A5000990828- Health Systems, Economic Evaluations, Quality of Life
- Chronic Disease Management Strategies
- Primary Care and Health Outcomes
- Healthcare Policy and Management
- Complementary and Alternative Medicine Studies
- Telemedicine and Telehealth Implementation
- Patient Satisfaction in Healthcare
- Treatment of Major Depression
- Mental Health Treatment and Access
- Musculoskeletal pain and rehabilitation
- Global Health Care Issues
- Intimate Partner and Family Violence
- Respiratory and Cough-Related Research
- Cardiac Health and Mental Health
- Patient-Provider Communication in Healthcare
- Pediatric health and respiratory diseases
- Emergency and Acute Care Studies
- Mental Health Research Topics
- Clinical practice guidelines implementation
- Child Abuse and Trauma
- Digital Mental Health Interventions
- Health Promotion and Cardiovascular Prevention
- Asthma and respiratory diseases
- Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Dermatology and Skin Diseases
University of Bristol
2011-2020
National Institute for Health Research
2017-2019
Primary Health Care
2005-2018
NIHR School for Primary Care Research
2013-2018
NIHR Bristol Biomedical Research Centre
2018
At Bristol
2017
Community Care
2017
University Hospitals Bristol NHS Foundation Trust
2017
Royal Victoria Infirmary
2016
Great Ormond Street Hospital
2016
The management of people with multiple chronic conditions challenges health-care systems designed around single conditions. There is international consensus that care for multimorbidity should be patient-centred, focus on quality life, and promote self-management towards agreed goals. However, there little evidence about the effectiveness this approach. Our hypothesis was so-called 3D approach (based dimensions health, depression, drugs) patients would improve their health-related which...
To determine the effectiveness of lessons in Alexander technique, massage therapy, and advice from a doctor to take exercise (exercise prescription) along with nurse delivered behavioural counselling for patients chronic or recurrent back pain.Factorial randomised trial.64 general practices England.579 low pain; 144 were normal care, 147 massage, six technique lessons, 24 lessons; half each these groups prescription.Normal care (control), sessions on prescription counselling.Roland Morris...
<b>Objective</b> To determine whether modifying eating behaviour with use of a feedback device facilitates weight loss in obese adolescents. <b>Design</b> Randomised controlled trial 12 month intervention. <b>Setting</b> Hospital based obesity clinic. <b>Participants</b> 106 newly referred young people aged 9-17. <b>Interventions</b> A computerised device, Mandometer, providing real time to participants during meals slow down speed and reduce total intake; standard lifestyle modification...
In the United Kingdom (UK) over last 10 years, there has been a significant increase in use of vacuum-formed retainers (VFRs) rather than conventional Hawley retainers. There are currently no data to compare cost-effectiveness this change practice. The two aims study were (1) VFRs and 6 months, from perspective National Health Service, orthodontic practice, patient (2) satisfaction retainer groups. A randomized controlled trial (RCT) was carried out specialist Three hundred ninety-seven...
Objective To investigate whether paracetamol (acetaminophen) plus ibuprofen are superior to either drug alone for increasing time without fever and the relief of associated discomfort in febrile children managed at home. Design Individually randomised, blinded, three arm trial. Setting Primary care households England. Participants Children aged between 6 months years with axillary temperatures least 37.8°C up 41.0°C. Intervention Advice on physical measures reduce temperature provision of,...
S1 Using computerized adaptive testing Tim Croudace S2 Well-being: what is it, how does it compare to health and are the implications of using inform policy John Brazier O1 “Am I going get better?”—Using PROMs patients about likely benefit surgery Nils Gutacker, Andrew Street O2 Identifying Patient Reported Outcome Measures for an electronic Personal Health Record Dan Robotham, Samantha Waterman, Diana Rose, Safarina Satkunanathan, Til Wykes O3 Examining change process over time...
BackgroundCognitive behavioural therapy (CBT) is an effective treatment for people whose depression has not responded to antidepressants. However, the long-term outcome unknown. In a follow-up of CoBalT trial, we examined clinical and cost-effectiveness cognitive as adjunct usual care that included medication over 3–5 years in primary patients with treatment-resistant depression.MethodsCoBalT was randomised controlled trial done across 73 general practices three UK centres. recruited aged...
BackgroundThe UK lags behind many European countries in terms of cancer survival. Initiatives to address this disparity have focused on barriers presentation, symptom recognition, and referral for specialist investigation. Selection patients further investigation has come under particular scrutiny, although preferences thresholds the population not been studied. We investigated diagnostic testing colorectal, lung, pancreatic cancers primary-care attendees.MethodsIn a vignette-based study,...
Background Only one-third of patients with depression respond fully to treatment antidepressant medication. However, there is little robust evidence guide the management those whose symptoms are 'treatment resistant'. Objective The CoBalT trial examined clinical effectiveness and cost-effectiveness cognitive behavioural therapy (CBT) as an adjunct usual care (including pharmacotherapy) for primary treatment-resistant (TRD) compared alone. Design Pragmatic, multicentre individually randomised...
Many countries are exploring the potential of telehealth interventions to manage rising number people with chronic disorders. However, evidence effectiveness is ambiguous. Based on an evidence-based conceptual framework, we developed integrated service (the Healthlines Service) for disorders and assessed its in patients depression. We aimed compare Depression Service plus usual care alone.This study was a pragmatic, multicentre, randomised controlled trial participants recruited from 43...
The relevance of EEG effect parameters as a measure pharmacological intensity benzodiazepines was evaluated. concentration-EEG relationships four benzodiazepine agonists, flunitrazepam, midazolam, oxazepam and clobazam, were quantified in individual rats correlated with receptor affinity anticonvulsant these compounds. Male Wistar-derived received single i.v. dose flunitrazepam (2.5 mg/kg), midazolam (5 (10 mg/kg) clobazam (20 mg/kg). Arterial blood samples drawn frequently monitored...
Therapist-delivered online cognitive-behavioural therapy (CBT) has been found to be effective for depression in primary care.To determine the cost-effectiveness of CBT compared with usual care.Economic evaluation at 8 months alongside a randomised controlled trial. Cost National Health Service (NHS), personal costs, and value lost productivity, each outcomes based on Beck Depression Inventory quality-adjusted life-years (QALYs). Incremental analysis indicated NHS cost per QALY gain.Online...
Objective: The evaluation of a community-based exercise and education scheme for stroke survivors. Design: A single blind parallel group randomized controlled trial. Setting: Leisure community centres in the south-west England. Subjects: Stroke survivors (median (IQR) time post 10.3 (5.4—17.1) months). 243 participants were to standard care (124) or intervention (119). Intervention: Exercise schemes held twice weekly eight weeks, facilitated by volunteers qualified instructors (supported...
Comorbidity is increasingly common in primary care. The cost implications for patient care and budgetary management are unclear.To investigate whether caring patients with specific disease combinations increases or decreases costs compared treating separate one condition each.Retrospective observational study using data on 86 100 the General Practice Research Database.Annual was estimated each including consultations, medication, investigations. Patients comorbidity were defined as those a...
<b>Objectives</b> To assess the clinical effectiveness, effect on waiting times, and patient acceptability of PhysioDirect services in patients with musculoskeletal problems, compared usual care. <b>Design</b> Pragmatic randomised controlled trial to equivalence effectiveness. Patients were individually a 2:1 ratio or <b>Setting</b> Four physiotherapy England. <b>Participants</b> Adults (aged ≥18 years) referred by general practitioners self for physiotherapy. <b>Interventions</b> invited...
To develop a conceptual model for effective use of telehealth in the management chronic health conditions, and to this evaluate an intervention people with two exemplar conditions: raised cardiovascular disease risk depression.
<b>Objective</b> To assess whether non-clinical staff can effectively manage people at high risk of cardiovascular disease using digital health technologies. <b>Design</b> Pragmatic, multicentre, randomised controlled trial. <b>Setting</b> 42 general practices in three areas England. <b>Participants</b> Between 3 December 2012 and 23 July 2013 we recruited 641 adults aged 40 to 74 years with a 10 year 20% or more, no previous event, least one modifiable factor (systolic...
To test the hypothesis that group cognitive behavioural therapy (CBT) will produce an effective and cost-effective management strategy for patients in primary care with chronic fatigue syndrome/myalgic encephalopathy (CFS/ME). A double-blind, randomised controlled trial was adopted three arms. Outcomes were assessed at baseline 6 12 months after first assessment results analysed on intention-to-treat basis. health psychology department of illness a general hospital Bristol, UK. Adults...
Background As a result of long delays for physiotherapy musculoskeletal problems, several areas in the UK have introduced PhysioDirect services which patients telephone physiotherapist initial assessment and treatment advice. However, there is no robust evidence about effectiveness, cost-effectiveness or acceptability to PhysioDirect. Objective To investigate whether not equally as clinically effective more cost-effective than usual care with (MSK) problems primary care. Design Pragmatic...