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Biomedical subjects

M Chambers

Publications and source records attributed to M Chambers.

At least 19 recordsLinked to original sources
PubMed2006

An evaluation of a combined education and multi-project practice development programme in mental health.

This paper describes a unique mental health practice development programme, which aims to integrate education, research, clinical practice and culture change, and promote collaboration between academics, researchers and healthcare practitioners to meet current government policy needs. The programme combines academic qualifications within the context of practice development and aims to produce practitioners who are dynamic leaders, capable of critical thinking, influencing culture change and challenging the nature of conventional practice. The aim of the evaluation was to give insight into participants' experience of the programme using a qualitative approach. Open-ended questionnaires obtained participant's views on facilitation and module content. Focus groups discovered the views and experiences of participants of the programme. The findings showed that the programme was well-received and impacted positively on both patient care and the personal and professional development of participants. The findings were used to modify the programme for the next intake of participants. The research complements the existing body of knowledge on practice development and highlights the benefits for staff, nurses and service users, and the challenges of implementation. The framework and design has the potential to be applied to other areas of practice beyond mental health.

Evidence-Based Medicine↗
PubMed2006

Flexible trainees in Scotland.

INTRODUCTION: Demand for flexible training is increasing. The contribution of such trainees to the trained medical workforce is not clear. METHODS: All full time and flexible trainees in Scotland were 'tracked' at the completion of training. RESULTS: 80% of flexible trainees took up a consultant post of which 93% were in Scotland. 82% of full time trainees took up a consultant post of which 80% were in Scotland. DISCUSSION: Flexible trainees become consultants at the same rate as their full time counterparts. They are commonly geographically tied and are therefore more likely to remain in Scotland and contribute to retention of doctors in this country.

Attitude of Health Personnel↗
PubMed2005

Substance use and young people: the potential of technology.

There is widespread concern about alcohol and drug use and abuse among young people in the United Kingdom, Europe and the United States. Evaluations of current drug and alcohol education approaches have mixed findings and some methodological difficulties. This paper reports on exploratory research to explore the potential of technology to provide information and support to young people regarding substance use and abuse. Eight focus groups were conducted with young people (n = 78) and three with key informants (n = 22). The findings revealed that technology has potential to provide information on this topic, and that young people are critical of some of the more traditional methods of provision. The young people were prepared to experiment with technology, felt competent to do so, and made suggestions of information they would like. These findings are discussed and recommendations made for future research in the area.

Adolescent↗
PubMed2005

Outcomes of electrically stimulated gracilis neosphincter surgery.

OBJECTIVES: To examine patient quality of life (QoL) and long-term costs of electrically stimulated gracilis neosphincter surgery (ESGNS). DESIGN: Independently conducted prospective case-comparison study of patients at the Royal London Hospital (RLH), plus a cross-sectional study of outcomes of ESGNS performed at three other UK centres. PARTICIPANTS: Cases were patients who underwent ESGNS at the participating hospitals during a 5-year period from 1977. Comparisons were made with two groups of people with similar bowel disorders who did not undergo ESGNS. INTERVENTION: ESGNS is a procedure designed to improve bowel function for people living with severe faecal incontinence or stomas. It involves transposition of the gracilis muscle to form a neo-anal sphincter. The transposed muscle is electrically stimulated via an electronic pulse generator implanted beneath the skin of the abdomen. MAIN OUTCOME MEASURES: Clinical success and symptomatic outcomes of surgery. Generic, domain and condition specific measures of QoL. Comparative costs to the NHS of ESGNS and conventional alternatives. RESULTS: At 3 years after surgery approximately three-quarters of patients still had functioning neosphincters. At this stage, bowel-related QoL and continence improved by more than 20% for nearly two-thirds of RLH patients. However, ongoing bowel evacuation difficulties occurred in half of those with good continence outcomes. QoL improvements were maintained in the smaller group of RLH patients who had reached 4 and 5 years of follow-up, although at this stage the proportion with failed neosphincters had increased. The RLH findings were supported by those from the three other UK centres. No significant changes in QoL were observed in the comparison groups during the follow-up period. The mean cost of patient care at RLH, was 23,253 pounds. In the other three centres, the estimated mean cost of the intervention per patient was 11,731 pounds, reflecting fewer planned operations and repeat admissions. Costs of patient care for those with stomas who did not undergo ESGNS were estimated at 2125 pounds per patient-year and for those who remained with severe faecal incontinence, 442 pounds per patient-year. For patients with prior faecal incontinence, a decision to refer to ESGNS resulted in a cost-effectiveness ratio, estimated over 25 years of follow-up, of between 30,000 pounds and 40,000 pounds per quality-adjusted life-year (QALY) gained, depending on centre. The choice of stoma for these patients resulted in a slightly higher cost than ESGNS. For those with prior stoma, referral to ESGNS resulted in a cost-effectiveness ratio of between 5000 pounds and 15,000 pounds per QALY gained, depending on the centre. Cost-effectiveness ratios of around 30,000 pounds per QALY gained are generally regarded to be reasonably attractive in the UK NHS context. CONCLUSIONS: Although ESGNS is a major procedure associated with a high rate of long-term failure and bowel evacuation difficulty, it could be considered as an option at the extreme end of the treatment spectrum for refractory faecal incontinence. A strategy to refer patients for ESGNS would be regarded as cost-effective for patients already with stoma, whilst on the margin of cost-effectiveness for patients initially being managed conservatively.

Anal Canal↗
PubMed2002

Supporting family carers through the use of information and communication technology--the EU project ACTION.

Assisting Carers Using Telematics Interventions to meet Older persons' Needs (ACTION) is an EU project designed to improve the quality of life of frail older and disabled people and their family carers by the use of information and communication technology. It involved Sweden, England, Northern Ireland, the Republic of Ireland and Portugal. This article provides an overview of the research and development process of the ACTION system and services. The focus is upon the evaluation results with regard to the quality of life of older people and their family carers, the usability of ACTION and cost considerations. Recommendations are made regarding user-focused technology such as ACTION.

Aged↗
PubMed2002

Usability of multimedia technology to help caregivers prepare for a crisis.

The objective of the research was to evaluate the usability of a multimedia software application that provides information on coping with difficult situations, dealing with everyday caring problems, and first aid for emergency situations. Casual users (family caregivers, professional caregivers, and older people) were invited to use the software application and complete a questionnaire measuring quality and efficiency in utility and usability. Quantitative data were analyzed using the Statistical Package for the Social Sciences (SPSS) and qualitative data were analyzed by content analysis. Findings indicated the software application to have high global usability, correspond to user expectations, respond quickly, and be visually pleasant and easily understood. The authors conclude that software applications of this type have the potential to increase the quality of life of family caregivers, enhance their coping capacity, and enable them to continue for a longer period in their caring role.

Caregivers↗
PubMed2001

Exploring the emotional support needs and coping strategies of family carers.

This paper explores the emotional support needs and coping strategies of family carers derived from two focus group interviews, each group comprising seven family carers. The interviews were carried out in Northern Ireland as part of phase one of the ACTION (Assisting Carers using Telematics Interventions to meet Older persons Needs) project. The purpose of the interviews was to investigate family carers' needs and experiences, but this paper focuses specifically on the emotional support needs and coping strategies identified by group members. The issues discussed included information and social support needs, the emotional impact of caring, and coping with and adaptation to the caring role. The findings reveal that for the majority of family carers their experience was one of constant searching for support and information. The anxiety and frustration associated with inconsistent and irregular support and lack of information was a major source of concern for the carers in the study. However, the carers employed a number of positive and negative coping strategies to deal with the stress associated with their caregiving role. The study concluded with the recommendation for nurses and other health care professionals to become more proactive in assessing and meeting carers' emotional support needs.

Adaptation, Psychological↗
PubMed2001

Metastatic lesions in the joint associated with acute inflammatory arthritis after dendritic cell immunotherapy for metastatic melanoma.

A 47 year old man undergoing immunotherapy for metastatic melanoma with autologous dendritic cells pulsed with autologous tumour peptide and hepatitis B surface antigen developed acute left ankle arthritis. Gout and acute infection were excluded, and an autoimmune aetiology or occult metastasis were considered. The arthritis initially subsided with indomethacin, but the symptoms recurred 2 months later, and magnetic resonance imaging demonstrated metastatic melanoma of the left talus. Immunohistochemical staining of a cerebral metastatic deposit biopsied 1 week after the onset of arthritis demonstrated T-cell and macrophage infiltration of the tumour. In addition, the patient developed melanoma-specific delayed type hypersensitivity and cytotoxic T-cell responses after vaccination. Thus, the monoarthritis represented an 'appropriate' inflammatory response directed against metastatic melanoma.

Arthritis↗
PubMed2001

Technology as an aid to coping with caring: a usability evaluation of a telematics intervention.

This paper presents evaluation data for an interactive software program designed to provide family carers with information, advice and psychological support by way of feedback of their coping capacity. The multimedia program consists of an information-based package that provides carers with advice on health promotion and relaxation and offers them a range of coping strategies (for example, positive self-talk, assertiveness training and relaxation tapes and videos). The program also includes a carer's self-assessment instrument, designed to provide both family and professional carers with information to assess how family carers are coping with their care-giving role. As part of the usability evaluation, casual users (family carers, professional carers and older people) were invited to test the program and were administered a program evaluation questionnaire measuring quality and efficiency in utility and usability. Quantitative data were analysed by using the Statistical Package for the Social Sciences (SPSS) and qualitative data were analysed by content analysis. Findings indicated that the program is visually pleasant, easily understood, responds quickly and corresponds with user expectations. A number of recommendations are made for improvement of the navigation of the program.

Adaptation, Psychological↗
PubMed2000

Medication compliance in older individuals with depression: gaining the views of family carers.

Documented evidence indicates that medication non-compliance for the older person is a common and poorly understood problem. This paper reports on a pilot study, which used a focus group interview to explore carers' attitudes, experiences and perceptions regarding medication compliance for their older depressed relative. It aimed to understand the problems and challenges encountered by carers in respect of their relative being non-compliant, and provide material to develop a comprehensive educational and support package to promote antidepressant compliance. A convenience sample of seven carers participated in the focus group and a qualitative analysis of the interview identified a number of key issues. Carers had little knowledge of depression, they were not well informed regarding antidepressant medication and they took an active role to ensure compliance. The focus group highlighted the need for health care professionals to promote and encourage carers to be part of the older individuals treatment programme and provide concise and unambiguous educational information in relation to antidepressants and the importance of compliance.

Caregivers↗
PubMed2000

Tackling inequalities in health and social wellbeing: evidence of 'good practice' by nurses, midwives and health visitors.

This paper details a project which assessed the contribution made by nurses, midwives and health visitors to Targeting Health and Social Need (THSN). Targeting Health and Social Need is an important theme within the Northern Ireland Regional Strategy entitled Health and Wellbeing into the Next Millennium: A Regional Strategy for Health and Social Wellbeing 1997-2002 which is concerned with addressing inequalities in health status and social wellbeing. While there is a considerable body of research and information on variations in health and social wellbeing there is a paucity of corresponding research on those interventions which may improve the health of disadvantaged groups. Health professionals are addressing such inequalities so it is appropriate that their efforts should be recorded and assessed. The project was conducted jointly by the departments of nursing at The Queen's University of Belfast and the University of Ulster, funded by the Department of Health and Social Services and had a timetable that covered three phases. Phase 1 entailed the distribution of a survey questionnaire to all nurses, including those professionals working with community and voluntary groups, to assess their contribution to THSN. The paper describes the results from the 392 questionnaires identified (a response rate of almost 40%) and the work in phase 2 of analysing the responses by selection criteria devised by the Project Advisory Board to allow further investigation. The resulting interventions were reduced to 22 and in an overview of each of these a number of characteristics kept recurring that could serve to define aspects of 'good practice'. These 22 case studies demonstrate the efforts made by nurses and health professionals to change behaviour, practice, the community and the environment. Also highlighted are the nursing competencies gained through working, the lessons learnt and the problems and difficulties encountered. The paper concludes that the use of qualitative research opens the door to measures of social position that reflect the ways in which people define themselves and the relationships that sustain them. Although there is still some way to go in understanding the different approaches to evaluation, an environment that fosters the monitoring and assessment of practice might be created in the future within the nursing community.

Community Health Nursing↗
PubMed1999

Immature human monocyte-derived dendritic cells migrate rapidly to draining lymph nodes after intradermal injection for melanoma immunotherapy.

Injected antigen-loaded immature monocyte-derived dendritic cells (DCs) may be incapable of migrating from skin to draining lymph nodes for antigen presentation. The in vivo migratory capacity of intradermally administered immature monocyte-derived DCs was therefore investigated during a phase I/II clinical trial for metastatic melanoma. DCs cultured from adherent monocytes in the presence of autologous serum, granulocyte-macrophage colony stimulating factor and interleukin-4 were pulsed with antigen and labelled with technetium-99m hexamethylpropylene-amineoxime (99mTc-HMPAO) ex vivo, then injected intradermally. A 99mTc-HMPAO control containing an equivalent amount of radioactivity was injected into the opposite thigh. The pelvis was then imaged with a gamma camera. The DCs were characterized as immature by functional and phenotypic analysis. Labelled DCs travelled to the draining inguinal lymph nodes within 10 min, and the draining lymph nodes were clearly outlined up to 4 h after injection. Free NmTc outlined draining lymph nodes after 10 min but was cleared from the nodes within 1 h. Thus, immature human monocyte-derived DCs migrate rapidly to and remain in draining lymph nodes after intradermal injection for immunotherapy.

Adult↗
PubMed1999

Cost-effectiveness analysis of antiplatelet therapy in the prevention of recurrent stroke in the UK. Aspirin, dipyridamole and aspirin-dipyridamole.

OBJECTIVES: To evaluate the cost effectiveness from a UK health and social services perspective of antiplatelet therapies tested in the Second European Stroke Prevention Study (ESPS-2) in preventing recurrent stroke. To demonstrate the value of modelling studies in this area. DESIGN AND SETTING: A decision-analytic model was developed to evaluate health outcomes and associated costs. Sources of data for efficacy, adverse events, background event risks, disability and mortality were ESPS-2, the Oxfordshire Community Stroke Project and UK national statistics. Published national unit costs were applied to clinician panel estimates of resource use for acute stroke, rehabilitation and long term care. Outcome measures were strokes or disabled life-years averted, and disability-free, stroke-free or quality-adjusted life-years gained. PATIENTS AND INTERVENTIONS: 30-day survivors of ischaemic stroke treated with low dose aspirin, modified-release dipyridamole; the coformulation of low dose aspirin plus modified-release dipyridamole, or no antiplatelet therapy. MAIN OUTCOME MEASURES AND RESULTS: The model predicted that over 5 years the coformulation prevented 29 more strokes than aspirin alone per 1000 patients, at an additional cost of 1900 Pounds per stroke averted (1996 values). Over 5 years, each antiplatelet therapy was cost saving compared with no therapy. Results were sensitive to the cost of acute care, the cost of long term care of disabled stroke survivors, the effectiveness of therapy and the background risk of recurrent stroke. In sensitivity analyses, the cost effectiveness did not exceed 7000 Pounds per stroke averted or 11,000 Pounds per quality-adjusted life-year (QALY) gained, except when varying the effectiveness parameter. CONCLUSIONS: Application of a decision-analytic model to the results of ESPS-2 indicated that first-line therapy with the coformulation of modified-release dipyridamole and low dose aspirin to patients with a previous ischaemic stroke is likely to generate significant health benefits at modest extra costs to health and social services. The extra costs of treatment are balanced by the savings in future costs of acute care and long term care of the disabled. Future economic evaluations in this area should pay particular attention to the cost perspective, the duration of analysis, the selection of trials from which effectiveness data are derived, and the impact of the pooling of outcome events with potentially different economic consequences.

Aged↗
PubMed1998

Mice expressing the E7 oncogene of HPV16 in epithelium show central tolerance, and evidence of peripheral anergising tolerance, to E7-encoded cytotoxic T-lymphocyte epitopes.

In order to derive mice which expressed both the E7 open reading frame transgene of human papillomavirus type 16 in skin and MHC class 1 restriction elements for several E7-encoded cytotoxic T-lymphocyte (CTL) epitopes, K14.HPV16E7 mice which express E7 in basal keratinocytes were crossed to the F1 generation with A2.1 Kb transgenic mice which express the MHC binding cleft domains of human HLA A*0201, and murine H-2b. F1 mice (denoted K14E7 x A2.1) expressed E7 in the thymus at least as early as 2-5 days before birth. Immunisation of FVB x A2.1 control mice (transgenic for HLA A*0201 and H-2b but not for E7), with two HLA A*0201-restricted epitopes of E7 and one H-2b-restricted CTL epitope of E7, gave strong primary CTL responses recognising epitope-pulsed or constitutively E7-expressing syngeneic target cells. In contrast, in immunised K14E7 x A2.1 mice, the CTL responses to the H-2b epitope and one of the HLA A*0201 CTL epitopes were strongly down-regulated, and to the other HLA A*0201 epitope, completely abolished, as demonstrated by percentage specific killing by bulk splenocyte cultures in cytotoxicity assays, and by CTL precursor frequency analysis. In thymus-transplanted bone marrow radiation chimeras in which the immune system of K14E7 x A2.1 mice was replaced by a FVB x A2.1 immune system, specific immunisation did not result in reemergence of strong E7-directed CTL responses. In agreement with these in vitro findings, specific immunisation failed to significantly alter the course of E7-associated tumour development in K14E7 x A2.1 mice. These data are consistent with a model of central deletional CTL tolerance to E7-encoded epitopes recognised in the context of two distinct MHC class 1 restriction elements, and with the possibility of peripheral T-cell anergy maintained by expression of E7 in the skin.

Amino Acid Sequence↗
PubMed1998

Interpersonal mental health nursing: research issues and challenges.

Since Peplau outlined her perceptions of psychiatric/mental health nursing in (1952) interpersonal relationships has been considered by many as the core of practice. In the intervening period of almost a half century many researchers and theorists have endeavoured to develop and integrate Peplau's framework into day-to-day nursing activity. However, more recently, as a result of the fusion between the professional nursing agenda and the wider political agenda, the importance of interpersonal relationships and the individuality of psychiatric/mental health nursing is being questioned. This questioning is represented in the debate about the aetiology of mental illness, the choice of research methods to determine treatment outcomes and by association the role and value of the psychiatric/mental health nurse. This paper will focus on the interpersonal nature of psychiatric/mental health nursing and explore possible research approaches aimed at explicating its core. Attention will be given to the necessity of using pluralistic methodology in order to do so.

Health Knowledge, Attitudes, Practice↗