Biomedical subjects

Liz Steed

Publications and source records attributed to Liz Steed.

6 recordsLinked to original sources

PubMed2006

Self management for men with lower urinary tract symptoms: randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of self management as a first line intervention for men with lower urinary tract symptoms. DESIGN: Randomised controlled trial. SETTING: A teaching hospital and a district general hospital in London. PARTICIPANTS: 140 men (mean age 63 (SD 10.7) years), recruited between January 2003 and April 2004, referred by general practitioners to urological outpatient departments with uncomplicated lower urinary tract symptoms. INTERVENTIONS: Self management and standard care (n=73) or standard care alone (n=67). The self management group took part in three small group sessions comprising education, lifestyle advice, and training in problem solving and goal setting skills. MAIN OUTCOME MEASURES: The primary outcome measure was treatment failure measured at 3, 6, and 12 months. Symptom severity (international prostate symptom score; higher scores represent a poorer outcome) was used as a secondary outcome. RESULTS: At three months, treatment failure had occurred in 7 (10%) of the self management group and in 27 (42%) of the standard care group (difference=32%, 95% confidence interval 18% to 46%). Corresponding differences in the frequency of treatment failure were 42% (27% to 57%) at six months and 48% (32% to 64%) at 12 months. At three months, the mean international prostate symptom score was 10.7 in the self management group and 16.4 in the standard care group (difference=5.7, 3.7 to 7.7). Corresponding differences in score were 6.5 (4.3 to 8.7) at six months and 5.1 (2.7 to 7.6) at 12 months. CONCLUSIONS: Self management significantly reduced the frequency of treatment failure and reduced urinary symptoms. Because of the large observed benefit of self management, the results of this study support the case for a large multicentre trial to confirm whether self management could be considered as first line treatment for men with lower urinary tract symptoms. TRIAL REGISTRATION: National Research Register N0263115137; Clinical trials NCT00270309 [ClinicalTrials.gov].

Ambulatory Care↗

PubMed2006

The community intensive therapy team: development and philosophy of a new service.

The Community Intensive Therapy Team (CITT) has been operating since 1998. It was developed to cater for the needs of patients with complex difficulties referred to a specialist Child and Adolescent Health Service (CAMHS) in South Wales, UK. The patients served by the CITT are comparable with patients who might be referred for admission to an inpatient unit and include patients with eating disorders, psychosis, affective disorders, adjustment disorders or repetitive self-harm. The theoretical model used is based on a biopsychosocial model which aims to empower and support family members. The philosophy of the CITT is to work with the child and family in their own environment, tailoring the therapy to the needs of all concerned. CITT makes use of the strengths within the patient, the family and extended family, the agencies already involved and the environment. Since its introduction, the CITT has been able to manage all the complex referrals made to it from the generic Tier 2/3 CAMHS teams it serves, with minimal recourse to inpatient beds.

Adolescent↗

PubMed2005

Evaluation of the UCL diabetes self-management programme (UCL-DSMP): a randomized controlled trial.

Self-management has been described as the cornerstone of care for diabetes. Many self-management studies are limited by poor methodology and poor descriptions of the intervention. The current study developed a theoretically based self-management programme for patients with type 2 diabetes, which was evaluated via a randomized controlled trial. At immediate post-intervention and three-month follow-up the intervention group showed significant improvement relative to controls on self-management behaviours, quality of life and illness beliefs. A trend towards improved HbA1c was also observed. Documentation in a manual and development of a training programme for facilitators ensures the programme is replicable.

Aged↗

PubMed2003

A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus.

Self-management and psychological interventions for diabetes have become increasingly common and have shown some positive impact on glycemic control. The association of such interventions with psychosocial outcomes is however, less clear. The current review examines the impact of these interventions on psychosocial outcomes including depression, anxiety, adjustment and quality of life. A systematic search of the literature was performed on Medline, Embase and Psychlit. Reference lists were screened for studies that met inclusion/exclusion criteria. Studies were coded on outcomes both over time and relative to control groups. In addition studies were classified as being principally educational, self-management or psychological in type, and the different components in the intervention were determined. Thirty-six studies were identified. Detrimental effects were not generally seen following any type of intervention. Depression seemed to be particularly improved following psychological interventions, whilst quality of life improved more following self-management interventions. A number of methodological issues, such as the specificity of measure used, characteristics of the population and type of intervention were however, influential in the impact of interventions on outcomes. It is recommended that future studies would benefit from being larger with controlled designs, using diabetes specific measures and providing clearer descriptions of intervention components. This will allow greater understanding of what contexts different interventions are most suited to, and which components are key to, improving psychological well-being and quality of life.

Adult↗

PubMed2003

Cognitive change 5 years after coronary artery bypass surgery.

A longitudinal study of cognitive function after coronary artery bypass surgery examined 107 participants using 11 tests, preoperatively and at 6 days, 8 weeks, and 5 years after surgery. The overall neuropsychological (NP) change score declined at 6 days, showed some recovery at 8 weeks, and declined again at 5 years. The number of microemboli recorded during surgery, postoperative short-term cognitive change, and degree of recovery at 8 weeks were identified as predictors of change in NP score to 5 years. This suggests that even over a 5-year period, operative damage is detectable. Patients' vulnerability to short-term deterioration and resilience or ability to recover over a few weeks from operative cerebral insult are important processes of unknown mechanisms.

Acetamides↗

PubMedDate not supplied

Self-management interventions for chronic illness.

An increasing number of interventions have been developed for patients to better manage their chronic illnesses. They are characterised by substantial responsibility taken by patients, and are commonly referred to as self-management interventions. We examine the background, content, and efficacy of such interventions for type 2 diabetes, arthritis, and asthma. Although the content and intensity of the programmes were affected by the objectives of management of the illness, the interventions differed substantially even within the three illnesses. When comparing across conditions, it is important to recognise the different objectives of the interventions and the complexity of the issues that they are attempting to tackle. For both diabetes and asthma, the objectives are concerned with the underlying control of the condition with clear strategies to achieve the desired outcome. By contrast, strategies to deal with symptoms of pain and the consequences of disability in arthritis can be more complex. The interventions that were efficacious provide some guidance as to the components needed in future programmes to achieve the best results. But to ensure that these results endure over time remains an important issue for self-management interventions.

Arthritis, Rheumatoid↗