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Adherence with Treatment

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Bamford Amy – One of the best experts on this subject based on the ideXlab platform.

  • Pressure garment to prevent abnormal scarring after burn injury in adults and children: the PEGASUS feasibility RCT and mixed-methods study.
    'National Institute for Health Research', 2018
    Co-Authors: Moiemen Naiem, Mathers Jonathan, Jones Laura, Bishop Jonathan, Kinghorn Philip, Monahan Mark, Calvert Melanie, Slinn Gemma, Gardiner Fay, Bamford Amy
    Abstract:

    BACKGROUND Eleven million people suffer a fire-related injury worldwide every year, and 71% have significant scarring. Pressure garment therapy (PGT) is a standard part of burn scar management, but there is little evidence of its clinical effectiveness or cost-effectiveness. OBJECTIVE To identify the barriers to, and the facilitators of, conducting a randomised controlled trial (RCT) of burn scar management with and without PGT and test whether or not such a trial is feasible. DESIGN Web-based surveys, semistructured individual interviews, a pilot RCT including a health economic evaluation and embedded process evaluation. SETTING UK NHS burns services. Interviews and the pilot trial were run in seven burns services. PARTICIPANTS Thirty NHS burns services and 245 staff provided survey responses and 15 staff participated in individual interviews. Face-to-face interviews were held with 24 adult patients and 16 parents of paediatric patients who had undergone PGT. The pilot trial recruited 88 participants (57 adults and 31 children) who were at risk of hypertrophic scarring and were considered suitable for scar management therapy. Interviews were held with 34 participants soon after recruitment, with 23 participants at 12 months and with eight staff from six sites at the end of the trial. INTERVENTIONS The intervention was standard care with pressure garments. The control was standard care comprising scar management techniques involving demonstration and recommendations to undertake massage three or four times per day with moisturiser, silicone Treatment, stretching and other exercises. MAIN OUTCOME MEASURES Feasibility was assessed by eligibility rates, consent rates, retention in allocated arms, Adherence with Treatment and follow-up and completion of outcome assessments. The outcomes from interview-based studies were core outcome domains and barriers to, and facilitators of, trial participation and delivery. RESULTS NHS burns services treat 2845 patients per annum (1476 paediatric and 1369 adult) and use pressure garments for 6-18 months, costing £2,171,184. The majority of staff perceived a need for a RCT of PGT, but often lacked equipoise around the research question and PGT as a Treatment. Strong views about the use of PGT have the potential to influence the conduct of a full-scale RCT. A range of outcome domains was identified as important via the qualitative research: perceptions of appearance, specific scar characteristics, function, pain and itch, broader psychosocial outcomes and Treatment burden. The outcome tools evaluated in the pilot trial did not cover all of these domains. The planned 88 participants were recruited: the eligibility rate was 88% [95% confidence interval (CI) 83% to 92%], the consent rate was 47% (95% CI 40% to 55%). Five (6%) participants withdrew, 14 (16%) were lost to follow-up and 8 (9%) crossed over. Adherence was as in clinical practice. Completion of outcomes was high for adult patients but poorer from parents of paediatric patients, particularly for quality of life. Sections on range of movement and willingness to pay were found to be challenging and poorly completed. LIMITATIONS The Brisbane Burn Scar Impact Profile appears more suitable in terms of conceptual coverage than the outcome scales that were used in the trial but was not available at the time of the study. CONCLUSIONS A definitive RCT of PGT in burn scar management appears feasible. However, staff attitudes to the use of pressure garments may lead to biases, and the provision of training and support to sites and an ongoing assessment of trial processes are required. FUTURE WORK We recommend that any future trial include an in-depth mixed-methods recruitment investigation and a process evaluation to account for this. TRIAL REGISTRATION Current Controlled Trials ISRCTN34483199. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 22, No. 36. See the NIHR Journals Library website for further project information

  • Pressure garment to prevent abnormal scarring after burn injury in adults and children: the PEGASUS feasibility RCT and mixed-methods study
    'National Institute for Health Research', 2018
    Co-Authors: Moiemen Naiem, Mathers Jonathan, Jones Laura, Bishop Jonathan, Kinghorn Philip, Monahan Mark, Calvert Melanie, Slinn Gemma, Gardiner Fay, Bamford Amy
    Abstract:

    Background: Eleven million people suffer a fire-related injury worldwide every year, and 71% have significant scarring. Pressure garment therapy (PGT) is a standard part of burn scar management, but there is little evidence of its clinical effectiveness or cost-effectiveness. Objective: To identify the barriers to, and the facilitators of, conducting a randomised controlled trial (RCT) of burn scar management with and without PGT and test whether or not such a trial is feasible. Design: Web-based surveys, semistructured individual interviews, a pilot RCT including a health economic evaluation and embedded process evaluation. Setting: UK NHS burns services. Interviews and the pilot trial were run in seven burns services. Participants: Thirty NHS burns services and 245 staff provided survey responses and 15 staff participated in individual interviews. Face-to-face interviews were held with 24 adult patients and 16 parents of paediatric patients who had undergone PGT. The pilot trial recruited 88 participants (57 adults and 31 children) who were at risk of hypertrophic scarring and were considered suitable for scar management therapy. Interviews were held with 34 participants soon after recruitment, with 23 participants at 12 months and with eight staff from six sites at the end of the trial. Interventions: The intervention was standard care with pressure garments. The control was standard care comprising scar management techniques involving demonstration and recommendations to undertake massage three or four times per day with moisturiser, silicone Treatment, stretching and other exercises. Main outcome measures: Feasibility was assessed by eligibility rates, consent rates, retention in allocated arms, Adherence with Treatment and follow-up and completion of outcome assessments. The outcomes from interview-based studies were core outcome domains and barriers to, and facilitators of, trial participation and delivery. © Queen’s Printer and Controller of HMSO 2018. This work was produced by Moiemen et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should ABSTRACT Results: NHS burns services treat 2845 patients per annum (1476 paediatric and 1369 adult) and use pressure garments for 6–18 months, costing £2,171,184. The majority of staff perceived a need for a RCT of PGT, but often lacked equipoise around the research question and PGT as a Treatment. Strong views about the use of PGT have the potential to influence the conduct of a full-scale RCT. A range of outcome domains was identified as important via the qualitative research: perceptions of appearance, specific scar characteristics, function, pain and itch, broader psychosocial outcomes and Treatment burden. The outcome tools evaluated in the pilot trial did not cover all of these domains. The planned 88 participants were recruited: the eligibility rate was 88% [95% confidence interval (CI) 83% to 92%], the consent rate was 47% (95% CI 40% to 55%). Five (6%) participants withdrew, 14 (16%) were lost to follow-up and 8 (9%) crossed over. Adherence was as in clinical practice. Completion of outcomes was high for adult patients but poorer from parents of paediatric patients, particularly for quality of life. Sections on range of movement and willingness to pay were found to be challenging and poorly completed. Limitations: The Brisbane Burn Scar Impact Profile appears more suitable in terms of conceptual coverage than the outcome scales that were used in the trial but was not available at the time of the study. Conclusions: A definitive RCT of PGT in burn scar management appears feasible. However, staff attitudes to the use of pressure garments may lead to biases, and the provision of training and support to sites and an ongoing assessment of trial processes are required. Future work: We recommend that any future trial include an in-depth mixed-methods recruitment investigation and a process evaluation to account for this. Trial registration: Current Controlled Trials ISRCTN34483199. Funding: 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. 22, No. 36. See the NIHR Journals Library website for further project informatio

Paula Zimbrean – One of the best experts on this subject based on the ideXlab platform.

  • Systematic Review: Treatment for Addictive Disorder in Transplant Patients
    The American journal on addictions, 2020
    Co-Authors: Walter Luchsinger, Paula Zimbrean
    Abstract:

    BACKGROUND AND OBJECTIVES The number of patients with substance use disorders in need for organ trantransplantation is expected to increase. Patients with addictive disorders are considered a higher risk of negative outcomes after organ trantransplantation due to the impact of substance use upon medical status and Adherence with Treatment. The goal of this systematic review was to assess the current literature on Treatment for addiction transplant candidates and recipients. METHODS We conducted a literature search within four databases PubMed, MEDLINE, EMBASE, and PsycINFO for publications dated 1/1/1988 to 12/31/2018. RESULTS Out of 3108 articles identified through database screening, 39 were included in the qualitative synthesis. Sixteen studies described addiction Treatment in groups over five patients. All the articles included liver transplant patients, with only two studies including patients who needed a kidney or a heart transplant. Nine articles described Treatment of alcohol use disorder exclusively, five focused on Treatment of opioid use disorders. Although 9 of 16 studies were prospective, the variability of the Treatment intervention, outcome measures, and control group when applicable prohibited a meaningful meta-analysis of the results. Eight articles that described the case reports are analyzed separately. DISCUSSION AND CONCLUSIONS Promising Treatment options for alcohol use disorder have been reported but more studies are needed to confirm their effectiveness and their feasibility. Methadone appears effective for opioid disorder in transplant patients. SCIENTIFIC SIGNIFICANCE To the best of our knowledge, this is the first systematic review on the Treatment of addictive disorders in transplant patients. (Am J Addict 2020;29:445-462).

Patrick J Raue – One of the best experts on this subject based on the ideXlab platform.

  • personalised intervention for people with depression and severe copd
    British Journal of Psychiatry, 2013
    Co-Authors: George S Alexopoulos, Dimitris N Kiosses, Jo Anne Sirey, Dora Kanellopoulos, Richard S Novitch, Samiran Ghosh, Joanna K Seirup, Patrick J Raue
    Abstract:

    Chronic obstructive pulmonary disease (COPD) is often complicated by depression and exemplifies the challenge in managing chronic illnesses that require active patient participation in care. In a clinical trial (NCT00151372), we compared a novel personalised intervention for depression and COPD (PID-C) targeting Treatment Adherence with Treatment as usual (TAU). In 138 patients with major depression and severe COPD, PID-C led to a higher remission rate and a greater reduction in depressive symptoms and in dyspnoea-related disability than TAU over 28 weeks and 6 months after the last session. If replicated, PID-C may serve as a care model for patients with both depression and medical illnesses with a deteriorating course.

Moiemen Naiem – One of the best experts on this subject based on the ideXlab platform.

  • Pressure garment to prevent abnormal scarring after burn injury in adults and children: the PEGASUS feasibility RCT and mixed-methods study.
    'National Institute for Health Research', 2018
    Co-Authors: Moiemen Naiem, Mathers Jonathan, Jones Laura, Bishop Jonathan, Kinghorn Philip, Monahan Mark, Calvert Melanie, Slinn Gemma, Gardiner Fay, Bamford Amy
    Abstract:

    BACKGROUND Eleven million people suffer a fire-related injury worldwide every year, and 71% have significant scarring. Pressure garment therapy (PGT) is a standard part of burn scar management, but there is little evidence of its clinical effectiveness or cost-effectiveness. OBJECTIVE To identify the barriers to, and the facilitators of, conducting a randomised controlled trial (RCT) of burn scar management with and without PGT and test whether or not such a trial is feasible. DESIGN Web-based surveys, semistructured individual interviews, a pilot RCT including a health economic evaluation and embedded process evaluation. SETTING UK NHS burns services. Interviews and the pilot trial were run in seven burns services. PARTICIPANTS Thirty NHS burns services and 245 staff provided survey responses and 15 staff participated in individual interviews. Face-to-face interviews were held with 24 adult patients and 16 parents of paediatric patients who had undergone PGT. The pilot trial recruited 88 participants (57 adults and 31 children) who were at risk of hypertrophic scarring and were considered suitable for scar management therapy. Interviews were held with 34 participants soon after recruitment, with 23 participants at 12 months and with eight staff from six sites at the end of the trial. INTERVENTIONS The intervention was standard care with pressure garments. The control was standard care comprising scar management techniques involving demonstration and recommendations to undertake massage three or four times per day with moisturiser, silicone Treatment, stretching and other exercises. MAIN OUTCOME MEASURES Feasibility was assessed by eligibility rates, consent rates, retention in allocated arms, Adherence with Treatment and follow-up and completion of outcome assessments. The outcomes from interview-based studies were core outcome domains and barriers to, and facilitators of, trial participation and delivery. RESULTS NHS burns services treat 2845 patients per annum (1476 paediatric and 1369 adult) and use pressure garments for 6-18 months, costing £2,171,184. The majority of staff perceived a need for a RCT of PGT, but often lacked equipoise around the research question and PGT as a Treatment. Strong views about the use of PGT have the potential to influence the conduct of a full-scale RCT. A range of outcome domains was identified as important via the qualitative research: perceptions of appearance, specific scar characteristics, function, pain and itch, broader psychosocial outcomes and Treatment burden. The outcome tools evaluated in the pilot trial did not cover all of these domains. The planned 88 participants were recruited: the eligibility rate was 88% [95% confidence interval (CI) 83% to 92%], the consent rate was 47% (95% CI 40% to 55%). Five (6%) participants withdrew, 14 (16%) were lost to follow-up and 8 (9%) crossed over. Adherence was as in clinical practice. Completion of outcomes was high for adult patients but poorer from parents of paediatric patients, particularly for quality of life. Sections on range of movement and willingness to pay were found to be challenging and poorly completed. LIMITATIONS The Brisbane Burn Scar Impact Profile appears more suitable in terms of conceptual coverage than the outcome scales that were used in the trial but was not available at the time of the study. CONCLUSIONS A definitive RCT of PGT in burn scar management appears feasible. However, staff attitudes to the use of pressure garments may lead to biases, and the provision of training and support to sites and an ongoing assessment of trial processes are required. FUTURE WORK We recommend that any future trial include an in-depth mixed-methods recruitment investigation and a process evaluation to account for this. TRIAL REGISTRATION Current Controlled Trials ISRCTN34483199. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 22, No. 36. See the NIHR Journals Library website for further project information

  • Pressure garment to prevent abnormal scarring after burn injury in adults and children: the PEGASUS feasibility RCT and mixed-methods study
    'National Institute for Health Research', 2018
    Co-Authors: Moiemen Naiem, Mathers Jonathan, Jones Laura, Bishop Jonathan, Kinghorn Philip, Monahan Mark, Calvert Melanie, Slinn Gemma, Gardiner Fay, Bamford Amy
    Abstract:

    Background: Eleven million people suffer a fire-related injury worldwide every year, and 71% have significant scarring. Pressure garment therapy (PGT) is a standard part of burn scar management, but there is little evidence of its clinical effectiveness or cost-effectiveness. Objective: To identify the barriers to, and the facilitators of, conducting a randomised controlled trial (RCT) of burn scar management with and without PGT and test whether or not such a trial is feasible. Design: Web-based surveys, semistructured individual interviews, a pilot RCT including a health economic evaluation and embedded process evaluation. Setting: UK NHS burns services. Interviews and the pilot trial were run in seven burns services. Participants: Thirty NHS burns services and 245 staff provided survey responses and 15 staff participated in individual interviews. Face-to-face interviews were held with 24 adult patients and 16 parents of paediatric patients who had undergone PGT. The pilot trial recruited 88 participants (57 adults and 31 children) who were at risk of hypertrophic scarring and were considered suitable for scar management therapy. Interviews were held with 34 participants soon after recruitment, with 23 participants at 12 months and with eight staff from six sites at the end of the trial. Interventions: The intervention was standard care with pressure garments. The control was standard care comprising scar management techniques involving demonstration and recommendations to undertake massage three or four times per day with moisturiser, silicone Treatment, stretching and other exercises. Main outcome measures: Feasibility was assessed by eligibility rates, consent rates, retention in allocated arms, Adherence with Treatment and follow-up and completion of outcome assessments. The outcomes from interview-based studies were core outcome domains and barriers to, and facilitators of, trial participation and delivery. © Queen’s Printer and Controller of HMSO 2018. This work was produced by Moiemen et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should ABSTRACT Results: NHS burns services treat 2845 patients per annum (1476 paediatric and 1369 adult) and use pressure garments for 6–18 months, costing £2,171,184. The majority of staff perceived a need for a RCT of PGT, but often lacked equipoise around the research question and PGT as a Treatment. Strong views about the use of PGT have the potential to influence the conduct of a full-scale RCT. A range of outcome domains was identified as important via the qualitative research: perceptions of appearance, specific scar characteristics, function, pain and itch, broader psychosocial outcomes and Treatment burden. The outcome tools evaluated in the pilot trial did not cover all of these domains. The planned 88 participants were recruited: the eligibility rate was 88% [95% confidence interval (CI) 83% to 92%], the consent rate was 47% (95% CI 40% to 55%). Five (6%) participants withdrew, 14 (16%) were lost to follow-up and 8 (9%) crossed over. Adherence was as in clinical practice. Completion of outcomes was high for adult patients but poorer from parents of paediatric patients, particularly for quality of life. Sections on range of movement and willingness to pay were found to be challenging and poorly completed. Limitations: The Brisbane Burn Scar Impact Profile appears more suitable in terms of conceptual coverage than the outcome scales that were used in the trial but was not available at the time of the study. Conclusions: A definitive RCT of PGT in burn scar management appears feasible. However, staff attitudes to the use of pressure garments may lead to biases, and the provision of training and support to sites and an ongoing assessment of trial processes are required. Future work: We recommend that any future trial include an in-depth mixed-methods recruitment investigation and a process evaluation to account for this. Trial registration: Current Controlled Trials ISRCTN34483199. Funding: 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. 22, No. 36. See the NIHR Journals Library website for further project informatio

Philippe Blache – One of the best experts on this subject based on the ideXlab platform.

  • Virtual Reality for Training Doctors to Break Bad News
    , 2016
    Co-Authors: Magalie Ochs, Philippe Blache
    Abstract:

    The way doctors deliver bad news has a significant impact on the therapeutic process: disease evolution, Adherence with Treatment recommendations, litigation possibilities (Andrade et al., 2010). However, both experienced clinicians and medical trainees consider this task as difficult, daunting, and stressful. Nowadays, training health care professional to break bad news, recommended by the French Haute Autorité de la Santé (HAS), is organized as workshops during which doctors disclose bad news to actors playing the role of patient. In our project, we are developing an embodied conversational agent simulating a patient to train doctors to break bad news. The embodied conversational agent is incorporated in an immersive virtual reality environment (a CAVE) integrating several sensors to detect and recognize in real time the verbal and non-verbal behavior of the doctors interacting with the virtual patient. The virtual patient will adapt its behavior depending on the doctor’s verbal and non-verbal behavior. The methodology used to construct the virtual patipatient behavior model is based on a quantitative and qualitative analysis of corpus of doctors training sessions.

  • Virtual Patient for Training Doctors to Break Bad News
    , 2016
    Co-Authors: Magalie Ochs, Brice Donval, Philippe Blache
    Abstract:

    The way doctors deliver bad news has a significant impact on the therapeutic process: disease evolution, Adherence with Treatment recommendations, litigation possibilities (Andrade et al., 2010). However, both experienced clinicians and medical trainees consider this task as difficult, daunting, and stressful. Nowadays, training health care professional to break bad news, recommended by the French Haute Autorite de la Sante (HAS), is organized as workshops during which doctors disclose bad news to actors playing the role of patient. In our project, we are developing an embodied conversational agent simulating a patient to train doctors to break bad news. The embodied conversational agent is incorporated in an immersive virtual reality environment (a CAVE) integrating several sensors to detect and recognize in real time the verbal and non-verbal behavior of the doctors interacting with the virtual patient. The virtual patient will adapt its behavior depending on the doctor’s verbal and non-verbal behavior. The methodology used to construct the virtual patipatient behavior model is based on a quantitative and qualitative analysis of corpus of doctors training sessions.

  • Virtual Patient for Training Doctors to Break Bad News
    , 2016
    Co-Authors: Magalie Ochs, Brice Donval, Philippe Blache
    Abstract:

    The way doctors deliver bad news has a significant impact on the therapeutic process: disease evolution, Adherence with Treatment recommendations, litigation possibilities (Andrade et al., 2010). However, both experienced clinicians and medical trainees consider this task as difficult, daunting, and stressful. Nowadays, training health care professional to break bad news, recommended by the French Haute Autorité de la Santé (HAS), is organized as workshops during which doctors disclose bad news to actors playing the role of patient. In our project, we are developing an embodied conversational agent simulating a patient to train doctors to break bad news. The embodied conversational agent is incorporated in an immersive virtual reality environment (a CAVE) integrating several sensors to detect and recognize in real time the verbal and non-verbal behavior of the doctors interacting with the virtual patient. The virtual patient will adapt its behavior depending on the doctor’s verbal and non-verbal behavior. The methodology used to construct the virtual patipatient behavior model is based on a quantitative and qualitative analysis of corpus of doctors training sessions.