PubMed Health⌕ Search

Biomedical subjects

Jeremy Dale

Publications and source records attributed to Jeremy Dale.

10 recordsLinked to original sources
PubMed2006

A psychological approach to providing self-management education for people with type 2 diabetes: the Diabetes Manual.

BACKGROUND: The objectives of this study were twofold (i) to develop the Diabetes Manual, a self-management educational intervention aimed at improving biomedical and psychosocial outcomes (ii) to produce early phase evidence relating to validity and clinical feasibility to inform future research and systematic reviews. METHODS: Using the UK Medical Research Council's complex intervention framework, the Diabetes Manual and associated self management interventions were developed through pre-clinical, and phase I evaluation phases guided by adult-learning and self-efficacy theories, clinical feasibility and health policy protocols. A qualitative needs assessment and an RCT contributed data to the pre-clinical phase. Phase I incorporated intervention development informed by the pre-clinical phase and a feasibility survey. RESULTS: The pre-clinical and phase I studies resulted in the production in the Diabetes Manual programme for trial evaluation as delivered within routine primary care consultations. CONCLUSION: This complex intervention shows early feasibility and face validity for both diabetes health professionals and people with diabetes. Randomised trial will determine effectiveness against clinical and psychological outcomes. Further study of some component parts, delivered in alternative combinations, is recommended.

Adult↗
PubMed2006

The Diabetes Manual trial protocol - a cluster randomized controlled trial of a self-management intervention for type 2 diabetes [ISRCTN06315411].

BACKGROUND: The Diabetes Manual is a type 2 diabetes self-management programme based upon the clinically effective 'Heart Manual'. The 12 week programme is a complex intervention theoretically underpinned by self-efficacy theory. It is a one to one intervention meeting United Kingdom requirements for structured diabetes-education and is delivered within routine primary care. METHODS/DESIGN: In a two-group cluster randomized controlled trial, GP practices are allocated by computer minimisation to an intervention group or a six-month deferred intervention group. We aim to recruit 250 participants from 50 practices across central England. Eligibility criteria are adults able to undertake the programme with type 2 diabetes, not taking insulin, with HbA1c over 8% (first 12 months) and following an agreed protocol change over 7% (months 13 to 18). Following randomisation, intervention nurses receive two-day training and delivered the Diabetes Manual programme to participants. Deferred intervention nurses receive the training following six-month follow-up. Primary outcome is HbA1c with total and HDL cholesterol; blood pressure, body mass index; self-efficacy and quality of life as additional outcomes. Primary analysis is between-group HbA1c differences at 6 months powered to give 80% power to detect a difference in HbA1c of 0.6%. A 12 month cohort analysis will assess maintenance of effect and assess relationship between self-efficacy and outcomes, and a qualitative study is running alongside. DISCUSSION: This trial incorporates educational and psychological diabetes interventions into a single programme and assesses both clinical and psychosocial outcomes. The trial will increase our understanding of intervention transferability between conditions, those diabetes related health behaviours that are more or less susceptible to change through efficacy enhancing mechanisms and how this impacts on clinical outcomes.

Adult↗
PubMed2006

Values-based practice in primary care: easing the tensions between individual values, ethical principles and best evidence.

BACKGROUND: The provision of health care is inseparable from universal values such as caring, helping and compassion. Consideration for individual values, particularly those of the patient, has also been increasing. However, such consideration is difficult within the context of modern health care, where complex and conflicting values are often in play. This is particularly so when a patient's values seem to be at odds with evidence-based practice or widely shared ethical principles, or when a health professional's personal values may compromise the care provided. SUGGESTED NEW FRAMEWORK: Values-based practice, a framework developed originally in the domain of mental health, maintains that values are pervasive and powerful parameters influencing decisions about health, clinical practice and research, and that their impact is often underestimated. Although it shares starting points with other approaches to values, it suggests that our current approaches lead us to ignore some important manifestations of values at both the general level, as relevant in legal, policy and research contexts, as well as at the individual level, as relevant in clinical practice. Drawing on ideas from philosophy, values-based practice significantly extends the range of phenomena that may be regarded as value-laden. It suggests that one of the reasons for overlooking values is that they are presumed to be shared when not apparently conflicting. Values-based practice is an approach to supporting clinical decision-making, which provides practical skills and tools for eliciting individual values and negotiating these with respect to best available evidence.

Delivery of Health Care↗
PubMed2004

Information needs and prostate cancer: the development of a systematic means of identification.

OBJECTIVE: To design, from first principles, a valid and reliable scale for assessing the importance of specific items of information needed by patients with prostate cancer that would be straightforward to use in clinical settings, as despite its prevalence, there is little research focusing specifically on the information needs associated with prostate cancer. PATIENTS AND METHODS: Several stages of consultation and modification were used to inform the development of a scale which was then piloted on 96 patients with prostate cancer. Respondents were asked to rate the importance they placed on a range of prostate cancer-related topics of information, and the extent to which they felt these information needs had been met. The construct and content validity of the instrument were established and an exploratory factor analysis used to guide restructuring of the tool. Internal consistency/reliability was calculated using Cronbach's alpha. RESULTS: Using the scale showed that men with prostate cancer placed considerable importance on a broad range of information needs, most of which had been inadequately met. Age had a significant influence on the overall importance attributed to information, with younger patients having more need for information. The construct and content validity of the instrument were established. The factor analysis revealed four discrete factors which together explained > 68% of the variance, termed 'basics of prostate cancer care', 'disease management', 'physical well-being' and 'self-help'. Internal consistency/reliability was satisfactory (alpha = 0.91). CONCLUSIONS: The basis of a tool capable of ascertaining the information needs of patients with prostate cancer was developed; it may offer clinicians a valid means of ascertaining information preferences and hence potentially enhance the quality of service provided. Further research is now required to refine the tool and test the effect of its longitudinal use in clinical practice on patient satisfaction and outcome.

Aged↗
PubMed2003

An evaluation of the west Surrey telemedicine monitoring project.

We conducted a three-month pilot study of a home monitoring service for patients with chronic obstructive pulmonary disease. Fifty-five patients were recruited. They transmitted physiological data to a monitoring centre once a day. During the period of the study, 36 escalations were reported to have occurred. Of these, 29 (81%) were managed at home; the other 7 (19%) resulted in acute admission after emergency telephone calls. Although only a small number of patients were involved for a relatively short period of time, there was evidence of a substantial (approximately 50%) decrease in rates of hospital admission. The service was highly acceptable to the patients.

England↗
PubMed2003

Children's home nursing: results of a national survey.

A questionnaire survey was undertaken to establish the characteristics of children's home nursing teams in the UK that deal with acute and chronic cases, to assess their impact on hospital referrals and determine whether they are cost effective. The sample consisted of acute and community trusts listed on the Royal College of Pediatrics and Child Health (RCPCH) database. Differences were found in trust affiliation, staffing, skill mix, caseload, procedures undertaken and hours of operation. Variations depend on whether teams had a predominantly acute caseload, dealt with a mixture of acute and chronic cases, or dealt with predominantly chronic cases. Thirty-two per cent of respondents stated that home care replaced inpatient care for the majority of the children. Budgets of home nursing services varied enormously with a very clear relationship between budget and staffing levels. This survey shows that in 2001, many trusts in the UK provide a children's hospital at home or home nursing service, but that the scale and scope of these services vary widely. Further research is needed on several aspects of home care including the relative costs and benefits of different forms of service in comparison to hospital-based care.

Acute Disease↗
PubMed2002

Developing benchmark inventories to assess the content of telephone consultations in accident and emergency departments: use of the Delphi technique.

The provision of telephone advice to members of the general public from staff based in accident and emergency departments is common practice. However, it is largely conducted on an ad hoc basis without the use of formal guidelines or decision support. The evidence base from which to derive guidelines for the telephone assessment and advice of many common conditions is lacking. This study, using the Delphi technique, was undertaken to develop a number of benchmarks for use as objective measures against which the comprehensiveness of telephone assessments could be tested. Consensus views on the essential and desirable items to be considered for each of 10 presenting complaints was achieved. It is argued that establishing consensus views on clinical topics provides an effective means of developing an evidence base where other sources of evidence are lacking.

Benchmarking↗
PubMed2002

Out-of-hours palliative care in the UK: perspectives from general practice and specialist services.

Palliative care within the community requires well coordinated multidisciplinary teamworking, involving both primary and secondary care practitioners. 'Out-of-hours' periods are a potentially problematic time for delivery of high quality care. We report on two national surveys-one of medical directors of out-of-hours general practitioner cooperatives, the other of medical directors of specialist palliative care units. The aim was to describe general practitioners' and specialists' perspectives on the availability and scope of community nursing and specialist palliative care services. The results point to wide variation in service provision within the community. The two groups differed strikingly in their perceptions, the general practitioners being much less positive than the specialists about the availability of specialist advice and admission to specialist units out of hours. Equitable out-of-hours palliative care services of high quality are unlikely to be achieved without dialogue between primary and secondary care based providers, local needs assessment and adequate resourcing.

Attitude of Health Personnel↗
PubMed1999

Using and providing out-of-hours services: can patients and GPs agree?

Increasing demand for primary care outside the normal working week has come into conflict with the reluctance of doctors to continue to bear 'intolerable' workloads and carry 24-h responsibility for their patients. These developments have led to widespread changes in the organization of out-of-hours primary care. This paper provides new findings on differing perceptions of use of out-of-hours primary care (general medical) services in Great Britain. By drawing on comparative data from an audit and research study on out-of-hours demand involving 25 south-east London practices, the longitudinal perspective of patients and cross sectional perspective of GPs have been identified which can lead to miscommunication during a short out-of-hours consultation. In order to achieve more effective and efficient use and provision of out-of-hours general medical services, a consensus must be developed over what emergency primary care constitutes, and the provider perspective become more accommodating in defining 'appropriate' use. Greater emphasis must also be placed on multidisciplinary working out-of-hours, to enable a more 'appropriate' response to the wide-ranging nature of demand for general medical services.

Journal Article↗