived as an important component of treatment.

Adult↗
PubMed2006

Atomic resolution crystal structures, EXAFS, and quantum chemical studies of rusticyanin and its two mutants provide insight into its unusual properties.

Rusticyanin from the extremophile Thiobacillus ferrooxidans is a blue copper protein with unusually high redox potential and acid stability. We present the crystal structures of native rusticyanin and of its Cu site mutant His143Met at 1.27 and 1.10 A, respectively. The very high resolution of these structures allows a direct comparison with EXAFS data and with quantum chemical models of the oxidized and reduced forms of the proteins, based upon both isolated and embedded clusters and density functional theory (DFT) methods. We further predict the structure of the Cu(II) form of the His143Met mutant which has been experimentally inaccessible due to its very high redox potential. We also present metrical EXAFS data and quantum chemical calculations for the oxidized and reduced states of the Met148Gln mutant, this protein having the lowest redox potential of all currently characterized mutants of rusticyanin. These data offer new insights into the structural factors which affect the redox potential in this important class of proteins. Calculations successfully predict the structure and the order of redox potentials for the three proteins. The calculated redox potential of H143M ( approximately 400 mV greater than native rusticyanin) is consistent with the failure of readily available chemical oxidants to restore a Cu(II) species of this mutant. The structural and energetic effects of mutating the equatorial cysteine to serine, yet to be studied experimentally, are predicted to be considerable by our calculations.

Azurin↗
PubMed2006

A comparison of the pattern of occurrence of breast cancer in Nigerian and British women.

Studies have suggested a predominance of premenopausal breast cancer in black compared to white women. The aim of the study was to compare the age specific incidence of breast cancer in Nigerian and British women. The mean age at presentation was 43.1 and 64 years for Jos (Nigeria) and Norfolk (United Kingdom), respectively. The age specific incidence rates were higher in women above 50 years compared to women less than 50 years of age in both populations. The odds of having breast cancer for women aged less than 50 years is 3.0 times higher in Norfolk (95% Confidence Interval 2.0-4.4) than Jos and 9.0 times higher for women over 50 years of age in Norfolk (95% Confidence Interval 5.3-18.3) than Jos. The age specific incidence rates are higher for postmenopausal women in both populations; with higher rates for all age groups in the United Kingdom population.

Adolescent↗
PubMed2006

Statistical methods for analysing Barthel scores in trials of poststroke interventions: a review and computer simulations.

BACKGROUND AND PURPOSE: Arguments persist as to whether parametric or non-parametric methods should be used to analyse ordinal data in trials. This paper aims to assess methods used for presenting and analysing an ordinal scale, the Barthel Index, in trials of poststroke interventions. METHODS: All randomized controlled trials (RCTs) of poststroke interventions published from 1995 to 2004 in two journals (Stroke and Clinical Rehabilitation) were scrutinized for methods used to present and analyse Barthel scores. Computer simulations were used to compare the type I errors and the statistical power of different statistical methods under a range of assumed circumstances. RESULTS: One hundred and fifty-six RCTs were identified within the two journals. The central tendency of Barthel scores was measured by the median in 47 trials and by the mean in 35 trials. Non-parametric analyses of Barthel scores were conducted in 47 trials and parametric methods used in 18 trials. The results of computer simulations demonstrate that the t-test has a similar type I error rate and statistical power when compared with the rank sum test. However, when a zero final Barthel score is assigned to patients who have died, the statistical power of the t-test is much reduced. The possible maximal statistical power of dichotomization and ordinal regression is usually much lower than that of the rank sum test. CONCLUSIONS: To facilitate comparison and meta-analysis, we recommend that mean values (with standard deviations or standard errors) of Barthel scores should be routinely reported in trials of poststroke interventions. The rank sum test appears the most powerful inferential technique for detecting differences in Barthel scores.

Computer Simulation↗
PubMed2005

The index of multiple deprivation 2000 access domain: a useful indicator for public health?

The access domain of the UK index of multiple deprivation (IMD) 2000 was designed to identify populations in small areas with poor geographical access to certain local key services. The measure is a composite of straight line distances to post offices, large food shops, primary schools and general practice surgeries for population sub-groups. Using the region of East Anglia as a case study area, this research evaluated the utility of the IMD2000 as an indicator of access to primary care. IMD2000 access scores for electoral wards were compared with a range of more detailed indicators of travel times and bus availability for visiting a general practitioner generated in a geographical information system (GIS). A range of easy-to-calculate surrogate variables was developed and tested as possible candidates to improve the explanatory power of the IMD2000 access score. The access domain was negatively correlated with the other five deprivation domains that comprise the overall index, suggesting that access should not be combined with the other measures of deprivation into a composite single score. The access domain was also found to predict access to primary care only with moderate accuracy. Two additional indicators of accessibility calculated in a GIS (road kilometres per thousand population and the presence of a major road in each ward) were found to add slightly to the power of the index. The predictive power of the index was best in urban areas, although it is in rural areas that access to primary care is a more important public health issue. The IMD2000 should be therefore used with caution as a measure of health service accessibility in rural areas.

Catchment Area, Health↗
PubMed2005

Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial.

OBJECTIVE: To determine whether home based medication review by pharmacists affects hospital readmission rates among older people. DESIGN: Randomised controlled trial. SETTING: Home based medication review after discharge from acute or community hospitals in Norfolk and Suffolk. PARTICIPANTS: 872 patients aged over 80 recruited during an emergency admission (any cause) if returning to own home or warden controlled accommodation and taking two or more drugs daily on discharge. INTERVENTION: Two home visits by a pharmacist within two weeks and eight weeks of discharge to educate patients and carers about their drugs, remove out of date drugs, inform general practitioners of drug reactions or interactions, and inform the local pharmacist if a compliance aid is needed. Control arm received usual care. MAIN OUTCOME MEASURE: Total emergency readmissions to hospital at six months. Secondary outcomes included death and quality of life measured with the EQ-5D. RESULTS: By six months 178 readmissions had occurred in the control group and 234 in the intervention group (rate ratio = 1.30, 95% confidence interval 1.07 to 1.58; P = 0.009, Poisson model). 49 deaths occurred in the intervention group compared with 63 in the control group (hazard ratio = 0.75, 0.52 to 1.10; P = 0.14). EQ-5D scores decreased (worsened) by a mean of 0.14 in the control group and 0.13 in the intervention group (difference = 0.01, -0.05 to 0.06; P = 0.84, t test). CONCLUSIONS: The intervention was associated with a significantly higher rate of hospital admissions and did not significantly improve quality of life or reduce deaths. Further research is needed to explain this counterintuitive finding and to identify more effective methods of medication review.

Aftercare↗
PubMed2005

Geographical distribution of road traffic deaths in England and Wales: place of accident compared with place of residence.

BACKGROUND: There are two sources of information on road traffic mortality in England and Wales: ONS records giving the place of residence and police records giving the place of the accident. Use of the police records has been limited by the lack of an obvious denominator to control for population at risk. This study compares the two measures and explores the implications of using the same population denominator for both. METHODS: The number of road traffic deaths occurring in 403 local authority districts in England and Wales during 1995-1999 was compared to the number of deaths to residents in the same period. Both numbers were related to the expected number of deaths to residents and selected environmental risk factors using regression techniques. RESULTS: Large differences were found between the number of deaths in each district and the number of deaths to residents. The expected number of deaths to residents was the strongest predictor of both observed totals. The number of deaths in the district and the number divided by expected deaths of residents were highly predictable from road accident risk factors, but the number of deaths to residents and the conventional SMR were not. CONCLUSION: Information on the place of residence of road traffic accident fatalities does not show true variations in accident risk. Police records are better for this purpose. The expected number of deaths to residents estimate provides a partial but effective and unbiased control for population effects.

Accidents, Traffic↗
PubMed2004

Occupational therapy compared with social work assessment for older people. An economic evaluation alongside the CAMELOT randomised controlled trial.

OBJECTIVES: To compare costs and outcome of occupational therapy-led assessment with social worker-led assessment of older people, in terms of their independence and quality of life. DESIGN: Cost-effectiveness analysis alongside a randomised controlled trial. The analysis took viewpoints of health services and patients. The primary outcome measure for cost-effectiveness was dependency using the Community Dependency Index (CDI). Secondary outcomes included utility scores based on the EuroQoL (EQ-5D). Resource use was measured for each patient, from clinical records and from patient carer interviews at 8 months. Unit costs of health and social care resources were derived from local sources and national datasets. Cost-effectiveness was analysed using cost-effectiveness acceptability curves. RESULTS: There were no differences between the two arms of the trial in terms of cost-effectiveness. There is an apparent increase in mean cost per case for the occupational therapy arm but this is not statistically significant (mean difference in cost per case 542 pounds, 95% CI 434-1,519 pounds). Mean total costs of care per participant were 4,379 pounds and 3,837 pounds for the occupational therapy and social work arms, respectively. At best the intervention would improve outcomes at a cost of 14,000 pounds per quality-adjusted life year (QALY). The probability of such an outcome was <50%. CONCLUSIONS: From a policy perspective, the lack of difference in clinical and cost-effectiveness means that either a social work or an occupational therapy service is successful in making care assessments that enable an older person to remain in their own home.

Aged↗
PubMed2004

Factors affecting feasibility and acceptability of a practice-based educational intervention to support evidence-based prescribing: a qualitative study.

BACKGROUND: Inappropriate and costly GP prescribing is a major problem facing Primary Care Trusts. Educational outreach into practices, alongside other measures, such as audit and feedback, have the potential to enable GP prescribing to become more evidence based. High GP prescribing costs are associated with GPs who see drug company representatives; tend to end consultations with prescriptions; and 'try out' new drugs on an 'ad hoc basis' and use this as evidence of the drug's effect. An educational intervention called 'reflective practice' was developed to meet these and other educational needs. The design of the intervention was informed by studies that have identified the pre-requisites of successful behaviour change in general practice. OBJECTIVES: The study investigated the following: (i) Is it feasible for GPs to attend the sessions included in the educational intervention? (ii) Is the intervention acceptable to the participants and the session facilitators? (iii) What are the barriers to the group educational processes, and how can these be overcome? METHODS: Four practices were recruited in South West England, all of them experiencing problems with prescribing appropriateness and cost. Reflective practice sessions (including a video-taped scenario) were run in each of these practices and qualitative methods were used to explore the complex attitudes and behaviour of the participants. A researcher observed and audio-taped sessions in each practice. At the end of the programme, a sample of doctors and all the facilitators were interviewed about their experiences. The recorded data were transcribed and analysed using standard qualitative methods. RESULTS: The doctors in the largest partnerships were those who had the greatest difficulty in attending the sessions. Elsewhere, doctors were also reluctant to become involved because of previous experience of top-down managerial initiatives about prescribing quality. Facilitators came from a broad range of professional backgrounds. While knowledge of prescribed drug management issues was important, the professional background of the facilitator was less important than group facilitation skills in creating a group process which participating GPs found satisfactory. The video-taped scenario was found to be useful to set the scene for the discussion. Preserving the anonymity of responses of the GPs in the initial stages of the sessions was important in ensuring honesty in the discussion. Reaching a consensus on management of common conditions was sometimes difficult, partly because the use of the term 'best buy' implies economic pressures, rather than benefits to patients, and partly because of the value with which GPs regard the concept of clinical autonomy. 'Reflective Practice' appeared to have the potential to make GPs aware of the link to be made between their clinical management decisions and the evidence provided by the British National Formulary and Clinical Evidence. CONCLUSION: The study indicates the importance of preparing the practice adequately, including providing protected time for all GPs to attend the educational intervention. Scenarios and the structure of the sessions need to make more explicit the links between everyday practice and published evidence of effectiveness. Emphasis on cost-effectiveness may be counterproductive and wider benefits need to be emphasized. We have also identified the skill profile of the facilitator role. Our study indicates a need for a clearer understanding of GPs' perception of clinical autonomy and how this conflicts with the goal of agreement on practice guidelines for treatment. The intervention is now ripe for further development, perhaps by integrating it with other interventions to change professional behaviour. The improved intervention should then be evaluated in a randomized controlled trial.

Attitude of Health Personnel↗
PubMed2004

Are occupational therapists more effective than social workers when assessing frail older people? Results of CAMELOT, a randomised controlled trial.

OBJECTIVES: To compare the effectiveness of occupational therapist-led assessments of older people on dependency and service costs with that of social worker-led assessments. DESIGN: Pragmatic community-based randomised controlled trial over 2 years 4 months. SETTING: Cambridgeshire, UK. PARTICIPANTS: 321 older people aged 65 and over living in their own homes and 113 carers. INTERVENTION: participants were randomised to two groups, to receive either occupational therapist-led or social worker-led assessment. OUTCOME MEASURES: Primary outcome was dependency (Community Dependency Index). Secondary outcomes included quality of life scores (EQ-5D) and psychological outlook (Perceived Stress Scale (PSS)). Outcome measures for carers included Carer Assessment of Difficulty Index (CADI), PSS and EQ-5D, collected at baseline, 4 and 8 months. Resource use data were collected from professional practice records, participants and carers at final follow-up. RESULTS: 264 (82%) of the randomised participants completed the study. No between-group statistically significant differences were found, except that carers in the occupational therapist arm had significantly better EQ-5D scores at the 8 month follow-up (thermometer P = 0.03) and in the social worker arm better CADI scores on stress (P = 0.047) and amount of caring (P = 0.049). CONCLUSIONS: There was no clear difference in patient-centred effectiveness measures between occupational therapists and social workers in assessing frail older people and their carers in the community. More extensive use of primary care health services by occupational therapists may have contributed to the differences in EQ-5D scores for carers. Delays in making occupational therapy assessments and in completing recommended housing adaptations may have contributed to these negative findings.

Aged↗