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At least 1,477 records · Page 82Linked to original sources
PubMed2003

Randomised controlled trial of smoking cessation intervention after admission for coronary heart disease.

OBJECTIVE: To determine whether a nurse led smoking cessation intervention affects smoking cessation rates in patients admitted for coronary heart disease. DESIGN: Randomised controlled trial. SETTING: Cardiac ward of a general hospital, Norway. PARTICIPANTS: 240 smokers aged under 76 years admitted for myocardial infarction, unstable angina, or cardiac bypass surgery. 118 were randomly assigned to the intervention and 122 to usual care (control group). INTERVENTION: The intervention was based on a booklet and focused on fear arousal and prevention of relapses. The intervention was delivered by cardiac nurses without special training. The intervention was initiated in hospital, and the participants were contacted regularly for at least five months. MAIN OUTCOME MEASURE: Smoking cessation rates at 12 months determined by self report and biochemical verification. RESULTS: 12 months after admission to hospital, 57% (n = 57/100) of patients in the intervention group and 37% (n = 44/118) in the control group had quit smoking (absolute risk reduction 20%, 95% confidence interval 6% to 33%). The number needed to treat to get one additional person who would quit was 5 (95% confidence interval, 3 to 16). Assuming all dropouts relapsed at 12 months, the smoking cessation rates were 50% in the intervention group and 37% in the control group (absolute risk reduction 13%, 0% to 26%). CONCLUSION: A smoking cessation programme delivered by cardiac nurses without special training, significantly reduced smoking rates in patients 12 months after admission to hospital for coronary heart disease.

Adult↗
PubMed2006

Use of personal child health records in the UK: findings from the millennium cohort study.

OBJECTIVES: The personal child health record (PCHR) is a record of a child's growth, development, and uptake of preventive health services, designed to enhance communication between parents and health professionals. We examined its use throughout the United Kingdom with respect to recording children's weight and measures of social disadvantage and infant health. DESIGN: Cross sectional survey within a cohort study. SETTING: UK. PARTICIPANTS: Mothers of 18,503 children born between 2000 and 2002, living in the UK at 9 months of age. MAIN OUTCOME MEASURES: Proportion of mothers able to produce their child's PCHR; proportion of PCHRs consulted containing record of child's last weight; effective use of the PCHR (defined as production, consultation, and child's last weight recorded). RESULTS: In all, 16,917 (93%) mothers produced their child's PCHR and 15,138 (85%) mothers showed effective use of their child's PCHR. Last weight was recorded in 97% of PCHRs consulted. Effective use was less in children previously admitted to hospital, and, in association with factors reflecting social disadvantage, including residence in disadvantaged communities, young maternal age, large family size (four or more children; incidence rate ratio 0.87; 95% confidence interval 0.83 to 0.91), and lone parent status (0.88; 0.86 to 0.91). CONCLUSIONS: Use of the PCHR is lower by women living in disadvantaged circumstances, but overall the record is retained and used by a high proportion of all mothers throughout the UK in their child's first year of life. PCHR use is endorsed in the National Service Framework for Children and has potential benefits which extend beyond the direct care of individual children.

Body Weight↗
PubMed2004

Randomised controlled trial of effect of leaflets to empower patients in consultations in primary care.

OBJECTIVE: To assess the impact of leaflets encouraging patients to raise concerns and to discuss symptoms or other health related issues in the consultation. DESIGN: Randomised controlled trial. SETTING: Five general practices in three settings in the United Kingdom. PARTICIPANTS: 636 consecutive patients, aged 16-80 years, randomised to receive a general leaflet, a depression leaflet, both, or neither. MAIN OUTCOMES: Mean item score on the medical interview satisfaction scale, consultation time, prescribing, referral, and investigation. RESULTS: The general leaflet increased patient satisfaction and was more effective with shorter consultations (leaflet 0.64, 95% confidence interval 0.19 to 1.08; time 0.31, 0.0 to 0.06; interaction between both -0.045, -0.08 to-0.009), with similar results for subscales related to the different aspects of communication. Thus for a 10 minute consultation the leaflet increased satisfaction by 7% (seven centile points) and for a five minute consultation by 14%. The leaflet overall caused a small non-significant increase in consultation time (0.36 minutes, -0.54 to 1.26). Although there was no change in prescribing or referral, a general leaflet increased the numbers of investigations (odds ratio 1.43, 1.00 to 2.05), which persisted when controlling for the major potential confounders of perceived medical need and patient preference (1.87, 1.10 to 3.19). Most of excess investigations were not thought strongly needed by the doctor or the patient. The depression leaflet had no significant effect on any outcome. CONCLUSIONS: Encouraging patients to raise issues and to discuss symptoms and other health related issues in the consultation improves their satisfaction and perceptions of communication, particularly in short consultations. Doctors do, however, need to elicit expectations to prevent needless investigations.

Adolescent↗
PubMed2004

Randomised controlled factorial trial of dietary advice for patients with a single high blood pressure reading in primary care.

OBJECTIVE: To assess the effect of brief interventions during the "watchful waiting" period for hypertension. DESIGN: Factorial trial. SETTING: General practice. METHODS: 296 patients with blood pressure > 160/90 mm Hg were randomised to eight groups defined by three factors: an information booklet; low sodium, high potassium salt; prompt sheets for high fruit, vegetable, fibre; and low fat. MAIN OUTCOME MEASURES: Blood pressure (primary outcome); secondary outcomes of diet, weight, and dietary biomarkers (urinary sodium:potassium (Na:K) ratio; carotenoid concentrations). RESULTS: Blood pressure was not affected by the booklet (mean difference (diastolic blood pressure) at one month 0.2, 95% confidence interval 1.6 to 2.0), salt (0.13; 1.7 to 2.0), or prompts (0.52; 1.3 to 2.4). The salt decreased Na:K ratio (difference 0.32; 0.08 to 0.56, P = 0.01), and the prompts helped control weight (difference 0.39 (0.85 to 0.05) kg at one month, P = 0.085; 1.2 (0.1 to 2.25) kg at six months, P = 0.03). Among those with lower fruit and vegetable consumption (< 300 g per day), prompts increased fruit and vegetable consumption and also carotenoid concentrations (difference 143 (16 to 269) mmol/l, P < 0.03) but did not decrease blood pressure. CONCLUSION: During watchful waiting, over and above the effect of brief advice and monitoring, an information booklet, lifestyle prompts, and low sodium salt do not reduce blood pressure. Secondary analysis suggests that brief interventions-particularly lifestyle prompts-can make useful changes in diet and help control weight, which previous research indicates are likely to reduce the long term risk of stroke.

Adolescent↗
PubMed2006

Receiving a summary of the results of a trial: qualitative study of participants' views.

OBJECTIVE: To explore trial participants' responses to receiving a summary of the results of a trial in pregnancy. DESIGN: Qualitative study with semistructured interviews. PARTICIPANTS: 20 women who had when pregnant participated in the ORACLE trial of antibiotics for preterm labour and preterm rupture of the membranes and requested a copy of the trial results. RESULTS: Less than a fifth of women who participated in the ORACLE trial indicated that they wished to receive the trial results. Reactions to the leaflet summarising the trial results were generally positive or neutral, although some women had difficulty in understanding the leaflet, and there was evidence of possible negative implications for women who had adverse outcomes. Women requested the results because they were interested in being able to complete their own personal narrative. They wished to know to which arm of the trial they had been allocated and the implications for their own pregnancy, and they were disappointed with receiving a generic summary. Women's accounts indicated some confusion about the trial findings. CONCLUSIONS: Recommendations that research participants be routinely provided with the results of studies have been made without the benefit of research to show the consequences of doing this or how it should best be managed. Caution is needed, as is more evaluation of how feedback of results should be handled, and assessment of the risks, benefits, and costs.

Anti-Bacterial Agents↗
PubMed2006

Effect of different forms of information produced for cancer patients on their use of the information, social support, and anxiety: randomised trial.

OBJECTIVE: To explore the hypothesis that different methods of selecting and printing information for cancer patients could improve emotional support by affecting interaction with others, and so lead to improved psychological wellbeing. DESIGN: Randomised trial with eight groups (three factors, 2x2x2). Data collected at recruitment and three month follow-up. PARTICIPANTS: 400 patients starting radiotherapy, of whom 325 with breast or prostate cancer and complete anxiety and depression data were included in the analysis. INTERVENTIONS: Printed booklets: half had only general information from CancerBACUP about each patient's cancer and half had personalised information from the patient's medical record plus selected general information; half were composed of information chosen interactively by the patient and half were produced automatically with a larger volume of material; and half had additional advice on anxiety management and half did not. MAIN OUTCOME MEASURES: Patients' views of the information, use of their booklets with others; change in reported social support; change in anxiety and depression. RESULTS: The larger booklets produced automatically were more likely to be found useful and to tell patients something new and less likely to be seen as too limited than the booklets produced interactively, but they were also more likely to overwhelm some patients. Personalised booklets were more likely than general booklets to tell patients something new. There was no difference in patients' perceived understanding of their cancer by any of the intervention factors. Patients with personalised information were more likely to show their booklets to others and to think it helped in discussing their cancer or its treatment. There were no major differences in social support, anxiety, or depression by any intervention factors. CONCLUSIONS: Patients were more likely to show personalised information to their confidants than general information. Further research is needed into the effects of sharing information on patients' social support and anxiety. Trial registration US Government Clinical Trials Database NCT00127465.

Adult↗
PubMed2006

A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice.

OBJECTIVE: To assess different management strategies for acute infective conjunctivitis. DESIGN: Open, factorial, randomised controlled trial. SETTING: 30 general practices in southern England. PARTICIPANTS: 307 adults and children with acute infective conjunctivitis. INTERVENTION: One of three antibiotic prescribing strategies-immediate antibiotics (chloramphenicol eye drops; n = 104), no antibiotics (controls; n = 94), or delayed antibiotics (n = 109); a patient information leaflet or not; and an eye swab or not. MAIN OUTCOME MEASURES: Severity of symptoms on days 1-3 after consultation, duration of symptoms, and belief in the effectiveness of antibiotics for eye infections. RESULTS: Prescribing strategies did not affect the severity of symptoms but duration of moderate symptoms was less with antibiotics: no antibiotics (controls) 4.8 days, immediate antibiotics 3.3 days (risk ratio 0.7, 95% confidence interval 0.6 to 0.8), delayed antibiotics 3.9 days (0.8, 0.7 to 0.9). Compared with no initial offer of antibiotics, antibiotic use was higher in the immediate antibiotic group: controls 30%, immediate antibiotics 99% (odds ratio 185.4, 23.9 to 1439.2), delayed antibiotics 53% (2.9, 1.4 to 5.7), as was belief in the effectiveness of antibiotics: controls 47%, immediate antibiotics 67% (odds ratio 2.4, 1.1 to 5.0), delayed antibiotics 55% (1.4, 0.7 to 3.0), and intention to reattend for eye infections: controls 40%, immediate antibiotics 68% (3.2, 1.6 to 6.4), delayed antibiotics 41% (1.0, 0.5 to 2.0). A patient information leaflet or eye swab had no effect on the main outcomes. Reattendance within two weeks was less in the delayed compared with immediate antibiotic group: 0.3 (0.1 to 1.0) v 0.7 (0.3 to 1.6). CONCLUSIONS: Delayed prescribing of antibiotics is probably the most appropriate strategy for managing acute conjunctivitis in primary care. It reduces antibiotic use, shows no evidence of medicalisation, provides similar duration and severity of symptoms to immediate prescribing, and reduces reattendance for eye infections. TRIAL REGISTRATION: Current Controlled Trials ISRCTN32956955 [controlled-trials.com].

Acute Disease↗
PubMed2001

Treatment notes--an update.

In January 2000, we launched Treatment Notes--our series of leaflets for patients. By December, we had published 10 issues and were pleased to be able to supply a free sample copy of each one with Drug and Therapeutics Bulletin (DTB). However, the cost of printing complimentary copies (over 125,000 of each issue) has become prohibitive and, for the time being at least, Treatment Notes will only be available by order. Here, we review the origin and development of the series and explain the changes.

Humans↗
PubMed2003

Evaluation of an evidence based patient educational booklet for management of whiplash associated disorders.

OBJECTIVES: This study aimed to develop and evaluate an evidence based educational booklet on whiplash associated disorders. METHODS: A comprehensive review of the available scientific evidence produced a set of unambiguous patient centred messages that challenge unhelpful beliefs about whiplash and promote an active approach to recovery. These messages were incorporated into a novel booklet, which was then evaluated qualitatively for end user acceptability and its ability to impart the intended messages, and quantitatively for its ability to improve beliefs about whiplash and what to do about it. The subjects comprised people attending accident and emergency or manipulative practice with a whiplash associated disorder, along with a sample of workers without a whiplash associated disorder (n = 142). RESULTS: The qualitative results showed that the booklet was considered easy to read, understandable, believable, and conveyed its key messages. Quantitatively, it produced a substantial statistically significant improvement in beliefs about whiplash among accident and emergency patients (mean 6.5, 95% CI 3.9 to 9.1, p<0.001), and among workers (mean 9.4, 95% CI 7.9 to 10.9, p<0.001), but the shift in the more chronic manipulation patients was substantially smaller (mean 3.3, 95% CI 0.5 to 6.1, p<0.05). CONCLUSIONS: A rigorously developed educational booklet on whiplash (The Whiplash Book) was found acceptable to patients, and capable of improving beliefs about whiplash and its management; it seems suitable for use in the accident and emergency environment, and for wider distribution at the population level. A randomised controlled trial would be required to determine whether it exerts an effect on behaviour and clinical outcomes.

Adolescent↗
PubMed2005

Simple measures to reduce the rate of contamination of blood cultures in Accident and Emergency.

OBJECTIVES: To reduce the contamination rate of blood cultures taken in the Accident and Emergency (A&E) department. METHODS: The standard blood culture sampling kit was supplemented with an instruction sheet on the optimal method for drawing blood cultures and a large 62% ethyl alcohol impregnated wipe. RESULTS: There was a statistically significant reduction in the number of contaminants (p = 0.03). CONCLUSIONS: Simple measures to encourage skin disinfection and appropriate sampling technique will reduce the incidence of contamination of blood cultures in the A&E department.

Anti-Infective Agents, Local↗
PubMed2005

A randomised controlled trial of self-help interventions in patients with a primary care diagnosis of irritable bowel syndrome.

INTRODUCTION: Functional abdominal symptoms are very common and account for nearly two million primary care consultations in Britain every year and produce significant morbidity. The aims of this study were to evaluate the impact of two self-help interventions on consultation rates and symptom severity in patients with a primary care diagnosis of irritable bowel syndrome. METHODS: A total of 420 patients from 54 primary care centres were randomised either to receive self-help information in the form of a guidebook or the guidebook plus a "self-help" group meeting or to be in a control group receiving neither intervention. Data were collected using questionnaires and primary care records. RESULTS: At one year, patients in the guidebook group had a 60% reduction in primary care consultations (p < 0.001) and a reduction in perceived symptom severity (p < 0.001) compared with controls. Allocation to the self-help group conferred no additional benefit. Actual symptom scores did not change significantly in any group. Costs per patient were reduced by Pounds 73 (confidence interval Pounds 43, Pounds 103) or 40% per year. CONCLUSION: Introduction of a self-help guidebook results in a reduction in primary care consultations, a perceived reduction in symptoms, and significant health service savings. This suggests that patients attending their primary care physician with functional abdominal symptoms should be offered self-help information as part of their management.

Adult↗
PubMed1989

Effect of information leaflets on knowledge in patients with gastrointestinal diseases.

Twelve patient information leaflets concerning common gastrointestinal diseases were produced by the British Digestive Foundation and evaluated to determine whether patients knew more about their disease if they received a leaflet. Eleven hundred and fifty patients attending gastroenterology clinics in the United Kingdom were assessed by postal questionnaire of whom half had received a leaflet relevant to their diagnosis six weeks before assessment. Seven hundred and fifty one replied (398 leafleted, 353 non-leafleted). Most patients found the leaflets helpful and easy to understand; few found them worrying. They were regarded as a better source of information than doctors, particularly for information about the characteristics of the illness and side effects of treatment. In all diagnostic groups assessed the patients' knowledge of their disease was significantly greater if they had received a leaflet than if they had not. Individual responses by patients without leaflets showed that fundamental misconceptions persisted about digestive diseases. The British Digestive Foundation leaflets are an effective means of imparting disease related information to patients.

Female↗