Gene Feder | University of Bristol (original) (raw)

Papers by Gene Feder

BMJ, 2002

Why should you read about a trial comparing homoeopathic treatment to placebo? If you prescribe h... more Why should you read about a trial comparing homoeopathic treatment to placebo? If you prescribe homoeopathic medicines a trial will not influence your prescribing decisions because most trials of homoeopathic medicines do not individualise treatment, the hallmark of homoeopathic ...

The British journal of general practice : the journal of the Royal College of General Practitioners, 2015

The British journal of general practice : the journal of the Royal College of General Practitioners, 1997

In the United Kingdom (UK), 9% of adults consult their doctor annually with back pain. The treatm... more In the United Kingdom (UK), 9% of adults consult their doctor annually with back pain. The treatment recommendations are based on orthopaedic teaching, but the current management is causing increasing dissatisfaction. Many general practitioners (GPs) are confused about what constitutes effective advice. To review all randomized controlled trials of bed rest and of medical advice to stay active for acute back pain. A systematic review based on a search of MEDLINE and EMBASE from 1966 to April 1996 with complete citation tracking for randomized controlled trials of bed rest or medical advice to stay active and continue ordinary daily activities. The inclusion criteria were: primary care setting, patients with low back pain of up to 3 months duration, and patient-centred outcomes (rate of recovery from the acute attack, relief of pain, restoration of function, satisfaction with treatment, days off work and return to work, development of chronic pain and disability, recurrent attacks, a...

http://isrctn.org/>, 2000

Health Expectations, 2014

Informal and formal support for women experiencing domestic violence and abuse (DVA) can improve ... more Informal and formal support for women experiencing domestic violence and abuse (DVA) can improve safety and health outcomes. There has been little qualitative work on the role of both pathways to support and women's experiences of disclosing their experience of DVA in different contexts. This qualitative study used repeat interviews with women survivors of DVA to explore their pathways to support and their experiences of barriers and facilitators to disclosure and help-seeking. Thirty-one women seeking help from specialist DVA agencies in the UK were interviewed twice over 5 months. Women recounted long journeys of ambivalence, often only disclosing abuse after leaving the perpetrator. Access to specialist support rarely came via general practitioners, despite high levels of consulting for anxious and depressed feelings, and was more often facilitated by police or housing agencies following a crisis such as assault. Informal disclosure only led to specialist help if the family member or friend themselves had experience or knowledge of DVA. Women experiencing DVA need earlier access to specialized DVA services. Many women needed an 'enabler' to facilitate access, but once this contact was made, disclosure to other professionals or to family and friends was legitimized in the eyes of the women. Safely accessible publicity about DVA services and an appropriate response from social and health-care professionals should be promoted, including support for women disclosing DVA to take action on the information they receive about services.

sec> Aims Silent myocardial ischaemia occurs commonly in diabetes. Whether altered perception ... more sec> Aims Silent myocardial ischaemia occurs commonly in diabetes. Whether altered perception of ischaemia also predisposes to atypical presentations with under-diagnosis of coronary disease is not known. To determine whether (i) patients with diabetes diagnosed with angina are more likely to report atypical symptoms compared with patients without diabetes, and (ii) atypical symptoms in patients with diabetes cause angina to go unrecognized, increasing the risk of coronary events. Methods and results Prospective, multicentre cohort study of 8662 ambulatory patients with suspected angina, of whom 906 had diabetes. We recorded detailed chest pain descriptors and fatal and non-fatal coronary events over a median of 3.08 years of follow-up. Proportionately more patients with than without diabetes received a diagnosis of angina (42.7 vs. 25.1%). Among patients with diabetes diagnosed with angina, a greater proportion had atypical chest pain compared with patients without diabetes (21....

An extensive global perspective, written by an international team of experts Analyses how a publi... more An extensive global perspective, written by an international team of experts Analyses how a public health approach can help to prevent violence Multidisciplinary examination of interpersonal violence Violence has always been, and is to this day, a primary cause of tension and suffering the world over. More than half a million people are murdered each year around the world, making homicide the leading cause of death among people aged 15-44. The Oxford Textbook of Violence Prevention brings together an international team of experts to provide an extensive global account of the mortality and morbidity burden caused by violence. It does this by examining the causes of violence, and what can be done to prevent and reduce violence. Divided into six sections, the textbook analyses how a public health approach can help to prevent violence. This multidisciplinary book tackles interpersonal violence in all its forms. Early chapters describe epidemiology and consequences, followed by chapters ...

The Canadian journal of cardiology

Although the prevalence of angina remains high, the importance of grading angina severity is uncl... more Although the prevalence of angina remains high, the importance of grading angina severity is unclear. To determine the extent to which angina severity is associated with angiographic findings, and the rate of revascularization, mortality and nonfatal myocardial infarction. Prospective, population-based study with a 2.5-year follow-up of 2849 consecutive patients with angina undergoing coronary angiography at Barts and the London NHS Trust, London, United Kingdom, in the Appropriateness of Coronary Revascularisation (ACRE) study. Angina severity was assessed with the Canadian Cardiovascular Society (CCS) classification, ranging from class I (mild) to IV (severe). Outcome measures were revascularization rates, and all-cause mortality and nonfatal myocardial infarction. In age-adjusted analyses, a higher CCS class was linearly associated (P<0.001) with a higher number of diseased vessels and impaired left ventricular function. When adjusting for age, sex, smoking, history of hyperte...

Aggression and Violent Behavior, 2014

ABSTRACT Reflecting the higher prevalence of domestic violence and abuse experienced by women, an... more ABSTRACT Reflecting the higher prevalence of domestic violence and abuse experienced by women, and the recognised health impacts of such abuse, studies have focused on the responses of health-care practitioners to women in heterosexual relationships. Comparatively few studies have looked at the health impacts or help-seeking of men who may be perpetrators and/or victims of abuse within intimate relationships. In this paper we report on help seeking and the health professional&#39;s role based on a survey of 1368 men attending 16 general practices in the southwest of England and 31 interviews with a sample of survey respondents. The survey had a number of questions on experience or perpetration of behaviours which could be considered abusive, on whether respondents had ever been asked about such behaviours by health-care professionals, and on whether they had ever sought formal or informal help for such behaviours. Men were most likely to seek informal support from friends or family. The next most likely source of support was the family doctor. This paper suggests that health-care practitioners in general, and family doctors in particular, have a role in asking male patients about the experience or perpetration of domestic abuse and need training to do so effectively and safely.

Primary Health Care Research & Development

Aim To evaluate a training intervention for general practice-based doctors and nurses in terms of... more Aim To evaluate a training intervention for general practice-based doctors and nurses in terms of the identification, documentation, and referral of male patients experiencing or perpetrating domestic violence and abuse (DVA) in four general practices in the south west of England.

Background Researching sensitive topics, such as the rationing of treatments and denial of care, ... more Background Researching sensitive topics, such as the rationing of treatments and denial of care, raises a number of ethical and methodological problems. Aim To describe the methods and findings from a number of focus group discussions that examined how GPs apply ethical principles when allocating scarce resources. Design of study A small-scale qualitative study involving purposive sampling, semi-structured interviews and focus groups. Setting Twenty-four GPs from two contrasting areas of London: one relatively affluent and one relatively deprived. Method Initial interviews asked GPs to identify key resource allocation issues. The interviews were transcribed and themes were identified. A number of case studies, each illustrative of an ethical issue related to rationing, were written up in the form of vignettes. In focus group discussions, GPs were given a number of these vignettes to debate. Results With respect to the ethical basis for decision making, the findings from this part of...

British Journal of General Practice

Researching sensitive topics, such as the rationing of treatments and denial of care, raises a nu... more Researching sensitive topics, such as the rationing of treatments and denial of care, raises a number of ethical and methodological problems. To describe the methods and findings from a number of focus group discussions that examined how GPs apply ethical principles when allocating scarce resources. A small-scale qualitative study involving purposive sampling, semi-structured interviews and focus groups. Twenty-four GPs from two contrasting areas of London: one relatively affluent and one relatively deprived. Initial interviews asked GPs to identify key resource allocation issues. The interviews were transcribed and themes were identified. A number of case studies, each illustrative of an ethical issue related to rationing, were written up in the form of vignettes. In focus group discussions, GPs were given a number of these vignettes to debate. With respect to the ethical basis for decision making, the findings from this part of the study emphasised the role of social and psycholog...

British Journal of Cardiac Nursing, 2011

ABSTRACT Making a diagnosis in patients with stable chest pain can be challenging. Rapid access c... more ABSTRACT Making a diagnosis in patients with stable chest pain can be challenging. Rapid access chest pain clinics (RACPCs) assist diagnosis, providing timely assessment for patients with new onset suspected angina. However there is evidence that some patients assessed at the chest pain clinic may be labelled incorrectly as having non-cardiac chest pain. Recent NICE publications include guidance on diagnosis and investigation choice for patients suspected of having stable angina. The Optimising the Management of Angina (OMA) study aims to improve the outcome of patients attending chest pain clinics with a complex intervention that includes a computerized clinical decision support system (CDSS) based on the NICE guidance. This article describes the pathway used by the NICE guidance and how it has been used to inform a decision support tool, and our experience of piloting the tool in RACPCs.

Epidemiology and psychiatric sciences, 2014

Backgrounds. The extent to which psychiatric disorders are associated with an increased risk of v... more Backgrounds. The extent to which psychiatric disorders are associated with an increased risk of violence to partners is unclear. This review aimed to establish risk of violence against partners among men and women with diagnosed psychiatric disorders. Methods. Systematic review and meta-analysis. Searches of eleven electronic databases were supplemented by hand searching, reference screening and citation tracking of included articles, and expert recommendations. Results. Seventeen studies were included, reporting on 72 585 participants, but only three reported on past year violence. Pooled risk estimates could not be calculated for past year violence against a partner and the three studies did not consistently report increased risk for any diagnosis. Pooled estimates showed an increased risk of having ever been physically violent towards a partner among men with depression (odds ratio (OR) 2.8, 95% confidence intervals (CI) 2.5-3.3), generalized anxiety disorder (GAD) (OR 3.2, 95% C...

BMJ (Clinical research ed.), 2015

The British journal of general practice : the journal of the Royal College of General Practitioners, 2014

Domestic violence (DV) is highly prevalent in the developing and developed world. Healthcare syst... more Domestic violence (DV) is highly prevalent in the developing and developed world. Healthcare systems internationally are still not adequately addressing the needs of patients experiencing violence. To explore physicians' attitudes about responding to DV, their perception of the physician's role, and the factors that influence their response. Qualitative study using individual interviews among primary care practitioners working in Lebanon. Primary care clinicians practising for >5 years and with >100 patient consultations a week were interviewed. Physicians were asked about their practice when encountering women disclosing abuse, their opinion about the engagement of the health services with DV, their potential role, and the anticipated reaction of patients and society to this extended role. Physicians felt that they were well positioned to play a pivotal role in addressing DV; yet they had concerns related to personal safety, worry about losing patients, and opposing t...

Evidence-based complementary and alternative medicine : eCAM, 2014

ABSTRACT M. Kröz’s work was supported by the Humanus Institute, Berlin, and Software AG foundatio... more ABSTRACT M. Kröz’s work was supported by the Humanus Institute, Berlin, and Software AG foundation, Darmstadt, Germany. G. Feder has received support from Helixor in the form of mistletoe and placebo ampoules for a trial and the University of Bristol was paid by Weleda for his chairing of UK Iscador prescribing guidelines.

BMJ Open, 2012

Objective: The Identification and Referral to Improve Safety (IRIS) cluster randomised controlled... more Objective: The Identification and Referral to Improve Safety (IRIS) cluster randomised controlled trial tested the effectiveness of a training and support intervention to improve the response of primary care to women experiencing domestic violence (DV). The aim of this study is to estimate the cost-effectiveness of this intervention. Design: Markov model-based cost-effectiveness analysis.

Primary Care Respiratory Journal, 2005

Methods: We carried out a qualitative interview study alongside a randomised controlled trial whi... more Methods: We carried out a qualitative interview study alongside a randomised controlled trial which tested the effectiveness of asthma nurse specialists in east London. We carried out face-to-face interviews with five asthma nurse specialists, eight general practitioners (GPs) and six practice nurses, and also held a focus group session with six people who had attended hospital with acute asthma. Results: Four factors were associated with effective specialist nurse liaison: (1) primary care practices which prioritised asthma care; (2) GPs who trusted practice nurses to manage chronic disease autonomously; (3) GPs who recognised specialist nurse expertise and acted on their advice; and (4) practices which had simple systems in place to deal with recommendations. Patients found nurse specialists approachable and informative. Conclusions: Asthma specialist nurse influence was greatest in practices that prioritised asthma care and where practice nurses had clinical autonomy. Patients valued specialist nurses but found advice from a multiplicity of clinicians confusing. Ensuring that practices prioritise chronic disease care, and improving the credibility of nurse specialists amongst GPs, may improve the effectiveness of asthma nurse specialists.

BMJ, 2002

Why should you read about a trial comparing homoeopathic treatment to placebo? If you prescribe h... more Why should you read about a trial comparing homoeopathic treatment to placebo? If you prescribe homoeopathic medicines a trial will not influence your prescribing decisions because most trials of homoeopathic medicines do not individualise treatment, the hallmark of homoeopathic ...

The British journal of general practice : the journal of the Royal College of General Practitioners, 2015

The British journal of general practice : the journal of the Royal College of General Practitioners, 1997

In the United Kingdom (UK), 9% of adults consult their doctor annually with back pain. The treatm... more In the United Kingdom (UK), 9% of adults consult their doctor annually with back pain. The treatment recommendations are based on orthopaedic teaching, but the current management is causing increasing dissatisfaction. Many general practitioners (GPs) are confused about what constitutes effective advice. To review all randomized controlled trials of bed rest and of medical advice to stay active for acute back pain. A systematic review based on a search of MEDLINE and EMBASE from 1966 to April 1996 with complete citation tracking for randomized controlled trials of bed rest or medical advice to stay active and continue ordinary daily activities. The inclusion criteria were: primary care setting, patients with low back pain of up to 3 months duration, and patient-centred outcomes (rate of recovery from the acute attack, relief of pain, restoration of function, satisfaction with treatment, days off work and return to work, development of chronic pain and disability, recurrent attacks, a...

http://isrctn.org/>, 2000

Health Expectations, 2014

Informal and formal support for women experiencing domestic violence and abuse (DVA) can improve ... more Informal and formal support for women experiencing domestic violence and abuse (DVA) can improve safety and health outcomes. There has been little qualitative work on the role of both pathways to support and women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s experiences of disclosing their experience of DVA in different contexts. This qualitative study used repeat interviews with women survivors of DVA to explore their pathways to support and their experiences of barriers and facilitators to disclosure and help-seeking. Thirty-one women seeking help from specialist DVA agencies in the UK were interviewed twice over 5 months. Women recounted long journeys of ambivalence, often only disclosing abuse after leaving the perpetrator. Access to specialist support rarely came via general practitioners, despite high levels of consulting for anxious and depressed feelings, and was more often facilitated by police or housing agencies following a crisis such as assault. Informal disclosure only led to specialist help if the family member or friend themselves had experience or knowledge of DVA. Women experiencing DVA need earlier access to specialized DVA services. Many women needed an &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;enabler&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; to facilitate access, but once this contact was made, disclosure to other professionals or to family and friends was legitimized in the eyes of the women. Safely accessible publicity about DVA services and an appropriate response from social and health-care professionals should be promoted, including support for women disclosing DVA to take action on the information they receive about services.

sec> Aims Silent myocardial ischaemia occurs commonly in diabetes. Whether altered perception ... more sec> Aims Silent myocardial ischaemia occurs commonly in diabetes. Whether altered perception of ischaemia also predisposes to atypical presentations with under-diagnosis of coronary disease is not known. To determine whether (i) patients with diabetes diagnosed with angina are more likely to report atypical symptoms compared with patients without diabetes, and (ii) atypical symptoms in patients with diabetes cause angina to go unrecognized, increasing the risk of coronary events. Methods and results Prospective, multicentre cohort study of 8662 ambulatory patients with suspected angina, of whom 906 had diabetes. We recorded detailed chest pain descriptors and fatal and non-fatal coronary events over a median of 3.08 years of follow-up. Proportionately more patients with than without diabetes received a diagnosis of angina (42.7 vs. 25.1%). Among patients with diabetes diagnosed with angina, a greater proportion had atypical chest pain compared with patients without diabetes (21....

An extensive global perspective, written by an international team of experts Analyses how a publi... more An extensive global perspective, written by an international team of experts Analyses how a public health approach can help to prevent violence Multidisciplinary examination of interpersonal violence Violence has always been, and is to this day, a primary cause of tension and suffering the world over. More than half a million people are murdered each year around the world, making homicide the leading cause of death among people aged 15-44. The Oxford Textbook of Violence Prevention brings together an international team of experts to provide an extensive global account of the mortality and morbidity burden caused by violence. It does this by examining the causes of violence, and what can be done to prevent and reduce violence. Divided into six sections, the textbook analyses how a public health approach can help to prevent violence. This multidisciplinary book tackles interpersonal violence in all its forms. Early chapters describe epidemiology and consequences, followed by chapters ...

The Canadian journal of cardiology

Although the prevalence of angina remains high, the importance of grading angina severity is uncl... more Although the prevalence of angina remains high, the importance of grading angina severity is unclear. To determine the extent to which angina severity is associated with angiographic findings, and the rate of revascularization, mortality and nonfatal myocardial infarction. Prospective, population-based study with a 2.5-year follow-up of 2849 consecutive patients with angina undergoing coronary angiography at Barts and the London NHS Trust, London, United Kingdom, in the Appropriateness of Coronary Revascularisation (ACRE) study. Angina severity was assessed with the Canadian Cardiovascular Society (CCS) classification, ranging from class I (mild) to IV (severe). Outcome measures were revascularization rates, and all-cause mortality and nonfatal myocardial infarction. In age-adjusted analyses, a higher CCS class was linearly associated (P<0.001) with a higher number of diseased vessels and impaired left ventricular function. When adjusting for age, sex, smoking, history of hyperte...

Aggression and Violent Behavior, 2014

ABSTRACT Reflecting the higher prevalence of domestic violence and abuse experienced by women, an... more ABSTRACT Reflecting the higher prevalence of domestic violence and abuse experienced by women, and the recognised health impacts of such abuse, studies have focused on the responses of health-care practitioners to women in heterosexual relationships. Comparatively few studies have looked at the health impacts or help-seeking of men who may be perpetrators and/or victims of abuse within intimate relationships. In this paper we report on help seeking and the health professional&#39;s role based on a survey of 1368 men attending 16 general practices in the southwest of England and 31 interviews with a sample of survey respondents. The survey had a number of questions on experience or perpetration of behaviours which could be considered abusive, on whether respondents had ever been asked about such behaviours by health-care professionals, and on whether they had ever sought formal or informal help for such behaviours. Men were most likely to seek informal support from friends or family. The next most likely source of support was the family doctor. This paper suggests that health-care practitioners in general, and family doctors in particular, have a role in asking male patients about the experience or perpetration of domestic abuse and need training to do so effectively and safely.

Primary Health Care Research & Development

Aim To evaluate a training intervention for general practice-based doctors and nurses in terms of... more Aim To evaluate a training intervention for general practice-based doctors and nurses in terms of the identification, documentation, and referral of male patients experiencing or perpetrating domestic violence and abuse (DVA) in four general practices in the south west of England.

Background Researching sensitive topics, such as the rationing of treatments and denial of care, ... more Background Researching sensitive topics, such as the rationing of treatments and denial of care, raises a number of ethical and methodological problems. Aim To describe the methods and findings from a number of focus group discussions that examined how GPs apply ethical principles when allocating scarce resources. Design of study A small-scale qualitative study involving purposive sampling, semi-structured interviews and focus groups. Setting Twenty-four GPs from two contrasting areas of London: one relatively affluent and one relatively deprived. Method Initial interviews asked GPs to identify key resource allocation issues. The interviews were transcribed and themes were identified. A number of case studies, each illustrative of an ethical issue related to rationing, were written up in the form of vignettes. In focus group discussions, GPs were given a number of these vignettes to debate. Results With respect to the ethical basis for decision making, the findings from this part of...

British Journal of General Practice

Researching sensitive topics, such as the rationing of treatments and denial of care, raises a nu... more Researching sensitive topics, such as the rationing of treatments and denial of care, raises a number of ethical and methodological problems. To describe the methods and findings from a number of focus group discussions that examined how GPs apply ethical principles when allocating scarce resources. A small-scale qualitative study involving purposive sampling, semi-structured interviews and focus groups. Twenty-four GPs from two contrasting areas of London: one relatively affluent and one relatively deprived. Initial interviews asked GPs to identify key resource allocation issues. The interviews were transcribed and themes were identified. A number of case studies, each illustrative of an ethical issue related to rationing, were written up in the form of vignettes. In focus group discussions, GPs were given a number of these vignettes to debate. With respect to the ethical basis for decision making, the findings from this part of the study emphasised the role of social and psycholog...

British Journal of Cardiac Nursing, 2011

ABSTRACT Making a diagnosis in patients with stable chest pain can be challenging. Rapid access c... more ABSTRACT Making a diagnosis in patients with stable chest pain can be challenging. Rapid access chest pain clinics (RACPCs) assist diagnosis, providing timely assessment for patients with new onset suspected angina. However there is evidence that some patients assessed at the chest pain clinic may be labelled incorrectly as having non-cardiac chest pain. Recent NICE publications include guidance on diagnosis and investigation choice for patients suspected of having stable angina. The Optimising the Management of Angina (OMA) study aims to improve the outcome of patients attending chest pain clinics with a complex intervention that includes a computerized clinical decision support system (CDSS) based on the NICE guidance. This article describes the pathway used by the NICE guidance and how it has been used to inform a decision support tool, and our experience of piloting the tool in RACPCs.

Epidemiology and psychiatric sciences, 2014

Backgrounds. The extent to which psychiatric disorders are associated with an increased risk of v... more Backgrounds. The extent to which psychiatric disorders are associated with an increased risk of violence to partners is unclear. This review aimed to establish risk of violence against partners among men and women with diagnosed psychiatric disorders. Methods. Systematic review and meta-analysis. Searches of eleven electronic databases were supplemented by hand searching, reference screening and citation tracking of included articles, and expert recommendations. Results. Seventeen studies were included, reporting on 72 585 participants, but only three reported on past year violence. Pooled risk estimates could not be calculated for past year violence against a partner and the three studies did not consistently report increased risk for any diagnosis. Pooled estimates showed an increased risk of having ever been physically violent towards a partner among men with depression (odds ratio (OR) 2.8, 95% confidence intervals (CI) 2.5-3.3), generalized anxiety disorder (GAD) (OR 3.2, 95% C...

BMJ (Clinical research ed.), 2015

The British journal of general practice : the journal of the Royal College of General Practitioners, 2014

Domestic violence (DV) is highly prevalent in the developing and developed world. Healthcare syst... more Domestic violence (DV) is highly prevalent in the developing and developed world. Healthcare systems internationally are still not adequately addressing the needs of patients experiencing violence. To explore physicians' attitudes about responding to DV, their perception of the physician's role, and the factors that influence their response. Qualitative study using individual interviews among primary care practitioners working in Lebanon. Primary care clinicians practising for >5 years and with >100 patient consultations a week were interviewed. Physicians were asked about their practice when encountering women disclosing abuse, their opinion about the engagement of the health services with DV, their potential role, and the anticipated reaction of patients and society to this extended role. Physicians felt that they were well positioned to play a pivotal role in addressing DV; yet they had concerns related to personal safety, worry about losing patients, and opposing t...

Evidence-based complementary and alternative medicine : eCAM, 2014

ABSTRACT M. Kröz’s work was supported by the Humanus Institute, Berlin, and Software AG foundatio... more ABSTRACT M. Kröz’s work was supported by the Humanus Institute, Berlin, and Software AG foundation, Darmstadt, Germany. G. Feder has received support from Helixor in the form of mistletoe and placebo ampoules for a trial and the University of Bristol was paid by Weleda for his chairing of UK Iscador prescribing guidelines.

BMJ Open, 2012

Objective: The Identification and Referral to Improve Safety (IRIS) cluster randomised controlled... more Objective: The Identification and Referral to Improve Safety (IRIS) cluster randomised controlled trial tested the effectiveness of a training and support intervention to improve the response of primary care to women experiencing domestic violence (DV). The aim of this study is to estimate the cost-effectiveness of this intervention. Design: Markov model-based cost-effectiveness analysis.

Primary Care Respiratory Journal, 2005

Methods: We carried out a qualitative interview study alongside a randomised controlled trial whi... more Methods: We carried out a qualitative interview study alongside a randomised controlled trial which tested the effectiveness of asthma nurse specialists in east London. We carried out face-to-face interviews with five asthma nurse specialists, eight general practitioners (GPs) and six practice nurses, and also held a focus group session with six people who had attended hospital with acute asthma. Results: Four factors were associated with effective specialist nurse liaison: (1) primary care practices which prioritised asthma care; (2) GPs who trusted practice nurses to manage chronic disease autonomously; (3) GPs who recognised specialist nurse expertise and acted on their advice; and (4) practices which had simple systems in place to deal with recommendations. Patients found nurse specialists approachable and informative. Conclusions: Asthma specialist nurse influence was greatest in practices that prioritised asthma care and where practice nurses had clinical autonomy. Patients valued specialist nurses but found advice from a multiplicity of clinicians confusing. Ensuring that practices prioritise chronic disease care, and improving the credibility of nurse specialists amongst GPs, may improve the effectiveness of asthma nurse specialists.