Biomedical subjects

P Bower

Publications and source records attributed to P Bower.

30 records · Page 2Linked to original sources

PubMed2000

Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy and usual general practitioner care in the management of depression as well as mixed anxiety and depression in primary care.

OBJECTIVES: The aim of this study was to determine both the clinical and cost-effectiveness of usual general practitioner (GP) care compared with two types of brief psychological therapy (non-directive counselling and cognitive-behaviour therapy) in the management of depression as well as mixed anxiety and depression in the primary care setting. DESIGN: The design was principally a pragmatic randomised controlled trial, but was accompanied by two additional allocation methods allowing patient preference: the option of a specific choice of treatment (preference allocation) and the option to be randomised between the psychological therapies only. Of the 464 patients allocated to the three treatments, 197 were randomised between the three treatments, 137 chose a specific treatment, and 130 were randomised between the psychological therapies only. The patients underwent follow-up assessments at 4 and 12 months. SETTING: The study was conducted in 24 general practices in Greater Manchester and London. SUBJECTS: A total of 464 eligible patients, aged 18 years and over, were referred by 73 GPs and allocated to one of the psychological therapies or usual GP care for depressive symptoms. INTERVENTIONS: The interventions consisted of brief psychological therapy (12 sessions maximum) or usual GP care. Non-directive counselling was provided by counsellors who were qualified for accreditation by the British Association for Counselling. Cognitive-behaviour therapy was provided by clinical psychologists who were qualified for accreditation by the British Association for Behavioural and Cognitive Psychotherapies. Usual GP care included discussions with patients and the prescription of medication, but GPs were asked to refrain from referring patients for psychological intervention for at least 4 months. Most therapy sessions took place on a weekly basis in the general practices. By the 12-month follow-up, GP care in some cases did include referral to mental healthcare specialists. MAIN OUTCOME MEASURES: The clinical outcomes included depressive symptoms, general psychiatric symptoms, social function and patient satisfaction. The economic outcomes included direct and indirect costs and quality of life. Assessments were carried out at baseline during face-to-face interviews as well as at 4 and 12 months in person or by post. RESULTS: At 4 months, both psychological therapies had reduced depressive symptoms to a significantly greater extent than usual GP care. Patients in the psychological therapy groups exhibited mean scores on the Beck Depression Inventory that were 4-5 points lower than the mean score of patients in the usual GP care group, a difference that was also clinically significant. These differences did not generalize to other measures of outcome. There was no significant difference in outcome between the two psychological therapies when they were compared directly using all 260 patients randomised to a psychological therapy by either randomised allocation method. At 12 months, the patients in all three groups had improved to the same extent. The lack of a significant difference between the treatment groups at this point resulted from greater improvement of the patients in the GP care group between the 4- and 12-month follow-ups. At 4 months, patients in both psychological therapy groups were more satisfied with their treatment than those in the usual GP care group. However, by 12 months, patients who had received non-directive counselling were more satisfied than those in either of the other two groups. There were few differences in the baseline characteristics of patients who were randomised or expressed a treatment preference, and no differences in outcome between these patients. Similar outcomes were found for patients who chose either psychological therapy. Again, there were no significant differences between the two groups at 4 or 12 months. Patients who chose counselling were more satisfied with treatment than those who chose c

Adult↗

PubMed1999

Immobilized yeast bioreactor systems for continuous beer fermentation

Two different types of immobilized yeast bioreactors were examined for continuous fermentation of high-gravity worts. One of these is a fluidized bed reactor (FBR) that employs porous glass beads for yeast immobilization. The second system is a loop reactor containing a porous silicon carbide cartridge (SCCR) for immobilizing the yeast cells. Although there was some residual fermentable sugar in the SCCR system product, nearly complete attenuation of the wort sugars was achieved in either of the systems when operated as a two-stage process. Fermentation could be completed in these systems in only half the time required for a conventional batch process. Both the systems showed similar kinetics of extract consumption, and therefore similar volumetric productivity. As compared to the batch fermentation, total fusel alcohols were lower; total esters, while variable, were generally higher. The yeast biomass production was similar to that in a conventional fermentation process. As would be expected in an accelerated fermentation system, the levels of vicinal diketones (VDKs) were higher. To remove the VDKs, the young beer was heat-treated to convert the VDK precursors and processed through a packed bed immobilized yeast bioreactor for VDK assimilation. The finished product from the FBR system was found to be quite acceptable from a flavor perspective, albeit different from the product from a conventional batch process. Significantly shortened fermentation times demonstrate the feasibility of this technology for beer production.

Journal Article↗

PubMed1999

Conducting randomized trials in general practice: methodological and practical issues.

The evaluation of the outcome of health services technologies is a requirement for their efficient provision in clinical practice. The most reliable evidence for treatment efficacy comes from randomized trials. Randomized trials in general practice pose particular methodological and practical difficulties. In this paper, we discuss how best to plan and manage a clinical trial in this setting. We base our discussion on our experience of conducting randomized trials to evaluate the effectiveness of brief psychotherapy in general practice.

Ethics, Medical↗

PubMed1998

Understanding patients: implicit personality theory and the general practitioner.

The patient-centred general practitioner (GP) is expected to advance beyond biomedical illness categorization (the disease-centred method) and develop an understanding of the 'whole person' in order to inform clinical decision making. This paper argues that researchers cannot yet provide GPs with a relevant, reliable and predictive model of individual behaviour that would apply unproblematically to their everyday clinical work. Without such a system, it is hypothesized that GPs will continue to use their own implicit personality theories and models of human behaviour in their attempts to understand and predict patient behaviour. Research into such theories from a variety of perspectives could illuminate their content, structure, validity and function in general practice.

Communication↗

PubMed1997

Emotional problems in primary care: what is the potential for increasing the role of nurses?

It has been suggested that the role of primary care and community nurses should be expanded in relation to mental health in order to assist in the prevention and management of prevalent emotional disorders such as depression and anxiety. However, relatively little is known about the mental health work presently undertaken by these nurses. Furthermore, nurses' training needs, attitudes and organizational barriers to role expansion in this area have not been systematically explored. This article seeks to review the literature on nurses' potential and current mental health work, current and future training needs, the views of patients and nurses concerning an expanded nursing role, and organizational issues of relevance. Educational interventions which have been systematically evaluated are also reviewed. The results suggest that nurses are already involved in emotional health care with a variety of patient groups, although this is not always acknowledged as mental health work. While clear potential for an expanded role exists, there is little consensus as to what role would be most effective for each nursing group, and few educational interventions have been demonstrated to be of proven effectiveness.

Attitude to Health↗

PubMed1997

Measuring general practitioner psychology: the personal construct perspective.

BACKGROUND: According to personal construct theory (PCT), psychological processes are determined by the way in which individuals perceive differences and similarities between aspects of their environment and by the way this information is used to assist in the prediction of events. The important discriminations made by individuals are called "constructs'. OBJECTIVE: This article seeks to introduce PCT as a psychological measurement procedure to complement traditional standardized scales in research in general practice. METHOD: The repertory grid technique is a method of eliciting the content of the individual's constructs and determining their structure and inter-relationships. PCT and traditional measurement procedures are compared and contrasted, and the relevance of PCT to general practice psychology is discussed.

Attitude of Health Personnel↗

PubMed1995

Standardized Assessment for Elderly People (SAFE)--a feasibility study in district nursing.

Current policy requires systematic and comprehensive assessment of elderly people. Few standardized tools exist for assessment. This paper is in two parts. First it reports on the SAFE assessment measures agreed by a multidisciplinary working party initiated by the Royal College of Physicians and the British Geriatrics Society in 1992. The second part reports the findings of a feasibility study of SAFE in district nursing practice. The outcomes examined were the proportion of patients with completed assessments, the time taken to carry out the assessments, acceptability to the patient, carer and district nurse, and the training required. The findings show that SAFE is a practical and acceptable set of instruments in the assessment of elderly people by district nurses, but that further refinement is desirable.

Aged↗

PubMed1992

A comparison of academic and lay theories of schizophrenia.

This study investigated lay subjects' theories of schizophrenia. A questionnaire examining the five identified main academic theories of schizophrenia (medical, moral-behavioural, social, psychoanalytic, and conspiratorial) along various dimensions (aetiology, behaviour, treatment, function of the hospital, and the rights and duties of both patients and society) was constructed for use in the study. The results from 106 lay respondents showed that no single model was favoured exclusively but seemed to point to a synthesis of several academic theories. The lay subjects stressed the importance of patient environment in the aetiology of schizophrenia rather than a physiological malfunction, but tended to stress the personal rights of the schizophrenic. The differences between lay and the currently dominant psychiatric models are discussed in terms of the function these models serve for each group.

Activities of Daily Living↗

PubMed1981