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  • 1
    In: Trials, Springer Science and Business Media LLC, Vol. 24, No. 1 ( 2023-05-06)
    Abstract: Postoperative morbidity and mortality in patients undergoing major emergency gastrointestinal surgery are a major burden on healthcare systems. Optimal management of perioperative intravenous fluids may reduce mortality rates and improve outcomes from surgery. Previous small trials of cardiac-output guided haemodynamic therapy algorithms in patients undergoing gastrointestinal surgery have suggested this intervention results in reduced complications and a modest reduction in mortality. However, this existing evidence is based mainly on elective (planned) surgery, with little evaluation in the emergency setting. There are fundamental clinical and pathophysiological differences between the planned and emergency surgical setting which may influence the effects of this intervention. A large definitive trial in emergency surgery is needed to confirm or refute the potential benefits observed in elective surgery and to inform widespread clinical practice. Methods The FLO-ELA trial is a multi-centre, parallel-group, open, randomised controlled trial. 3138 patients aged 50 and over undergoing major emergency gastrointestinal surgery will be randomly allocated in a 1:1 ratio using minimisation to minimally invasive cardiac output monitoring to guide protocolised administration of intra-venous fluid, or usual care without cardiac output monitoring. The trial intervention will be carried out during surgery and for up to 6 h postoperatively. The trial is funded through an efficient design call by the National Institute for Health and Care Research Health Technology Assessment (NIHR HTA) programme and uses existing routinely collected datasets for the majority of data collection. The primary outcome is the number of days alive and out of hospital within 90 days of randomisation. Participants and those delivering the intervention will not be blinded to treatment allocation. Participant recruitment started in September 2017 with a 1-year internal pilot phase and is ongoing at the time of publication. Discussion This will be the largest contemporary randomised trial examining the effectiveness of perioperative cardiac output-guided haemodynamic therapy in patients undergoing major emergency gastrointestinal surgery. The multi-centre design and broad inclusion criteria support the external validity of the trial. Although the clinical teams delivering the trial interventions will not be blinded, significant trial outcome measures are objective and not subject to detection bias. Trial registration ISRCTN 14729158. Registered on 02 May 2017.
    Type of Medium: Online Resource
    ISSN: 1745-6215
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2040523-6
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  • 2
    In: Clinical Obesity, Wiley, Vol. 11, No. 1 ( 2021-02)
    Abstract: Weight loss programmes appeal mainly to women, prompting calls for gender‐specific programmes. In the United Kingdom, general practitioners (GPs) refer nine times as many women as men to community weight loss programmes. GPs endorsement and offering programmes systematically could reduce this imbalance. In this trial, consecutively attending patients in primary care with obesity were invited and 1882 were enrolled and randomized to one of two opportunistic 30‐second interventions to support weight loss given by GPs in consultations unrelated to weight. In the support arm, clinicians endorsed and offered referral to a weight loss programme and, in the advice arm, advised that weight loss would improve health. Generalized linear mixed effects models examined whether gender moderated the intervention. Men took effective weight loss action less often in both arms (support: 41.6% vs 60.7%; advice: 12.1% vs 18.3%; odds ratio (OR) = 0.38, 95% confidence interval (CI), 0.27, 0.52, P   〈  .001) but there was no evidence that the relative effect differed by gender (interaction P = .32). In the support arm, men accepted referral and attended referral less often, 69.3% vs 82.4%; OR = 0.48, 95% CI, 0.35, 0.66, P   〈  .001 and 30.4% vs 47.6%; OR = 0.48, 95% CI, 0.36, 0.63, P   〈  .001, respectively. Nevertheless, the gender balance in attending weight loss programmes closed to 1.6:1. Men and women attended the same number of sessions (9.7 vs 9.1 sessions, P = .16) and there was no evidence weight loss differed by gender (6.05 kg men vs 4.37 kg women, P = .39). Clinician‐delivered opportunistic 30‐second interventions benefits men and women equally and reduce most of the gender imbalance in attending weight loss programmes.
    Type of Medium: Online Resource
    ISSN: 1758-8103 , 1758-8111
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2603811-0
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  • 3
    Online Resource
    Online Resource
    Elsevier BV ; 2018
    In:  Preventive Medicine Vol. 108 ( 2018-03), p. 47-52
    In: Preventive Medicine, Elsevier BV, Vol. 108 ( 2018-03), p. 47-52
    Type of Medium: Online Resource
    ISSN: 0091-7435
    RVK:
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 1471564-8
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  • 4
    Online Resource
    Online Resource
    Georg Thieme Verlag KG ; 2019
    In:  Thrombosis and Haemostasis Vol. 119, No. 02 ( 2019-02), p. 294-307
    In: Thrombosis and Haemostasis, Georg Thieme Verlag KG, Vol. 119, No. 02 ( 2019-02), p. 294-307
    Abstract: Objective Oral anticoagulant (OAC) prescription for stroke prevention in atrial fibrillation (AF) patients frequently does not follow current guidelines, with underuse in patients at high risk of stroke and substantial overuse in those at low risk. This review aims to systematically evaluate the effectiveness of interventions to improve appropriate OAC prescription in eligible AF patients for stroke prevention. Methods Systematic review of controlled and uncontrolled studies published up to July 2017 with interventions designed to improve appropriate OAC prescription for stroke prevention in eligible AF patients (according to risk assessment tool or guidelines). Categorization of intervention types was pre-specified. The main outcome was change in proportion of eligible AF patients prescribed OACs for stroke prevention. Results Twenty studies conducted in 392 settings were included (cluster randomized controlled trials, controlled trials and uncontrolled before-after designs; n = 29,868 patients at baseline). Fifteen studies reported significant improvements in appropriate prescription of OACs in AF patients. All interventions with a persuasive element (8/8); all studies targeting health care professional (HCP) education or guideline/protocol implementation (7/7); and all medical care programs (4/4) achieved significant increases in appropriate OAC prescription. Computerized decision support interventions (3/5) and reviews of prescribing (2/4) were less likely to report significant improvements in appropriate OAC prescription. Conclusion Interventions designed to improve appropriate prescription of OACs in eligible AF patients for stroke prevention can be effective. Successful approaches include education of HCPs; implementation of local guidelines; interdisciplinary medical care programs educating both HCPs and patients and persuasive interventions utilizing peer-group experts. Protocol registration: PROSPERO (CRD42016039654).
    Type of Medium: Online Resource
    ISSN: 0340-6245 , 2567-689X
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2019
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  • 5
    In: Qualitative Health Research, SAGE Publications, Vol. 29, No. 5 ( 2019-04), p. 658-671
    Abstract: Health coaching is a novel population intervention to support self-management but it is untested in people with mild disease. People with chronic obstructive pulmonary disease with mild dyspnea are a population excluded from supported self-management and whose illness might progress without intervention. We explored participants’ experiences about how health coaching motivated behavior change. Interviews were conducted with 21 intervention and 10 control participants at 6 months, and 20 intervention participants at 12 months. Participants were identified from a randomized controlled trial of telephone health coaching. Data were analyzed using the framework method. Participants positively enacted behavior change to become more physically active. Participants took advantage of environmental affordances to pull themselves toward activity targets, or relied on being pushed to be more active by the health coach or significant others. Behavior change was maintained where efforts to be more active were built into the everyday lifeworld of participants.
    Type of Medium: Online Resource
    ISSN: 1049-7323 , 1552-7557
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2010333-5
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  • 6
    Online Resource
    Online Resource
    SAGE Publications ; 2020
    In:  Journal of Health Psychology Vol. 25, No. 5 ( 2020-04), p. 684-691
    In: Journal of Health Psychology, SAGE Publications, Vol. 25, No. 5 ( 2020-04), p. 684-691
    Abstract: Women with postnatal depression are often reluctant to take medication postnatally and access to psychological therapies is limited. Exercise offers a freely available treatment option but depressed mothers’ experience of exercise has not been investigated. We conducted a qualitative study nested within a randomised trial of an exercise intervention for women with postnatal depression. Women described deterioration in their sense of identity postnatally and through experiencing depression and described the positive impact exercise had on their sense of self. Views of exercise as treatment for postnatal depression ranged from doubts about its practicality to positive comparisons with other traditional treatments and to improved recovery.
    Type of Medium: Online Resource
    ISSN: 1359-1053 , 1461-7277
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2021897-7
    SSG: 5,2
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  • 7
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2006
    In:  BMC Complementary and Alternative Medicine Vol. 6, No. 1 ( 2006-12)
    In: BMC Complementary and Alternative Medicine, Springer Science and Business Media LLC, Vol. 6, No. 1 ( 2006-12)
    Abstract: There is growing concern that serious interactions are occurring between prescribed/over the counter and herbal medicines and that there is a lack of disclosure of herbal use by patients to doctors. This study explores women's perspectives about the safety of herbal remedies, herb-drug interactions and communication with doctors about herbal medicines. Methods Qualitative, cross-sectional study, with purposive sampling which took place in Cheshire, UK. Eighteen in depth semi-structured interviews were conducted with female herbal medicine users aged 18 years and above. Results The large majority did not inform their GPs of their use of herbal medicines. This was due to lack of physician enquiry, perception of importance and fear of a negative response. Several women were not aware that herbal remedies could interact with prescribed or over the counter medicines. Of the women who had experienced adverse effects none had reported them, believing them of low importance. Conclusion The women had little knowledge about herb-drug interactions and rarely disclosed use of herbal medicines to their doctor. Doctors' communication and openness regarding herbal medicines needs to improve and there should be increased access to accurate information on herbal medicines in the public and health care domain.
    Type of Medium: Online Resource
    ISSN: 1472-6882
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2006
    detail.hit.zdb_id: 2050429-9
    detail.hit.zdb_id: 3037610-5
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  • 8
    In: Cochrane Database of Systematic Reviews, Wiley, Vol. 2023, No. 10 ( 2023-10-27)
    Type of Medium: Online Resource
    ISSN: 1465-1858
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2038950-4
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  • 9
    In: European Respiratory Journal, European Respiratory Society (ERS), Vol. 44, No. 6 ( 2014-12), p. 1538-1547
    Abstract: Studies of programmes of self-management support for chronic obstructive pulmonary disease (COPD) have been inconclusive. The Self-Management Programme of Activity, Coping and Education (SPACE) FOR COPD is a 6-week self-management intervention for COPD, and this study aimed to evaluate the effectiveness of this intervention in primary care. A single-blind randomised controlled trial recruited people with COPD from primary care and randomised participants to receive usual care or SPACE FOR COPD. Outcome measures were performed at baseline, 6 weeks and 6 months. The primary outcome was symptom burden, measured by the self-reported Chronic Respiratory Questionnaire (CRQ-SR) dyspnoea domain. Secondary outcomes included other domains of the CRQ-SR, shuttle walking tests, disease knowledge, anxiety, depression, self-efficacy, smoking status and healthcare utilisation. 184 people with COPD were recruited and randomised. At 6 weeks, there were significant differences between groups in CRQ-SR dyspnoea, fatigue and emotion scores, exercise performance, anxiety, and disease knowledge. At 6 months, there was no between-group difference in change in CRQ-SR dyspnoea. Exercise performance, anxiety and smoking status were significantly different between groups at 6 months, in favour of the intervention. This brief self-management intervention did not improve dyspnoea over and above usual care at 6 months; however, there were gains in anxiety, exercise performance, and disease knowledge.
    Type of Medium: Online Resource
    ISSN: 0903-1936 , 1399-3003
    Language: English
    Publisher: European Respiratory Society (ERS)
    Publication Date: 2014
    detail.hit.zdb_id: 2834928-3
    detail.hit.zdb_id: 1499101-9
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  • 10
    Online Resource
    Online Resource
    Elsevier BV ; 2008
    In:  International Journal of Cardiology Vol. 125, No. 1 ( 2008-3), p. 144-145
    In: International Journal of Cardiology, Elsevier BV, Vol. 125, No. 1 ( 2008-3), p. 144-145
    Type of Medium: Online Resource
    ISSN: 0167-5273
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2008
    detail.hit.zdb_id: 1500478-8
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