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Biomedical subjects

Caroline Shuldham

Publications and source records attributed to Caroline Shuldham.

10 recordsLinked to original sources
PubMed2007

A systematic review of psychological interventions for children with asthma.

AIM: Psychological factors may influence the symptoms and management of asthma in children in many ways. It is, therefore, suggested that psychological interventions may be appropriate for this population. This paper reports a systematic review assessing the efficacy of psychological interventions in improving health outcomes for children with asthma. METHODOLOGY: A review of Randomized Controlled Trials (RCT) was designed. RCTs assessing the effects of a psychological intervention in child participants were included in the review. Outcome measures included healthcare utilization, lung function, asthma symptoms, and psychological health status. The search was conducted until April 2005. RESULTS: Twelve studies, involving 588 children, were included in the review; however, study quality was poor and sample sizes were frequently small. A meta-analysis was performed on two studies, examining the effects of relaxation therapy on PEFR which favored the treatment group (SD 0.82, CI 0.41-1.24). No other meta-analysis could be performed due to the diversity of interventions and the outcomes assessed. In addition, many studies reported insufficient data. CONCLUSIONS: This review was unable to draw firm conclusions for the role of psychological interventions for children with asthma. We recommend that valid outcome measures for evaluating the effectiveness of psychological interventions for children with asthma need to address adjustment to and coping with asthma, as well as other psychological indicators. The absence of an adequate evidence base is demonstrated, highlighting the need for well-conducted RCTs in this area.

Adaptation, Psychological↗
PubMed2006

Psychological interventions for adults with asthma: a systematic review.

AIM: The purpose of this study was to conduct a systematic review of randomized controlled trials where the efficacy of psychological interventions in modifying health and behavioural outcomes for adults with asthma was investigated. METHOD: A review of randomized controlled trials was designed. The literature search was conducted until May 2005. RESULTS: Fourteen studies, involving 617 adults, were included in the review. The use of 'as needed' medications was reduced by relaxation therapy (OR 4.47, CI 1.22-16.44), quality of life, measured using the Asthma Quality of Life Questionnaire, showed a positive effect following cognitive behavioural therapy (WMD 0.71, CI 0.23-1.19), and peak expiratory flow outcome data indicated a significant difference in favour of bio-feedback therapy (SMD 0.66, CI 0.09-1.23). CONCLUSIONS: Some promising results did emerge from meta-analyses performed. However, due to heterogeneity and the low quality of included studies, this review was unable to draw firm conclusions for the role of psychological interventions in asthma. We recommend that larger and well-conducted randomized trials use valid outcome measures to evaluate the effectiveness of psychological interventions for adults with asthma.

Adult↗
PubMed2005

Cardiac nursing: achieving competent practitioners.

This paper describes how competency statements were integrated into an academic framework to provide a transparent yet flexible career pathway for the nurse working in acute cardiac care. Nurses are expanding and developing their roles and use wide ranging skills and knowledge to care for patients. Additionally, models of care delivery are changing and patients are cared for in a variety of settings. Where evidence exists, these models demonstrate improvement in the provision and quality of services and contribute to improved quality of life, maximise medication and therapy and reduce waiting times for investigations. However, whilst many studies have demonstrated benefit, translating these results into routine practice requires skilled nurses who are "fit for purpose," and to support this, professional competencies can be used to measure competence in practice whilst informing educational initiatives. This paper outlines the development of competency statements that identify the knowledge and skills required for safe, effective and competent care and direct the cardiac nurse acquire skills and knowledge in a focused and coherent way.

Attitude of Health Personnel↗
PubMed2003

Practical application of educational rhetoric: a pathway to expert cardiac nurse practice?

Cardiac nursing takes place within various spheres of health care, reaching into primary, secondary and tertiary care within theses, cardiac expertise falls within four domains: health promotion, cardiac prevention and rehabilitation, acute, chronic and episodic care and palliative care. This paper sets out the possibility for a staged development of the cardiac nurse, which could promote homogeneity in role, skill and practice. A framework ('Expert Cardiac Nurse Pathway') for the United Kingdom, is proposed here, and views on its usefulness throughout Europe are sought.

Career Mobility↗
PubMed2003

A pilot study using a newly devised manual in a programme of education and support for patients waiting for coronary artery bypass surgery.

BACKGROUND: Cardiac rehabilitation programmes are widely accepted as being of benefit to patients with cardiac disease. The time spent waiting for cardiac surgery can be extremely stressful but can be used to address risk factors and provide information to reduce anxiety and prepare the patient for surgery. AIMS: To pilot the usefulness of a manual for pre-operative cardiac surgical patients, and assess the feasibility and usefulness to both nurses and patients of a monthly education and support programme for patients waiting for cardiac surgery. METHODS: A pilot study of 42 patients followed up for 3 months. Research tools included patient questionnaires and telephone interviews, risk factor measurements and nurse focus groups. RESULTS: Nurses and patients evaluated the manual and overall programme favourably, although the nurses found it was very labour intensive. Changes to risk factors made during the study were small but patients valued the opportunity to raise questions which fell into the categories of medical concerns, hospital procedure and risk factors. CONCLUSION: The manual is a useful tool for patients waiting for cardiac surgery. The programme is useful and feasible but could be targeted more specifically to patients with raised risk factors.

Adult↗