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Biomedical subjects

J Greenhalgh

Publications and source records attributed to J Greenhalgh.

12 recordsLinked to original sources
PubMed2005

Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies.

OBJECTIVES: To establish the clinical effectiveness and cost-effectiveness of electroconvulsive therapy (ECT) for depressive illness, schizophrenia, catatonia and mania. DATA SOURCES: Electronic bibliographic databases. The reference lists of relevant articles and health services research-related resources were consulted via the Internet. REVIEW METHODS: Identified studies were examined to ascertain whether they met the inclusion criteria for the review. The study quality of relevant articles was assessed using standard checklists and data were abstracted using standardised forms into a database. Where relevant, results from studies were pooled for meta-analysis. Two economic models were developed primarily based on evidence from the clinical effectiveness analysis and limited quality of life studies. RESULTS: Two good-quality systematic reviews of randomised evidence of the efficacy and safety of ECT in people with depression, schizophrenia, catatonia and mania were identified. Four systematic reviews on non-randomised evidence were also identified, although only one of these could be described as good quality. There was no randomised evidence of the effectiveness of ECT in specific subgroups including older people, children and adolescents, people with catatonia and women with postpartum exacerbations of depression or schizophrenia. The economic modelling results for depression did not demonstrate that any of the scenarios had a clear economic benefit over the others, mainly because of the uncertainty surrounding the clinical effectiveness of the different treatments and the quality of life utility gains. Sensitivity analysis surrounding the cost of ECT and the quality of life utility values had little effect on the overall results. The results of the model for schizophrenia adapted to include ECT suggest that clozapine is a cost-effective treatment compared with ECT. For patients who fail to respond to clozapine, ECT treatment may be preferred to the comparative treatment of haloperidol/chlorpromazine. CONCLUSIONS: Real ECT is probably more effective than sham ECT, but as stimulus parameters have an important influence on efficacy, low-dose unilateral ECT is no more effective than sham ECT. ECT is probably more effective than pharmacotherapy in the short term and limited evidence suggests that ECT is more effective than repetitive transcranial magnetic stimulation. Tricyclic antidepressants (TCAs) may improve the antidepressant effect of ECT during the course of treatment. Continuation pharmacotherapy with TCAs combined with lithium in people who have responded to ECT reduces the rate of relapses. Overall, gains in the efficacy of the intervention depending on the stimulus parameters of ECT are achieved only at the expense of an increased risk of cognitive side-effects. Limited evidence suggests these effects do not last beyond 6 months, but there is no evidence examining the longer term cognitive effects of ECT. There is little evidence of the long-term efficacy of ECT. ECT either combined with antipsychotic medication or as a monotherapy is not more effective than antipsychotic medication in people with schizophrenia. More research is needed to examine the long-term efficacy of ECT and the effectiveness of post-ECT pharmacotherapy, the short-term and longer term cognitive side-effects of ECT, and the impact of ECT on suicide and all-cause mortality. Further work is needed to examine the information needs of people deciding whether to accept ECT and how their decision-making can be facilitated. More research is also needed on the mechanism of action of ECT. Finally, the quality of reporting of trials in this area would be vastly improved by strict adherence to the Consolidated Standards of Reporting Trials recommendations. Economic analysis may identify areas in which research would be best targeted by identifying parameters where reducing the level of uncertainty would have the most effect in helping to make the decision on whether ECT is a cost-effective treatment.

Adolescent↗
PubMed2004

Electrical and neurotransmitter activity of mature neurons derived from mouse embryonic stem cells by Sox-1 lineage selection and directed differentiation.

Sx1TV2/16C is a mouse embryonic stem (ES) cell line in which one copy of the Sox1 gene, an early neuroectodermal marker, has been targeted with a neomycin (G418) selection cassette. A combination of directed differentiation with retinoic acid and G418 selection results in an enriched neural stem cell population that can be further differentiated into neurons. After 6-7 days post-plating (D6-7PP) most neurons readily fired tetrodotoxin (TTX)-sensitive action potentials due to the expression of TTX-sensitive Na(+) and tetraethylammonium (TEA)-sensitive K(+) channels. Neurons reached their maximal cell capacitance after D6-7PP; however, ion channel expression continued until at least D21PP. The percentage of cells receiving spontaneous synaptic currents (s.s.c.) increased with days in culture until 100% of cells received a synaptic input by D20PP. Spontaneous synaptic currents were reduced in amplitude and frequency by TTX, or upon exposure to a Ca(2+)-free, 2.5 mm Mg(2+) saline. S.s.c. of rapid decay time constants were preferentially blocked by the nonNMDA glutamatergic receptor antagonists CNQX or NBQX. Ca(2+) levels within ES cell-derived neurons increased in response to glutamate receptor agonists l-glutamate, AMPA, N-methyl-d-aspartate (NMDA) and kainic acid and to acetylcholine, ATP and dopamine. ES cell-derived neurons also generated cationic and Cl(-)-selective currents in response to NMDA and glycine or GABA, respectively. It was concluded that ES-derived neurons fire action potentials, receive excitatory and inhibitory synaptic input and respond to various neurotransmitters in a manner akin to primary central neurons.

6-Cyano-7-nitroquinoxaline-2,3-dione↗
PubMed2004

The MS Symptom and Impact Diary (MSSID): psychometric evaluation of a new instrument to measure the day to day impact of multiple sclerosis.

OBJECTIVES: This study aimed to develop further a diary originally devised to measure the impact of multiple sclerosis (MS) as part of a cost utility study of beta interferon, and to evaluate its reliability, validity, and responsiveness in an outpatient sample of people with MS. METHODS: The original diary was further developed using qualitative and quantitative methods to ensure that it addressed the views of people with MS. The psychometric properties of the MS Symptom and Impact Diary (MSSID) were evaluated in a sample of 77 people who completed the MSSID daily for 12 weeks. Internal and test-retest reliability, discriminant and convergent validity, and responsiveness were assessed using traditional psychometric methods. RESULTS: The MSSID formed three, internally consistent scales that measured mobility, fatigue, and the overall impact of MS. The test-retest reliability of the mobility scale was adequate for individual comparisons (ICC>0.90) and the fatigue and overall impact scales were adequate for group comparisons (ICC>0.70). The MSSID was able to distinguish between clinical groups depending on clinical course, indoor ambulation status, and relapse status. It demonstrated associations with other single point instruments in the expected direction. Compared with single point instruments, its responsiveness was similar or better, especially in detecting short term improvements in functioning. CONCLUSIONS: The MSSID may provide a useful complement to currently available instruments to measure the outcomes of MS within clinical trials. Further research is needed to explore its feasibility in the context of a randomised controlled trial and its utility for clinicians.

Activities of Daily Living↗
PubMed2000

Selecting a mental health needs assessment scale: guidance on the critical appraisal of standardized measures.

The assessment of need has become a central element of the NHS policy on mental health care. Despite the importance placed on a needs-led mental health service, little guidance has been provided as to the most appropriate means of assessing need. The use of standardized instruments can facilitate a systematic approach to the needs assessment process. However, available mental health needs assessment scales (MHNAS) vary considerably. Care is required to ensure that the scale selected is appropriate to the proposed purpose. This paper presents practical guidance on instrument selection for potential users of MHNAS including: (1) a review of the key issues to be considered when selecting an assessment scale, (2) a critical appraisal checklist for use in the review of needs assessment scales, and (3) a comparative analysis of three of the most commonly cited needs assessment scales. In addition, recommendations are made of ways to improve both the accessibility of MNHAS and to facilitate their appraisal prior to application in a clinical or research setting.

Health Care Surveys↗
PubMed1999

The effectiveness of the use of patient-based measures of health in routine practice in improving the process and outcomes of patient care: a literature review.

Despite a number of potential benefits to both the clinician and the patient, patient-based measures of health have not been routinely or systematically used within routine practice by clinicians in the care of individual patients. There are a number of practical, methodological and attitudinal barriers which have so far limited the use of patient-based measures of health within routine practice. The extent to which these barriers are overcome is likely to influence the effectiveness of such instruments in improving the process and outcomes of patient care. This study reviewed the evidence for the effectiveness of this intervention and identified some of the factors that may influence its effectiveness. Thirteen relevant studies were located using search strategies on three computerized databases for 1987-97. The study found that clinicians see information from patient-based measures of health as valuable in the overall assessment of the patient and that its feedback to clinicians increases the detection of psychological and, to a lesser extent, functional problems. However, there was little evidence to suggest their use substantially changed patient management or improved patient outcomes. Our findings suggest that the ways in which patient based measures of health are implemented in routine practice may have an impact on their effectiveness. It is recommended that implementation strategies that are guided by theories of individual and organizational change might allow the barriers to using patient-based measures of health in routine practice to be identified and overcome more effectively.

Health Services Research↗
PubMed1998

Nurse caring behaviours.

The purpose of this research paper is to examine caring behaviours and how they relate to nurses practice from the psychiatric and general nurses' views. Whether this caring is influenced by the nurses' age, gender or qualification is also examined. The convenience sample used were nurses (n = 118) of all grades and experience in a general hospital and in a psychiatric hospital. The Care-Q instrument was used. The response rate was 66%. Statistical analysis included rankings of sub-scale and individual items and the chi-square test of association. The results show that nurses ranked physically based caring behaviours higher than affective behaviours. They emphasized monitoring and comforting behaviours but paid less attention to anticipatory behaviours. Gender appeared to have the greatest influence on what caring behaviours were valued. Male nurses were less likely than female nurses to be accessible, forming trusting relationships or performing comforting behaviours. The results challenge both nurses and nurse educators to examine caring behaviours in nursing practice.

Adult↗
PubMed1998

Reviewing and selecting outcome measures for use in routine practice.

For the successful achievement of evidence-based practice, clinicians, managers and purchasers need evidence on whether a particular intervention works and ways to judge the appropriateness of the outcome criteria and measures used. Guidance is needed on what outcome measure to use, especially within routine clinical care settings. Beginning with a reclarification of the difference between a health status and an outcome measure, the paper presents an evaluative checklist for use by clinical audit and research staff to review outcome measures for use in routine care settings. Central features include the user-centredness of the measure, its psychometric properties, feasibility of use and utility. The applicability of the checklist is illustrated for outcome measurement in diabetes and stroke care. A modified form of the checklist is proposed for use by the busy clinician as an aid to the critical review of research papers within the context of evidence-based practice and to aid health care practitioners' choice of which outcome measure(s) to use within routine clinical care.

Cerebrovascular Disorders↗
PubMed1998

Searching for information on outcomes: do you need to be comprehensive?

The concepts of evidence-based practice and clinical effectiveness are reliant on up to date, accurate, high quality, and relevant information. Although this information can be obtained from a range of sources, computerised databases such as MEDLINE offer a fast, effective means of bringing up to date information to clinicians, as well as health service and information professionals. Common problems when searching for information from databases include missing important relevant papers or retrieving too much information. Effective search strategies are therefore necessary to retrieve a manageable amount of relevant information. This paper presents a range of strategies which can be used to locate information on MEDLINE efficiently and effectively.

Data Collection↗
PubMed1997

Doctors' perceptions of the links between stress and lowered clinical care.

We know from numerous industrial studies that stress, particularly in the form of tiredness and sleep deprivation, has a detrimental effect upon work performance, though this is not so clear-cut in studies of doctors, despite their stress levels being particularly high. This study explores the doctors' views on this using anonymous questionnaires from a population of 225 hospital doctors and general practitioners, 82 of whom reported recent incidents where they considered that symptoms of stress had negatively affected their patient care. The qualitative accounts they gave were coded for the attribution (type of stress symptom) made, and the effect it had. Half of these effects concerned lowered standards of care; 40% were the expression of irritability or anger; 7% were serious mistakes which still avoided directly leading to death; and two resulted in patient death. The attributions given for these were largely to do with tiredness (57%) and the pressure of overwork (28%), followed by depression or anxiety (8%), and the effects of alcohol (5%). The data are discussed in terms of the links made by the doctors between their fatigue or work pressure and the way they care for patients. It presumes that these incidents had been previously unreported and talks about the effects this secrecy has on the emotional state of the doctors concerned. It offers ways forward for tackling the problem, of interest to the profession, managers and commissioners.

Alcohol Drinking↗
PubMed1996

The value of an outcomes information resource. An evaluation of the UK Clearing House on Health Outcomes.

Reports on the first phase of an evaluation of the UK Clearing House on Health Outcomes (UKCHHO) undertaken by a sample survey of purchasers and providers on its mailing list and users of its enquiry service. Explores user satisfaction with the services and publications of the project, uses made of the information provided and perceptions of the future role of a UKCHHO. Reports overwhelming satisfaction with the enquiry service and agreement about the usefulness of Outcomes Briefing. States that the main areas of use for the information provided were within clinical audit, guidelines and the exploration of outcomes within routine clinical practice. Also that the findings provide evidence of the need for an expanded brief for a UKCHHO, to include the provision of an enquiry service on study design and demonstrations of the value of the collection of outcomes data. Notes there is an urgent need to show that the systematic collection and use of outcomes data makes a difference to the quality of care provided to patients and to the purchase of services.

Attitude↗
PubMed1984

Correlates of difficult temperament in infancy.

Despite interest in the construct of "difficult temperament" in infancy, little is known about its correlates within the first 2 years of life. In a study of 272 families consisting of 152 adopted and 120 nonadopted infants tested in their homes at 12 and 24 months of age, a parental report of difficult temperament was related to 3 major areas of correlates: (1) infant functioning (parental ratings of temperament, tester ratings using Bayley's Infant Behavior Record, and Bayley Mental Index scores); (2) parental personality (Cattell's 16PF test and a self-report temperament inventory); and (3) measures of the home environment (Home Observation for Measurement of the Environment and the Family Environment Scales). No systematic significant relationships were found between difficult temperament and other aspects of infant development, parental characteristics, or the home environment for the entire sample or for a subsample consisting of the 10% most difficult infants. In addition, we found no evidence for significant interactions between parental personality and home environment as they affect difficult temperament nor did interactions of any type emerge as significant. Taken together with other evidence indicating that difficult temperament in infancy fails to predict concurrent or later behavioral problems, these data add to growing doubts about the utility of the construct of difficult temperament and suggest the need to consider specific infant temperaments that parents find difficult.

Adoption↗