Search PubMed⌕ Search

Biomedical subjects

L Ridsdale

Publications and source records attributed to L Ridsdale.

At least 19 recordsLinked to original sources
PubMed2006

Headache and migraine in primary care: consultation, prescription, and referral rates in a large population.

BACKGROUND/AIMS: Headache is the most common new neurological symptom seen by general practitioners and neurologists. This study describes headache consultation, prescription, and referral rates in a large sample of UK general practices. METHODS: Analysis of data from patients > or = 15 years registered at 253 UK general practices diagnosed with headache/migraine from 1992 to 2000. Rates were age standardised using the European standard population for reference. RESULTS: There were 13.2 million patient years of observation. Headache consultation rates were 6.4/100 patients/year in women and 2.5 in men. They were highest at 15-24 years (15.8/100 in women; 5.8/100 in men), decreasing with age. Antimigraine drugs were prescribed at 36.7% of consultations for women and 26.6% for men. Among referrals to specialists, 55% were to neurology and 30% to general medicine. The neurology referral rate in patients with headache was 2.1/100, and was higher in men (2.7/100) than women (1.9/100). CONCLUSIONS: These results provide precise age specific and age standardised estimates for headache consulting in general practice, in addition to prescribing and referral to specialist care. Consultation rates are highest in young women; hospital referrals peak in middle aged men. Research is needed into reasons for referral, and on better ways of delivering headache services.

Adolescent↗
PubMed2004

Is graded exercise better than cognitive behaviour therapy for fatigue? A UK randomized trial in primary care.

BACKGROUND: Patients frequently present with unexplained fatigue in primary care, but there have been few treatment trials in this context. We aimed to test cognitive behaviour therapy (CBT) and graded exercise therapy (GET) for patients presenting to their family doctor with fatigue. Secondly, we described the outcome for a cohort of patients who presented to the same doctors with fatigue, who received standard care, plus a booklet. METHOD: This was a randomized trial, followed by a prospective cohort study. Twenty-two practices in SE England referred 144 patients aged 16 to 75 years with over 3 months of unexplained fatigue. Self-rated fatigue score, the hospital anxiety and depression rating scale, functional impairment, physical step-test performance and causal attributions were measured. In the trial six sessions of CBT or GET were randomly allocated. RESULTS: In the therapy groups the mean fatigue score decreased by 10 points (95% confidence interval (CI) = -25 to -15), with no significant difference between groups (mean difference = -1.3; CI = -3.9 to 1.3). Fewer patients attended for GET. At outcome one-half of patients had clinically important fatigue in both randomized groups, but patients in the group offered CBT were less anxious. Twenty-seven per cent of the patients met criteria for CFS at baseline. Only 25% of this subgroup recovered, compared to 60% of the subgroup that did not meet criteria for CFS. CONCLUSIONS: Short courses of GET were not superior to CBT for patients consulting with fatigue of over 3 months in primary care. CBT was easier 'to sell'. Low recovery in the CFS subgroup suggests that brief treatment is too short.

Adolescent↗
PubMed2004

Cost-effectiveness of cognitive behavioural therapy, graded exercise and usual care for patients with chronic fatigue in primary care.

BACKGROUND: Chronic fatigue is a common condition, frequently presenting in primary care. The aim of this study was to compare the cost-effectiveness of cognitive behavioural therapy (CBT) and graded exercise therapy (GET), and to compare therapy with usual care plus a self-help booklet (BUC). METHOD: Patients drawn from general practices in South East England were randomized to CBT or GET. The therapy groups were then compared to a group receiving BUC recruited after the randomized phase. The main outcome measure was clinically significant improvements in fatigue. Cost-effectiveness was assessed using the net-benefit approach and cost-effectiveness acceptability curves. RESULTS: Costs were available for 132 patients, and cost-effectiveness results for 130. Costs were dominated by informal care. There were no significant outcome or cost differences between the therapy groups. The combined therapy group had significantly better outcomes than the standard care group, and costs that were on average 149 pounds higher (a non-significant difference). Therapy would have an 81.9% chance of being cost-effective if society were willing to attach a value of around 500 pounds to each four-point improvement in fatigue. CONCLUSION: The cost-effectiveness of cognitive behavioural therapy and graded exercise were similar unless higher values were placed on outcomes, in which case CBT showed improved cost-effectiveness. The cost of providing therapy is higher than usual GP care plus a self-help booklet, but the outcome is better. The strength of this evidence is limited by the use of a non-randomized comparison. The cost-effectiveness of therapy depends on how much society values reductions in fatigue.

Adult↗
PubMed2003

How can a nurse intervention help people with newly diagnosed epilepsy? A qualitative study of patients' views.

The aim was to describe the patients' views of the challenges posed by a new diagnosis of epilepsy and their assessment of a nurse intervention. Neurologists in South-East England referred patients into the study. Following a trial of a nurse intervention a subgroup of patients were purposefully identified for in depth interviews. Transcriptions of tape-recorded interviews were analysed using qualitative methodology. We found that younger people with epilepsy seemed to experience more trouble with driving, jobs and managing their lives in the context of new epilepsy, while older people saw epilepsy as just another illness to cope with. Patients reported difficulty in remembering what their doctors told them which they attributed partly to lack of time available in the consultation. They valued the time, and the technique of probing with explanations used by the nurse. The nurse intervention was seen as useful in making sense of symptoms, tests, risk management, and driving regulations and in helping manage their medicine taking. We conclude that people with newly diagnosed epilepsy face different challenges, some of which are related to their age at diagnosis. Patients reported help from the nurse with understanding the diagnosis, tests, risk management and taking their medication. Follow-up is necessary to measure behavioural effects on self-management in the long-run.

Adolescent↗
PubMed2003

The economic cost of chronic fatigue and chronic fatigue syndrome in UK primary care.

BACKGROUND: Chronic fatigue and chronic fatigue syndrome are most often encountered in primary care settings. Given the disabling nature of chronic fatigue it may have a substantial impact on service use and costs as well as on employment. This study estimates this impact. METHOD: Patients presenting to general practitioners with unexplained chronic fatigue were recruited to the study. Service use over a 3 month period was measured and lost employment recorded. These data were used to estimate economic costs. Patients with chronic fatigue syndrome were compared to patients with only chronic fatigue using a multiple regression model with sample differences controlled. RESULTS: The mean total cost of services and lost employment across the sample was Pound Sterling1906 for the 3-month period with formal services accounting for 9.3% of this figure. Service use was higher for patients with chronic fatigue syndrome compared to those with chronic fatigue alone. Total 3-month costs were on average higher for chronic fatigue syndrome (Pound Sterling3515 v. Pound Sterling1176) but when sample differences were taken account of the mean difference was reduced to Pound Sterling1406 (P = 0.086). Over 90% of the cost was accounted for by care provided by friends and family members and by lost employment. Patients with dependants had significantly higher costs than those with none and costs were also significantly higher for greater levels of functional impairment. CONCLUSION: Chronic fatigue imposes substantial economic costs on society, mainly in the form of informal care and lost employment. Treatments need to be developed which recognize these impacts.

Adult↗
PubMed2003

Predictors of outcome in a fatigued population in primary care following a randomized controlled trial.

BACKGROUND: The objective of this study was to examine factors that predicted outcome in a chronically fatigued group of patients who were randomized to cognitive behaviour therapy or counselling in primary care. METHOD: Illness perceptions, attributions, fatigue, disability and demographic variables were recorded at assessment and levels of fatigue and disability were measured at 6 months post randomization. Logistic regression was used to examine associations. RESULTS: Factors that predicted a poor outcome (four or more on the fatigue questionnaire) were: poor social adjustment at assessment; the patients self-report that they had never seen the GP for an emotional reason; a physical illness attribution; and, a long perceived future illness duration. CONCLUSIONS: Patients who are more psychologically minded are more likely to improve with psychological treatments in primary care. General practitioners need to assess this before referring to an appropriate therapist.

Adolescent↗
PubMed2003

Distinguishing patients with chronic fatigue from those with chronic fatigue syndrome: a diagnostic study in UK primary care.

BACKGROUND: Chronic fatigue syndrome (CFS) has been defined, but many more patients consult in primary care with chronic fatigue that does not meet the criteria for CFS. General practitioners (GPs) do not generally use the CFS diagnosis, and have some doubt about the validity of CFS as an illness. AIM: To describe the proportion of patients consulting their GP for fatigue that met the criteria for CFS, and to describe the social, psychological, and physical differences between patients with CFS and those with non-CFS chronic fatigue in primary care. DESIGN OF STUDY: Baseline data from a trial of complex interventions for fatigue in primary care. SETTING: Twenty-two general practices located in London and the South Thames region of the United Kingdom recruited patients to the study between 1999 and 2001. METHOD: One hundred and forty-one patients who presented to their GP with unexplained fatigue lasting six months or more as a main symptom were recruited, and the Centers for Disease Control (CDC) case definition was applied to classify CFS. RESULTS: Approximately two-thirds (69%) of patients had chronic fatigue and not CFS. The duration of fatigue (32 months) and perceived control over fatigue were similar between groups; however, fatigue, functioning, associated symptoms, and psychological distress were more severe in the patients in the CFS group, who also consulted their GP significantly more frequently, were twice as likely to be depressed, and more than twice as likely to be unemployed. About half (CFS = 50%; chronic fatigue = 55%) in each group attributed their fatigue to mainly psychological causes. CONCLUSIONS: In primary care, CFS is a more severe illness than chronic fatigue, but non-CFS chronic fatigue is associated with significant fatigue and is reported at least twice as often. That half of patients, irrespective of CFS status, attribute their fatigue to psychological causes, more than is observed in secondary care, indicates an openness to the psychological therapies provided in that setting. More evidence on the natural history of chronic fatigue and CFS in primary care is required, as are trials of complex interventions. The results may help determine the usefulness of differentiating between chronic fatigue and CFS.

Adolescent↗
PubMed2002

How can a nurse intervention help people with newly diagnosed epilepsy? A qualitative study (of patients' views).

The aim was to describe the patients' views of the challenges posed by a new diagnosis of epilepsy and their assessment of a nurse intervention. Neurologists in South-East England referred patients into the study. Following a trial of a nurse intervention a subgroup of patients were purposefully identified for in-depth interviews. Transcriptions of tape-recorded interviews were analysed using qualitative methodology. We found that younger people with epilepsy seemed to experience more trouble with driving, jobs and managing their lives in the context of new epilepsy, while older people saw epilepsy as just another illness to cope with. Patients reported difficulty in remembering what their doctors told them which they attributed partly to lack of time available in the consultation. They valued the time, and the technique of probing with explanations used by the nurse. The nurse intervention was seen as useful in making sense of symptoms, tests, risk management, and driving regulations and in helping manage their medicine taking. We conclude that people with newly diagnosed epilepsy face different challenges, some of which are related to their age at diagnosis. Patients reported help from the nurse with understanding the diagnosis, tests, risk management and taking their medication. Follow-up is necessary to measure behavioural effects on self-management in the long run.

Adolescent↗
PubMed2001

Chronic fatigue in general practice: economic evaluation of counselling versus cognitive behaviour therapy.

BACKGROUND: There is a paucity of evidence relating to the cost-effectiveness of alternative treatment responses to chronic fatigue. AIM: To compare the relative costs and outcomes of counselling versus cognitive behaviour therapy (CBT) provided in primary care settings for the treatment of fatigue. DESIGN OF STUDY: A randomised controlled trial incorporating a cost-consequences analysis. SETTING: One hundred and twenty-nine patients from 10 general practices across London and the South Thames region who had experienced symptoms of fatigue for at least three months. METHOD: An economic analysis was performed to measure costs of therapy, other use of health services, informal care-giving, and lost employment. The principal outcome measure was the Fatigue Questionnaire; secondary measures were the Hospital Anxiety and Depression Scale and a social adjustment scale. RESULTS: Although the mean cost of treatment was higher for the CBT group (164 Pounds, standard deviation = 67) than the counselling group (109 Pounds, SD = 49; 95% confidence interval = 35 to 76, P < 0.001), a comparison of change scores between baseline and six-month assessment revealed no statistically significant differences between the two groups in terms of aggregate health care costs, patient and family costs or incremental cost-effectiveness (cost per unit of improvement on the fatigue score). CONCLUSIONS: Counselling and CBT both led to improvements in fatigue and related symptoms, while slightly reducing informal care and lost productivity costs. Counselling represents a less costly (and more widely available) intervention but no overall cost-effectiveness advantage was found for either form of therapy.

Adolescent↗
PubMed2001

Chronic fatigue in general practice: is counselling as good as cognitive behaviour therapy? A UK randomised trial.

BACKGROUND: Fatigue is a common symptom for which patients consult their doctors in primary care. With usual medical management the majority of patients report that their symptoms persist and become chronic. There is little evidence for the effectiveness of any fatigue management in primary care. AIM: To compare the effectiveness of cognitive behaviour therapy (CBT) with counselling for patients with chronic fatigue and to describe satisfaction with care. DESIGN OF STUDY: Randomised trial with parallel group design. SETTING: Ten general practices located in London and the South Thames region of the United Kingdom recruited patients to the trial between 1996 and 1998. Patients came from a wide range of socioeconomic backgrounds and lived in urban, suburban, and rural areas. METHOD: Data were collected before randomisation, after treatment, and six months later. Patients were offered six sessions of up to one hour each of either CBT or counselling. Outcomes include: self-report of fatigue symptoms six months later, anxiety and depression, symptom attributions, social adjustment and patients' satisfaction with care. RESULTS: One hundred and sixty patients with chronic fatigue entered the trial, 45 (28%) met research criteria for chronic fatigue syndrome; 129 completed follow-up. All patients met Chalder et al's standard criteria for fatigue. Mean fatigue scores were 23 on entry (at baseline) and 15 at six months' follow-up. Sixty-one (47%) patients no longer met standard criteria for fatigue after six months. There was no significant difference in effect between the two therapies on fatigue (1.04 [95% CI = -1.7 to 3.7]), anxiety and depression or social adjustment outcomes for all patients and for the subgroup with chronic fatigue syndrome. Use of antidepressants and consultations with the doctor decreased after therapy but there were no differences between groups. CONCLUSION: Counselling and CBT were equivalent in effect for patients with chronic fatigue in primary care. The choice between therapies can therefore depend on other considerations, such as cost and accessibility.

Adolescent↗
PubMed2000

The effect of specially trained epilepsy nurses in primary care: a review.

The paper describes the evidence on potential effects of specially trained nurses working in primary care for patients with epilepsy. The method used was a search and review of evidence published from 1992 to 1999. It was found that where nurses have been trained in epilepsy care, there is good evidence that it is feasible for them to set up and run clinics in family practice. Where this has been undertaken, there is level I evidence that this is acceptable and satisfactory to patients. Where clinics have been set up in primary care, there is level I evidence that there has been an increase in the information and advice recorded as being provided to patients. Structured checklists may additionally prompt service providers to increase the level of information provided to patients, and this hypothesis is being tested currently. In conclusion, epilepsy nurses can set up clinics for patients in primary care which are well attended, satisfy patients, and which are associated with better recording of advice given. There is little published evidence on outcome as opposed to process measures. Trials with adequate sample size and long-term follow-up are necessary to identify whether nurse monitoring with advice and counselling can benefit patients in terms of epilepsy self-management in the long run.

Epilepsy↗
PubMed2000

An epilepsy care package: the nurse specialist's role.

Deficiencies in existing primary care for people with epilepsy are well-recognized in the United Kingdom and include a lack of structure and an inability to meet the patients' needs for information and support to cope with their epilepsy. The introduction of clinics set up by nurse specialists within family practice in a few United Kingdom cities has met with a high degree of acceptability and satisfaction from patients. A package of care was developed to support epilepsy management in the community in the United Kingdom. It includes provision of advice and information, counseling, and interdisciplinary liaison. Nurse specialists with a sound training in epilepsy can adopt a proactive role and effectively deliver this package.

Adult↗
PubMed2000

Newly diagnosed epilepsy: can nurse specialists help? A randomized controlled trial. Epilepsy Care Evaluation Group.

PURPOSE: To describe a group of people with newly diagnosed epilepsy and to test the effect of an epilepsy nurse specialist on patients' knowledge of epilepsy, satisfaction with the advice provided, and psychological well-being. METHODS: Neurologists in the United Kingdom (U.K.) recruited adults with newly diagnosed epilepsy. Patients were randomized to receive the offer of two appointments with an epilepsy nurse specialist or usual medical care. The main outcome measures were a questionnaire assessing patients' knowledge of epilepsy, the Hospital Anxiety and Depression Scale, and patients' reported satisfaction with the advice and explanations provided on key epilepsy-related topics. RESULTS: Ninety people with new epilepsy completed the trial. At baseline, fewer than half the patients reported having been given enough advice on epilepsy, and there were important differences in patients' knowledge of epilepsy. Lack of a U.K. school-leaving examination pass (General Certificate School Examination) was associated with lower knowledge of epilepsy (p = 0.03). At follow-up, the patients randomized to see the nurse specialist were significantly more likely to report that enough advice had been provided on most epilepsy-related topics compared with the control group. There were no significant differences in knowledge of epilepsy scores. However, there were significant differences in the group who, at baseline, had knowledge scores in the lowest quartile; those randomized to the nurse had higher knowledge scores (42.7 vs. 37.2; p < 0.01). Compared with doctors, the nurse was highly rated for providing clear explanations. CONCLUSIONS: Patients who have less general education have less knowledge of epilepsy. The introduction of a nurse specialist in epilepsy is associated with a significant increase in patient reports that enough advice has been provided. Nurse intervention appears to help those with the least knowledge of epilepsy improve their knowledge scores.

Adolescent↗
PubMed1999

General practitioners' beliefs and attitudes about how to respond to death and bereavement: qualitative study.

OBJECTIVES: To investigate the perceptions of general practitioners when they are notified or hear of a death or bereavement in their practice; to explore doctors' accounts of their relationships with their patients in the context of bereavement; and to explore the concerns of general practitioners in managing themselves and bereaved patients. DESIGN: Semistructured interviews followed by qualitative content analysis. SETTING: London borough of Redbridge. PARTICIPANTS: 25 general practitioners. RESULTS: Almost all the doctors had felt guilty about issues relating to the death of patients. These feelings were based on their expectations of not making mistakes and diagnostic precision. They described a culture gap existing between hospital and general practice and a need to develop new models and methods to explain and manage the causes of illness presented to them. In the absence of useful teaching on bereavement, many devised strategies which relied more on their personal experiences. General practitioners used various methods to contact bereaved patients, especially if they had been involved in the terminal care or if the death was particularly shocking. The doctor was also bereaved by the death of well known patients and sometimes needed to grieve and express emotion. CONCLUSION: General practitioners may need support and learning methods to manage their own and their patients' bereavement.

Attitude of Health Personnel↗
PubMed1999

Promoting self-care in epilepsy: the views of patients on the advice they had received from specialists, family doctors and an epilepsy nurse.

The aim of the study was to examine patients' satisfaction with information and advice on epilepsy and self-care provided by medical specialists, general practitioners and a special nurse. We interviewed patients following a trial of nurse-run clinics for epilepsy in general practice. 44 patients, two-thirds of whom had at least one epilepsy attack in the prior 6 months were seen in their homes in the south of England. A recurring theme from interview data was that patients perceived the doctors' time as too limited to explain the condition and how to manage it, whilst the nurse had the time and expertise to do so. Overall the nurse trained in epilepsy care was valued highly for providing advice and support, especially in explaining the social aspects of epilepsy. Patients expressed the belief that they would have benefited most by seeing a special nurse at the time when epilepsy was first diagnosed.

Adolescent↗
PubMed1999

Tiredness as a ticket of entry. The role of patients' beliefs and psychological symptoms in explaining frequent attendance. General Practice Fatigue Group.

OBJECTIVES: To test when patients presented with fatigue whether their beliefs about its cause was related to their frequency of attending; and to measure the association between their fatigue and psychological symptoms and their frequency of attendance during the study year. DESIGN: A cohort study. SETTING: Primary health care. PATIENTS: Patients presenting with fatigue as their main symptom. MAIN OUTCOME MEASURES: A fatigue questionnaire, the general health questionnaire (GHQ), an attribution scale, and measurement of consulting frequency during the 6 months before and after the patient presented. RESULTS: Patients who believed their fatigue was due to a physical or costly physical cause consult for any reason significantly more frequently than patients who reported that psychological as well as physical problems might have caused their fatigue. Patients' psychological distress measured with the GHQ was more closely associated with frequent attendance than their level of fatigue was. CONCLUSIONS: When patients present with fatigue it is important to inquire about their beliefs and psychological symptoms; these factors may be more important than the fatigue itself in explaining their help-seeking behaviour.

Adolescent↗
PubMed1999

The effect of a special nurse on patients' knowledge of epilepsy and their emotional state. Epilepsy Evaluation Care Group.

BACKGROUND: People with epilepsy often report being given insufficient information and support. However, there is little evidence from general practice about how much they know and how they feel. AIM: To describe social differences in the knowledge of epilepsy of people with the condition and test the potential effect of a nurse intervention in general practice on patients' knowledge and depression levels. METHOD: A questionnaire that included measures of knowledge, anxiety, and depression was sent to people with epilepsy aged over 15 years who were registered with 37 general practitioners. Responders were randomized to a controlled trial, offering either two appointments with an epilepsy nurse or usual care. Six months later they were reassessed. RESULTS: Two hundred and fifty-one out of 283 (89%) of the patients with epilepsy completed questionnaires and entered the study at Stage 1. One hundred and ninety-six out of 232 (84%) of those who entered the study, who remained in the practices and were eligible, returned questionnaires at Stage 2. The average duration of epilepsy was 23 years (range 2-79 years). There were significant differences in patients' levels of knowledge of epilepsy at Stage 1. Younger people, those who had left school after 16 years of age, those with GCSEs, and people who belonged to self-help groups had higher knowledge levels, and these were independent effects. Older people and those with a recent epilepsy attack had significantly higher depression scores. Knowledge scores did not differ significantly after the nurse intervention (Stage 2). At Stage 2, the risk of depression was less in the group randomized to be offered nurse input; the effect was mainly in a subgroup of patients with no recent epilepsy attack; their risk of depression was a third of the risk in the control group. CONCLUSIONS: Knowledge of epilepsy differs significantly, with social factors and self-help group membership having independent effects. A nurse-run clinic reduced the risk of depression for people with no recent epilepsy attack, but knowledge levels were not affected. This does not exclude the potential for patients learning more about epilepsy; it may be useful to suggest that patients join self-help groups early on.

Adolescent↗