ORCID Profile
0000-0001-7398-1346
Current Organisation
University of Liverpool
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Publisher: National Institute for Health and Care Research
Date: 2020
DOI: 10.3310/HTA24060
Abstract: People with advanced dementia who live and die in nursing homes experience variable quality of life, care and dying. There is a need to identify appropriate, cost-effective interventions that facilitate high-quality end-of-life care provision. To establish the feasibility and acceptability to staff and family of conducting a cluster randomised controlled trial of the Namaste Care intervention for people with advanced dementia in nursing homes. The study had three phases: (1) realist review and (2) intervention refinement to inform the design of (3) a feasibility cluster randomised controlled trial with a process evaluation and economic analysis. Clusters (nursing homes) were randomised in a 3 : 1 ratio to intervention or control (usual care). The nature of the intervention meant that blinding was not possible. Nursing homes in England providing care for people with dementia. Residents with advanced dementia (assessed as having a Functional Assessment Staging Test score of 6 or 7), their informal carers and nursing home staff. Namaste Care is a complex group intervention that provides structured personalised care in a dedicated space, focusing on enhancements to the physical environment, comfort management and sensory engagement. The two contender primary outcome measures were Comfort Assessment in Dying – End of Life Care in Dementia for quality of dying (dementia) and Quality of Life in Late Stage Dementia for quality of life. The secondary outcomes were as follows: person with dementia, sleep/activity (actigraphy), neuropsychiatric symptoms, agitation and pain informal carers, satisfaction with care at the end of life staff members, person-centred care assessment, satisfaction with care at the end of life and readiness for change and other data – health economic outcomes, medication/service use and intervention activity. Phase 1 (realist review 86 papers) identified that a key intervention component was the activities enabling the development of moments of connection. In phase 2, refinement of the intervention enabled the production of a user-friendly 16-page A4 booklet. In phase 3, eight nursing homes were recruited. Two homes withdrew before the intervention commenced four intervention and two control homes completed the study. Residents with advanced dementia ( n = 32) were recruited in intervention ( n = 18) and control ( n = 14) homes. Informal carers (total, n = 12: intervention, n = 5 control, n = 7) and 97 staff from eight sites (intervention, n = 75 control, n = 22) were recruited over a 6-month period. Recruitment is feasible. Completion rates of the primary outcome questionnaires were high at baseline (100%) and at 4 weeks (96.8%). The Quality of Life in Late Stage Dementia was more responsive to change over 24 weeks. Even where economic data were missing, these could be collected in a full trial. The intervention was acceptable the dose varied depending on the staffing and physical environment of each care home. Staff and informal carers reported changes for the person with dementia in two ways: increased social engagement and greater calm. No adverse events related to the intervention were reported. A subsequent definitive trial is feasible if there are amendments to the recruitment process, outcome measure choice and intervention specification. In a full trial, consideration is needed of the appropriate outcome measure that is sensitive to different participant responses, and of clear implementation principles for this person-centred intervention in a nursing home context. Current Controlled Trials ISRCTN14948133. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment Vol. 24, No. 6. See the NIHR Journals Library website for further project information.
Publisher: Springer Science and Business Media LLC
Date: 20-02-2016
Publisher: Springer Science and Business Media LLC
Date: 11-2016
Abstract: Objectives Current guidance recommends that dental practitioners should routinely give dietary advice to patients, with diet diaries as a tool to help diet assessment. We explored patients' compliance with diet-diaries usage in a paediatric clinic within a teaching hospital setting, where remuneration is not an issue. Objectives were to investigate associated factors affecting diet diaries return rate and the information obtained from returned diaries.Methods A retrospective study of 200 randomly selected clinical records of children aged 5-11 years who had received diet analysis and advice as part of a preventive dental care programme at a dental teaching hospital between 2010 and 2013. Clinical records, with a preventive care pro forma, were included in the study. Data on social and family history, DMFT-dmft, oral hygiene practices, dental attendance and dietary habits were obtained and compared with information given in completed diet-diaries. A deductive content analysis of returned diet-diaries was undertaken using a pre-developed coding scheme.Results Of 174 complete records included in this study, diet diaries were returned in 60 (34.5%) of them. Diet diaries were more likely to be returned by those children who reported that they regularly brushed their teeth (P <0.05), and those who came from smaller families (P <0.05). Content analysis of diet diaries enabled the identification of harmful types of foods and drinks in 100% of diaries. General dietary issues, frequency and between-meals intake of sugars were also all captured in the majority of diaries (95.0%, N = 56). Information on sugar amount (53.0%, N = 32), prolonged-contact with teeth (57.0%, N = 34) and near bedtime intakes (17.0%, N = 28) was reported in fewer diaries.Conclusions The return rate of diet-diaries in this setting was low, and associated with patients' demographic and oral health characteristics. Returned diet-diaries showed a varied range of missing important dietary information, such as sugar amount, which appears to compromise their validity as a diet assessment tool. Development of a more reliable and acceptable dietary assessment tool for use in the dental setting is needed.
Publisher: Elsevier BV
Date: 09-2018
Publisher: Wiley
Date: 28-08-2017
Publisher: BMJ
Date: 11-2018
DOI: 10.1136/BMJOPEN-2018-026531
Abstract: Many people living with advanced dementia live and die in nursing care homes. The quality of life, care and dying experienced by these people is variable. Namaste Care is a multisensory programme of care developed for people with advanced dementia. While there is emerging evidence that Namaste Care may be beneficial for people with dementia, there is a need to conduct a feasibility study to establish the optimum way of delivering this complex intervention and whether benefits can be demonstrated in end-of-life care, for in iduals and service delivery. The aim of the study is to ascertain the feasibility of conducting a full trial of the Namaste Care intervention. A feasibility study, comprising a parallel, two-arm, multicentre cluster controlled randomised trial with embedded process and economic evaluation. Nursing care homes (total of eight) who deliver care to those with advanced dementia will be randomly allocated to intervention (delivered at nursing care home level) or control. Three participant groups will be recruited: residents with advanced dementia, informal carers of a participating resident and nursing care home staff. Data will be collected for 6 months. Feasibility objectives concern the recruitment and s ling of nursing homes, residents, informal carers and staff the selection and timing of primary (quality of dying and quality of life) and secondary clinical outcome measures (person centredness, symptom presence, agitation, quality of life, resource use and costs and residents’ activity monitored using actigraphy). Acceptability, fidelity and sustainability of the intervention will be assessed using semistructured interviews with staff and informal carers. This protocol has been approved by NHS Wales Research Ethics Committee 5 (ref: 17/WA0378). Dissemination plans include working with a public involvement panel, through a website ( www.namastetrial.org.uk ), social media, academic and practice conferences and via peer reviewed publications. ISRCTN14948133 Pre-results.
Publisher: National Institute for Health and Care Research
Date: 2020
DOI: 10.3310/HSDR08030
Abstract: A new NHS dental practice contract is being tested using a traffic light (TL) system that categorises patients as being at red (high), amber (medium) or green (low) risk of poor oral health. This is intended to increase the emphasis on preventative dentistry, including giving advice on ways patients can improve their oral health. Quantitative Light-Induced Fluorescence (QLF™) cameras (Inspektor Research Systems BV, Amsterdam, the Netherlands) also potentially offer a vivid portrayal of information on patients’ oral health. Systematic review – objective: to investigate how patients value and respond to different forms of information on health risks. Methods: electronic searches of nine databases, hand-searching of eight specialist journals and backwards and forwards citation-chasing followed by duplicate title, abstract- and paper-screening and data-extraction. Inclusion criteria limited studies to personalised information on risk given to patients as part of their health care. Randomised controlled trial (RCT) – setting: NHS dental practice. Objective: to investigate patients’ preferences for and response to different forms of information about risk given at check-ups. Design: a pragmatic, multicentred, three-arm, parallel-group, patient RCT. Participants: adults with a high/medium risk of poor oral health attending NHS dental practices. Interventions: (1) information given verbally supported by a card showing the patient’s TL risk category (2) information given verbally supported by a QLF photograph of the patient’s mouth. The control was verbal information only (usual care). Main outcome measures: primary outcome – median valuation for the three forms of information measured by willingness to pay (WTP). Secondary outcomes included toothbrushing frequency and duration, dietary sugar intake, smoking status, self-rated oral health, a basic periodontal examination, Plaque Percentage Index and the number of tooth surfaces affected by caries (as measured by QLF). Qualitative study – an ethnography involving observations of 368 dental appointments and interviews with patients and dental teams. Systematic review – the review identified 12 papers (nine of which were RCTs). Eight studies involved the use of computerised risk assessments in primary care. Intervention effects were generally modest, even with respect to modifying risk perceptions rather than altering behaviour or clinical outcomes. RCT – the trial found that 51% of patients identified verbal information as their most preferred form, 35% identified QLF as most preferred and 14% identified TL information as most preferred. The median WTP for TL was about half that for verbal information alone. Although at 6 and 12 months patients reported taking less sugar in drinks, and at 12 months patients reported longer toothbrushing, there was no difference by information group. Qualitative study – there was very little explicit risk talk. Lifestyle discussions were often cursory to avoid causing shame or embarrassment to patients. Only 45% of patients were retained in the trial at 6 months and 31% were retained at 12 months. The trial was conducted in four dental practices, and five dental practices were involved in the qualitative work. Patients prefer personal, detailed verbal advice on oral health at their check-up. A new NHS dental practice contract using TL categorisation might make this less likely. Research on how to deliver, within time constraints, effective advice to patients on preventing poor oral health. More research on ‘risk work’ in wider clinical settings is also needed. Current Controlled Trials ISRCTN71242343. This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research Vol. 8, No. 3. See the NIHR Journals Library website for further project information.
Publisher: Elsevier BV
Date: 2021
DOI: 10.2139/SSRN.3767901
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Girvan Burnside.