Biomedical subjects

Karina Lovell

Publications and source records attributed to Karina Lovell.

13 recordsLinked to original sources

PubMed2006

Telephone administered cognitive behaviour therapy for treatment of obsessive compulsive disorder: randomised controlled non-inferiority trial.

OBJECTIVES: To compare the effectiveness of cognitive behaviour therapy delivered by telephone with the same therapy given face to face in the treatment of obsessive compulsive disorder. DESIGN: Randomised controlled non-inferiority trial. SETTING: Two psychology outpatient departments in the United Kingdom. PARTICIPANTS: 72 patients with obsessive compulsive disorder. INTERVENTION: 10 weekly sessions of exposure therapy and response prevention delivered by telephone or face to face. MAIN OUTCOME MEASURES: Yale Brown obsessive compulsive disorder scale, Beck depression inventory, and client satisfaction questionnaire. RESULTS: Difference in the Yale Brown obsessive compulsive disorder checklist score between the two treatments at six months was -0.55 (95% confidence interval -4.26 to 3.15). Patient satisfaction was high for both forms of treatment. CONCLUSION: The clinical outcome of cognitive behaviour therapy delivered by telephone was equivalent to treatment delivered face to face and similar levels of satisfaction were reported. TRIAL REGISTRATION: Current Controlled Trials ISRCTN500103984 [controlled-trials.com].

Adolescent↗

PubMed2006

'Justifiable depression': how primary care professionals and patients view late-life depression? A qualitative study.

BACKGROUND: Depression is the commonest mental health problem in elderly people and continues to be underdiagnosed and undertreated. AIM: To explore the ways that primary care professionals and patients view the causes and management of late-life depression. DESIGN: A qualitative study using semistructured interviews. SETTING: One Primary Care Trust in North West England. PARTICIPANTS: Fifteen primary care practitioners comprising nine GPs, three practice nurses, two district nurses and one community nurse; twenty patients who were over the age of 60 and who were participating in a feasibility study of a new model of care for late-life depression [PRIDE Trial: PRimary care Intervention for Depression in the Elderly (a feasibility study in Central Manchester funded by the Department of Health)]. RESULTS: Primary care practitioners conceptualized late-life depression as a problem of their everyday work, rather than as an objective diagnostic category. They described depression as part of a spectrum including loneliness, lack of social network, reduction in function and viewed depression as 'understandable' and 'justifiable'. This view was shared by patients. Therapeutic nihilism, the feeling that nothing could be done for this group of patients, was a feature of all primary care professionals' interviews. Patients' views were characterized by passivity and limited expectations of treatment. Depression was not viewed as a legitimate illness to be taken to the GP. Primary care professionals recognized that managing late-life depression did fall within their remit, but identified limitations in their own skills and capabilities in this area, as well as a lack of other resources to which they could refer patients. CONCLUSION: This study highlights the complicated nature of the diagnosis and management of late-life depression. Protocols for the diagnosis and treatment of depression emphasis the biomedical model which does not fit with the everyday experience of GPs or elderly patients who share the views of primary care professionals that depression is a consequence of social and contextual issues. There is a need for the development of evidence-based provision for older people with depression within primary care, but also a need for elderly patients to be made aware of the legitimacy of presenting low mood and misery to their primary care professional.

Anecdotes as Topic↗

PubMed2006

How expert are the experts? An exploration of the concept of 'expert' within Delphi panel techniques.

The use of the term 'expert' occurs widely in healthcare research, in the context of national guidelines and consensus methods for the development of clinical protocols. Within consensus methods of research, especially Delphi panel techniques, the use of 'experts' is fundamental to reliability. Yet literature fails to debate the practicalities of defining 'experts' for use within Delphi panel research. This paper, by John Baker and colleagues, draws on methodological literature and discusses the concepts and elements of 'experts'. It concludes with recommendations for researchers to ensure experts for future Delphi research.

Delphi Technique↗

PubMed2005

The clinical effectiveness of guided self-help versus waiting-list control in the management of anxiety and depression: a randomized controlled trial.

BACKGROUND: There are significant barriers to accessing effective psychological therapy in primary care resulting from a lack of suitably trained therapists to meet current demand. More efficient service delivery using minimal interventions (such as bibliotherapy) provided by paraprofessional therapists may be one method of overcoming these problems, and is the subject of attention in the UK and elsewhere. A randomized trial was conducted to test the clinical effectiveness of this model. Assistant psychologists delivered a guided self-help intervention to patients with anxiety and depression who were currently waiting for psychological therapy. METHOD: A total of 114 patients were randomized either to guided self-help or a waiting-list control group. All patients were followed up 3 months later, prior to starting conventional psychological therapy. Measures included self-reported adherence to the intervention, anxiety and depressive symptoms, social functioning and patient satisfaction. RESULTS: Adherence to the guided self-help intervention was acceptable and patients reported satisfaction with the intervention. However, there were no statistically significant differences between groups in anxiety and depression symptoms at 3 months. CONCLUSIONS: The results demonstrate that this model of guided self-help did not provide additional benefit to patients on a waiting list for psychological therapy. The results are considered in the context of possible internal and external validity threats, and compared with previous trials of minimal interventions. The implications of the results for the design of future minimal interventions are considered.

Adult↗

PubMed2005

Healthy living interventions and schizophrenia: a systematic review.

AIM: This paper reports a systematic review of the published and grey literature which has investigated the efficacy of healthy living interventions for adults with a diagnosis of schizophrenia or schizo-affective disorder. BACKGROUND: Adults with a diagnosis of schizophrenia or schizo-affective disorder have reduced life expectancy when compared with members of the general population, with approximately 59% of excess mortality resulting from natural causes. METHODS: The review was conducted following guidelines provided by the United Kingdom National Health Service Centre for Reviews and Dissemination, and using the Medline, PsycINFO, CINAHL, Embase, Cochrane Library, National Research Register, and System for Info on Grey Literature databases. RESULTS: Sixteen studies were identified, examining four types of healthy living interventions: smoking cessation (n = 7), weight management (n = 5), exercise (n = 3) and nutritional education (n = 1). The smoking cessation, weight management and exercise studies showed positive outcomes in the main. The quality of the studies, however, was generally poor. Only two had control groups, most recruited small self-selected samples, six did not standardize for diagnosis, external validity was generally poor and no studies followed participants for longer than 6 months. The best quality evidence was produced by the smoking cessation and weight management studies, which were more methodologically robust and demonstrated promising outcomes. CONCLUSIONS: Further research is needed to assist the development of effective interventions to help this client group to adopt and maintain healthier lifestyles. Research and practice development in this area may be an important role for nurses in both hospital and community settings.

Health Promotion↗

PubMed2005

Specialist educational intervention for mental health nursing staff: delivery, content and personal impact.

AIM: This paper reports a study to ascertain the views of acute ward-based mental health nursing staff on the delivery, content and personal impact of an innovative 18-day, whole team educational intervention in acute mental health care. BACKGROUND: There are grave concerns internationally about the quality of inpatient mental health care for people with acute psychiatric problems. Educational courses are needed to improve these services. However, existing schemes are often selective, hard to access and limited to developing highly specialist skills for senior nurses. They have also been criticized for making no difference to clinical practice. There is little evidence to guide the development of these or alternative team-based courses. METHOD: Qualitative data were collected over a 6-week period using 12 focus group interviews and individual questionnaires. RESULTS: Four themes were identified. The joint education of nursing staff from different organizations was welcomed and reduced feelings of ward isolation. Mixing qualified and unqualified staff was not regarded positively. In terms of course content and learning themes, unqualified staff were more likely to report positive learning outcomes for knowledge, skills, attitude, morale and personal development; qualified nurses were more likely to indicate positive outcomes in anonymized data from questionnaires than from focus groups. Both groups reported little chance of knowledge implementation without changes in the organization of care. CONCLUSION: Whilst it may be desirable to educate whole nursing teams, more benefit might be gained from shared education between several organizations and separating the education of qualified and unqualified staff before combining these groups in team education. Participants remained pessimistic about their chances of implementing new knowledge and skills in current acute inpatient mental health environments.

Acute Disease↗

PubMed2005

Specialist educational intervention for acute inpatient mental health nursing staff: service user views and effects on nursing quality.

AIM: This paper reports a study to evaluate the impact of an innovative 18-day educational intervention for acute ward-based mental healthcare nursing staff on documented quality of nursing care and on service user views of that care. BACKGROUND: There are grave concerns internationally about the quality of inpatient mental health care for people with acute psychiatric problems. It is claimed that specialist educational courses are needed to improve these services. However, whilst such courses may lead to positive learning outcomes for participants, the impact on the actual care of service users is unknown. METHOD: An uncontrolled before-and-after evaluation of three acute mental health wards from different United Kingdom National Health Service trusts was carried out. Quality of nursing care was evaluated by extracting documentary evidence from service user records, assessed by two independent researchers according to predefined quality criteria. The views of a purposive sample of mental health service users, currently receiving services from the three designated wards, were ascertained by semi-structured interview. RESULTS: Both documentary evidence and service user views revealed some important baseline deficiencies in the quality of care offered at the study sites. Following the educational intervention, statistically significant improvements were observed in the quality of care planning, initial assessments and the provision of therapeutic care. No statistically significant changes were observed in the quality of risk assessments, medication management or external agency involvement. CONCLUSIONS: Education can have an impact on nursing care but may not be sufficient alone to change mental healthcare practices on acute inpatient wards in the radical manner demanded by policymakers and service user lobby groups. Educational interventions need to be implemented in conjunction with organizational changes that are specifically designed to maximize the opportunities presented by a newly skilled and positive workforce.

Acute Disease↗

PubMed2004

Peoples' understandings of a primary care-based mental health self-help clinic.

Self-help programmes are increasingly advocated as a means of managing mental health problems. This qualitative study explored patients' understandings of the use of a UK primary care-based self-help clinic (facilitated by a nurse). As part of a wider evaluation of the clinic, in-depth interviews were conducted with a purposive sub-sample of clinic users. Data indicate that people understand their problem as one of having lost an ability to cope, and that the ethos underlying the clinic is well matched to restore a sense of coping, by motivating patients to re-establish and retain control over their everyday lives. However, some patients experienced a sense of dissonance between prior expectations and actual use of the self-help clinic. Without prior familiarity with self-help, engaging the patient as the mechanism of change may be difficult. Some patients expected formal counselling and were influenced in this by their previous experience of services and discussions with the GP at the point of referral. It takes time and active engagement with self-help materials before patients become aware that they are a crucial mechanism of change. Patients may benefit from information and a referral process, which emphasises the centrality of self-efficacy and the patient as 'change agent' prior to referral.

Adaptation, Psychological↗

PubMed2003

Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training.

The authors examined the efficacy, speed, and incidence of symptom worsening for 3 treatments of posttraumatic stress disorder (PTSD): prolonged exposure, relaxation training, or eye movement desensitization and reprocessing (EMDR; N = 60). Treaments did not differ in attrition, in the incidence of symptom worsening, or in their effects on numbing and hyperarousal symptoms. Compared with EMDR and relaxation training, exposure therapy (a) produced significantly larger reductions in avoidance and reexperiencing symptoms, (b) tended to be faster at reducing avoidance, and (c) tended to yield a greater proportion of participants who no longer met criteria for PTSD after treatment. EMDR and relaxation did not differ from one another in speed or efficacy.

Adolescent↗

PubMed2003

Access and effectiveness in psychological therapies: self-help as a routine health technology.

The ability of psychological treatment services to deliver effective and accessible mental healthcare, as demanded by the National Service Framework for mental health, is compromised by the traditional configuration of psychological therapy services, powerful gatekeeping by these services and the difficulties which exist in engaging primary care in mental healthcare. Although a number of service models have been suggested, most address access from the perspective of secondary care service providers. In particular, self-help, a powerful ideology and a clinically effective health technology, is given insufficient prominence in psychological therapy services. Self-help is often only considered for mild problems or as an adjunct to therapy, and it is assumed that mental health professionals with traditional therapeutic skills are needed to support self-help. Following a review of access and self-help in psychological therapies, the present authors propose criteria against which services could be designed in order to fully utilise self-help as a powerful health technology in psychological therapies. Accompanying these criteria is a research framework drawn from recent work on access and illness self-management that can be used to evaluate the performance of services attempting to improve access to psychological therapies.

Adaptation, Psychological↗

PubMed2003

Agoraphobia: nurse therapist-facilitated self-help manual.

BACKGROUND: Agoraphobia is a common and disabling mental health disorder. Substantial evidence supports the use of cognitive behaviour therapy (CBT), in particular the intervention termed exposure therapy, as the treatment of choice. However, although the evidence base for cognitive-behaviour therapy is extensive, the service delivery evidence base is poor, and alternative ways of delivering therapy are required if mental health services are to achieve standards set out by the National Service Framework in the United Kingdom. AIM: The study had two aims: (1) to develop a self-help manual, which could be facilitated by a nurse trained in CBT, for clients suffering from agoraphobia and (2) to pilot the self-help manual and evaluate its effectiveness. METHOD: The self-help manual was piloted with experienced nurses trained in CBT on three clinical sites for 10 weekly sessions of 30 minutes duration. A range of clinical outcome measures was administered by an independent assessor before and after treatment and at 1-month follow-up. RESULTS: A total of 18 clients completed treatment and results showed improvement on all clinical measures; improvement was maintained at 1-month follow-up. Importantly, 89% of clients were clinically significantly improved at post-treatment assessment. Clients were satisfied with their treatment and the self-help manual, and therapists found facilitated self-help an acceptable way to deliver treatment. CONCLUSION: Nurses can deliver effective support to patients using a self-help manual for agoraphobia. Although the results are promising, further work is required with larger numbers, longer follow-up and economic evaluation under controlled conditions. The work could also be adapted to different psychological conditions. Variation in the amount of specialist educational training is necessary to determine how many nurses are needed to support patients using self-help.

Adolescent↗

PubMed2003

Improving access to primary mental health care: uncontrolled evaluation of a pilot self-help clinic.

Psychological therapy is widespread in primary care, but demand often exceeds supply. Innovative self-help approaches may overcome some problems associated with access to therapists. The feasibility, acceptability, efficiency, and effectiveness of a fast-access mental health self-help clinic were examined in a pilot study. The therapist saw 159 patients in 16 months, and on average required only one hour per patient. Generally, patients who used the clinic were satisfied. They reported similar levels of distress at baseline as patients in traditional psychological therapy services, and comparable outcomes. The self-help clinic approach should be evaluated formally within a randomised controlled trial.

Adolescent↗

PubMedDate not supplied

Developing a U.K. protocol for collaborative care: a qualitative study.

OBJECTIVE: This study aimed to explore the views of stakeholders including patients, general practitioners (GPs) and mental health workers on the feasibility, acceptability and barriers to a collaborative care model for treatment of depression within the context of U.K. primary health care. METHOD: We used semistructured interviews and focus groups with a purposive sample of 11 patients and 38 professionals from a wide selection of primary and secondary care mental health services, as well as framework analysis using a "constant comparative" approach to identify key concepts and themes. RESULTS: Regular contact for patients with depression is acceptable and valued by both patients and professionals. However, patients value support, whereas professionals focus on information. To be acceptable to patients, contacts about medication or psychosocial support must minimize the potential for patient disempowerment. The use of the telephone is convenient and lends anonymity, but established mental health workers think it will impair their judgments. While patients merely identified the need for skilled case managers, GPs preferred established professionals; however, these workers did not see themselves in this role. All involved were cautious about deploying new workers. Additional barriers included practical and organizational issues. CONCLUSIONS: Although a telephone-delivered mix of medication support and low-intensity psychological intervention is generally acceptable, significant issues to be addressed include the values of the current mental health workforce, fears about new workers' experience and competence, the balance of face-to-face and telephone contacts and case manager education in nonspecific skills necessary to develop a therapeutic alliance, as well as the knowledge and skills required for education, medication support and behavioral activation. Qualitative research can add value to careful modeling of collaborative care prior to international implementation.

Attitude of Health Personnel↗