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Biomedical subjects

David R Thompson

Publications and source records attributed to David R Thompson.

At least 37 records · Page 2Linked to original sources
PubMed2006

The use of placebo in clinical nursing research.

AIMS: This paper reviews placebo and placebo effects and their measurement and application to nursing. Ethical and methodological issues are also discussed. Implications for nursing and recommendations for future study are offered. BACKGROUND: Placebos have been used for decades in clinical trials but discussion about conceptual, methodological and ethical issues has been comparatively scarce. CONCLUSION: It is concluded that true placebo effects are difficult to measure and control and the use of credible placebo is sometimes impractical in clinical nursing research. This leads to the increased use of usual care as a control by researchers. However, more information should be reported in studies that use this approach, including the specification of usual care, its monitoring and patient adherence. RELEVANCE TO CLINICAL PRACTICE: Where its use is considered ethical, safe and feasible, a placebo arm should be included in studies of efficacy to distinguish between active and inactive treatment.

Clinical Nursing Research↗
PubMed2006

Nursing in Hong Kong: issues and challenges.

This column provides a discussion of the issues and challenges facing nurses and nursing in Hong Kong. The author introduces the role of nurses in the special administrative region and focuses on workforce, educational and practice issues, as well as on leadership in nursing. He concludes that Hong Kong needs to have a strategic plan to determine sufficient numbers of properly educated nurses.

Delivery of Health Care↗
PubMed2006

Perceived benefits and difficulties experienced in a mutual support group for family carers of people with schizophrenia.

In this qualitative study, the authors explore from the participants' perspective the benefits and difficulties experienced by participants in a mutual support group for Chinese family carers of patients with schizophrenia in Hong Kong. Thirty family carers and 10 patients who had participated in a 12-session mutual support group were interviewed, and the 12 group sessions were audiotaped for content analysis. Three main themes emerged from the data: (a) positive personal changes attributed to group participation, which included enhanced self-identity and acceptance of the caregiving role, increased knowledge of the illness, and adoption of new coping skills; (b) positive characteristics of the mutual support group, including the explicit group ideology and consensus, perceived social climate of the group, and informational support and empowerment; and (c) major inhibitors of group development, specifically low or irregular group attendance, negative pressure from dominant members, and overexpression of intense and negative feelings. These findings contribute to our understanding of the therapeutic components and limitations of mutual support groups for family carers.

Adult↗
PubMed2006

Effects of a mutual support group for families of Chinese people with schizophrenia: 18-month follow-up.

BACKGROUND: Family intervention in schizophrenia can reduce patient relapse and improve medication adherence, but few studies on this have involved a Chinese population. AIMS: To examine the effects of a mutual support group for Chinese families of people with schizophrenia, compared with psychoeducation and standard care. METHOD: Randomised controlled trial in Hong Kong with 96 families of out-patients with schizophrenia, of whom 32 received mutual support, 33 psychoeducation and 31 standard care. The psychoeducation group included patients in all the sessions, the mutual support group did not. Intervention was provided over 6 months, and patient- and family-related psychosocial outcomes were compared over an 18-month follow-up. RESULTS: Mutual support consistently produced greater improvement in patient and family functioning and caregiver burden over the intervention and follow-up periods, compared with the other two conditions. The number of readmissions did not decrease significantly, but their duration did. CONCLUSIONS: Mutual support for families of Chinese people with schizophrenia can substantially benefit family and patient functioning and caregiver burden.

Adaptation, Psychological↗
PubMed2006

Chinese nursing students' attitudes toward traditional Chinese medicine.

In this study, we examined Chinese nursing students' attitudes toward and use of traditional Chinese medicine (TCM). Survey questionnaires were distributed to 439 nursing students, 263 of whom (60%) returned them. Of the respondents, 92% had used TCM, while 48% had used TCM at least once during the previous year. Forty-five percent of respondents reported positive attitudes toward TCM use, 52% had neutral attitudes, and only 3% reported negative attitudes. The majority of respondents (76%) reported no change in their attitude toward TCM after studying nursing. Mean scores related to the adequacy of the current curriculum in TCM training and the state of respondents' TCM knowledge were generally low. Of the respondents who had used TCM during the past year, the most common use was for upper respiratory tract infection. The most common type of TCM used by respondents was herbal tea or soup. Final-year nursing students were more likely to have used TCM during the previous year, report they would like more courses on TCM, and consult Western medicine physicians before using TCM; they were also less likely to develop more negative attitudes toward TCM after studying nursing.

Adult↗
PubMed2005

Disease management programmes for older people with heart failure: crucial characteristics which improve post-discharge outcomes.

AIMS: Disease management programmes (DMPs) have evolved as an innovative clinical practice system to enhance the discharge outcomes of older people with heart failure. Yet, clinical trials which have examined their effectiveness have reported inconsistent findings. This may be explained by variations in the design of DMPs. The aim is to identify the characteristics of DMPs which are crucial to reducing hospital readmission and/or mortality of older people with heart failure. METHODS AND RESULTS: A systematic computerized search was conducted to identify randomized controlled trials of the last 10 years, which examined the effects of DMPs on hospital readmission and mortality of older people with heart failure. The identified DMPs were classified as effective and ineffective, according to statistically significant changes in discharge outcomes. Twenty-one trials were identified, 11 (52.4%) of which reported DMPs improving the discharge outcomes of older people with heart failure. The results indicate that an effective DMP should be multi-faceted and consists of an in-hospital phase of care, intensive patient education, self-care supportive strategy, optimization of medical regimen, and ongoing surveillance and management of clinical deterioration. Cardiac nurse and cardiologist should be actively involved and a flexible approach should be adopted to deliver the follow-up care. CONCLUSION: This study defines precisely the characteristics of the care team and the organization content and delivery method of the DMP which are crucial to enhance the discharge outcomes of older people with heart failure.

Community Health Services↗
PubMed2005

Supporting family caregivers in stroke care: a review of the evidence for problem solving.

BACKGROUND AND PURPOSE: Teaching effective problem-solving skills to family caregivers of patients with chronic disease has been shown to be useful for promoting physical and psychosocial well-being. However, the use and effectiveness of problem solving for supporting caregivers in stroke care has not been reviewed. This article aims to identify and review studies that have examined the effectiveness of teaching problem solving skills to caregivers in stroke care, highlight gaps in the evidence base, and recommend avenues for additional research. METHODS: A structured review of literature identified from nursing, medicine, and psychology databases from 1970 to 2004 was conducted. Eleven articles reporting the development or evaluation of effective problem-solving interventions for caregivers of patients with stroke were critically appraised using recognized quality criteria. RESULTS: The results of this review show that the strength of evidence for problem-solving interventions for caregivers of stroke patients is limited. Because some studies used small samples and varied methods and interventions, making a comparison was difficult. Caregivers' problem-solving abilities were rarely measured, and the theoretical concepts and framework underpinning most studies were unclear. CONCLUSIONS: Evidence from the review suggests a need to additionally study the link between theoretical concepts of effective problem solving and outcomes using standardized measures and to examine also the processes involved in implementing the intervention using multimethod designs, including both quantitative and qualitative approaches.

Adaptation, Psychological↗
PubMed2005

Improving research supervision in nursing.

In this paper, four experienced researchers from the UK, China and Australia offer guidance in research supervision based on their experiences and the recent document, Improving standards in postgraduate research degree programmes [Higher Education Funding Council for England, 2003. Improving standards in postgraduate research degree programmes. Formal consultation. Department for Employment and Learning, Northern Ireland, Higher Education Funding Council for England, Higher Education Funding Council for Wales, Scottish Higher Education Funding Council, HEFCE, London]. Supervision is an important aspect of not only the development of the neophyte researcher, but of academic staff and research activity in general. With increased academic accountability, good supervision should be an integral component of a quality research governance framework and resourced as such. Recommendations include: adoption of these standards; rigorous selection of research students and supervisors and development of projects; development of departmental procedures for monitoring, feedback and intellectual property; and transparency, rigour and fairness in examination procedures.

Attitude of Health Personnel↗
PubMed2005

Health-related quality of life in patients with congestive heart failure.

BACKGROUND: Despite abundant evidence attesting to poor physical, psychological and social functioning of congestive heart failure (CHF) patients, little is known about the impact of the disease itself on health-related quality of life (HRQL). Most previous work has focused on general quality of life issues rather than specifically on the impact of CHF on HRQL. AIM: To identify the significant demographic, clinical and psychosocial factors associated with HRQL in patients with CHF. METHODS: A total of 227 CHF patients were recruited from the medical unit of a general hospital in Hong Kong. Cross-sectional data on HRQL, functional status, psychological state, social support and health perception were obtained from each patient and clinical data were obtained from hospital records. RESULTS: In hierarchical regression analysis, psychological distress, poor health perception, higher NYHA grading and lower education level were identified as the significant factors associated with poorer HRQL. These correlates in total explained 52% of the variance for the HRQL scores. Among these correlates, psychological distress and NYHA grading demonstrated the greatest effect on HRQL scores. CONCLUSION: The findings highlight the significance of addressing the psychological and functional health of CHF patients. Assisting these patients to cultivate a positive attitude towards their own health status is also an important treatment goal.

Aged↗
PubMed2005

Effects of a nurse-led, clinic and home-based intervention on recurrent hospital use in chronic heart failure.

BACKGROUND: Few studies have examined the potential benefits of specialist nurse-led programs of care involving home and clinic-based follow-up to optimise the post-discharge management of chronic heart failure (CHF). OBJECTIVE: To determine the effectiveness of a hybrid program of clinic plus home-based intervention (C+HBI) in reducing recurrent hospitalisation in CHF patients. METHODS: CHF patients with evidence of left ventricular systolic dysfunction admitted to two hospitals in Northern England were assigned to a C+HBI lasting 6 months post-discharge (n=58) or to usual, post-discharge care (UC: n=48) via a cluster randomization protocol. The co-primary endpoints were death or unplanned readmission (event-free survival) and rate of recurrent, all-cause readmission within 6 months of hospital discharge. RESULTS: During study follow-up, more UC patients had an unplanned readmission for any cause (44% vs. 22%: P=0.019, OR 1.95 95% CI 1.10-3.48) whilst 7 (15%) versus 5 (9%) UC and C+HBI patients, respectively, died (P=NS). Overall, 15 (26%) C+HBI versus 21 (44%) UC patients experienced a primary endpoint. C+HBI was associated with a non-significant, 45% reduction in the risk of death or readmission when adjusting for potential confounders (RR 0.55, 95% CI 0.28-1.08: P=0.08). Overall, C+HBI patients accumulated significantly fewer unplanned readmissions (15 vs. 45: P<0.01) and days of recurrent hospital stay (108 vs. 459 days: P<0.01). C+HBI was also associated with greater uptake of beta-blocker therapy (56% vs. 18%: P<0.001) and adherence to Na restrictions (P<0.05) during 6-month follow-up. CONCLUSION: This is the first randomised study to specifically examine the impact of a hybrid, C+HBI program of care on hospital utilisation in patients with CHF. Its beneficial effects on recurrent readmission and event-free survival are consistent with those applying either a home or clinic-based approach.

Adrenergic beta-Antagonists↗
PubMed2005

Quality-of-life measurement in chronic heart failure: do we take account of the patient perspective?

The modern management of chronic heart failure has led to improved life expectancy, functioning and health-related quality of life (HRQL). HRQL measures the effects of an illness or a treatment from the patient's perspective. It is now recognised that the patient's perspective is as legitimate and valid as the clinician's in monitoring health care outcomes. Although there are a number of quality-of-life measures, which can be separated into two types-generic and disease specific-many have been developed, with little or no account being taken of the patient's perspective. Because most of the widely used measures are not patient centred, they may lack sensitivity and specificity in determining those aspects of HRQL important to individual patients. This paper reviews the use of quality-of-life assessment tools in the evaluation of patients with heart failure.

Health Status Indicators↗
PubMed2005

The reliability and validity of the therapeutic activity index.

PURPOSE: To assess the psychometric properties of the Simplified Therapeutic Intervention Scoring System (TISS 28) scale. MATERIALS AND METHODS: A prospective observational design was used. Patients were recruited from a medical-surgical intensive care unit (ICU) and 4 rehabilitation wards of 2 university-affiliated hospitals in Hong Kong. RESULTS: Data necessary for the calculation of the TISS 28, the Therapeutic Intervention Scoring System (TISS 76), and severity of illness scoring system (Simplified Acute Physiology Score [SAPS II]) were recorded for each patient during the first 24 hours after his/her admission to an ICU. A significant positive correlation was found between the TISS 76 and the TISS 28 scores as well as the TISS 28 and the SAPS II scores. There was a significant difference between the TISS 28 scores among ICU patients and patients in rehabilitation wards. A significant correlation was found between the TISS 28 scores of the first and second set of TISS 28 scores. CONCLUSIONS: Although the findings supported the validity and reliability of the TISS 28, there were limitations of the TISS 28 in measuring nursing workload in ICUs. Hence, continued amendment and validation of the TISS 28 on larger samples in different ICUs would be required so as to provide clinical nurses with a valid and reliable assessment of nursing workload.

Adolescent↗
PubMed2005

Do illness perceptions predict attendance at cardiac rehabilitation and quality of life following myocardial infarction?

OBJECTIVE: The aim of this study was to examine the extent to which illness perceptions predict attendance at cardiac rehabilitation and quality of life following myocardial infarction (MI). METHODS: The illness perceptions of 194 MI patients were assessed whilst the patients were still in hospital following an MI. The mean age was 63.3 years (S.D. = 10.6), and 142 of the patients were men. Cardiac rehabilitation attendance and quality of life were assessed via a postal questionnaire 6 months later. RESULTS: In contrast to previous work reported in this area, illness perceptions were not significantly associated with attendance at cardiac rehabilitation. Illness perceptions measured within 24 h of an acute MI were predictive of quality of life 6 months later. CONCLUSION: Previous reports may have overestimated the extent to which illness perceptions predict attendance at cardiac rehabilitation. The relationship between illness perceptions and quality of life at 6 months suggests that interventions to alter illness perceptions, especially perceptions of consequences, may be useful in improving health-related quality of life (HRQoL) following an MI.

Aged↗
PubMed2005

Does it matter what patients think? The relationship between changes in patients' beliefs about angina and their psychological and functional status.

OBJECTIVE: The aim of this study is to examine the association between changes in misconceived or maladaptive beliefs about angina and patients' functional and psychological status. METHOD: The method used was a prospective follow-up study over 1 year of 133 people with angina. RESULTS: Beliefs about angina were significantly associated with functional and psychological status. People with more misconceived or maladaptive beliefs were more anxious and physically limited than were people with fewer such beliefs, with differences in physical functioning that were clinically significant. Change in angina beliefs over 1 year was the most significant predictor for physical functioning at follow-up, after controlling for the effects of demographic variables and the outcome variable at baseline, whereas change in the frequency of angina did not contribute significantly to this model. CONCLUSION: Misconceived and maladaptive beliefs about angina are associated with reductions in both functional and psychological status. These beliefs are easily and quickly identified using a simple questionnaire and should be corrected.

Adult↗