C Todd - Academia.edu (original) (raw)

Papers by C Todd

Palliative and Supportive Care, 2009

Self-reported health-related quality of life (HRQoL) is an important predictor of survival alongs... more Self-reported health-related quality of life (HRQoL) is an important predictor of survival alongside clinical variables and physicians' prediction. This study assessed whether better prediction is achieved using generic (SF-36) HRQoL measures or cancer-specific (EORTC QLQ-C30) measures that include symptoms. Fifty-four lung and 46 colorectal patients comprised the sample. Ninety-four died before study conclusion. EORTC QLQ-C30 and SF-36 scores and demographic and clinical information were collected at baseline. Follow-up was 5 years. Deaths were flagged by the Office of National Statistics. Cox regression survival analyses were conducted. Surviving cases were censored in the analysis. Univariate analyses showed that survival was significantly associated with better EORTC QLQ-C30 physical functioning, role functioning, and global health and less dyspnea and appetite loss. For the SF-36, survival was significantly associated with better emotional role functioning, general health, energy/vitality, and social functioning. The SF-36 summary score for mental health was significantly related to better survival, whereas the SF-36 summary score for physical health was not. In the multivariate analysis, only the SF-36 mental health summary score remained an independent, significant predictor, mainly due to considerable intercorrelations between HRQoL scales. However, models combining the SF-36 mental health summary score with diagnosis explained a similar amount of variance (12%-13%) as models combining diagnosis with single scale SF-36 Energy/Vitality or EORTC QLQ-C30 Appetite Loss. HRQoL contributes significantly to prediction of survival. Generic measures are at least as useful as disease-specific measures including symptoms. Intercorrelations between HRQoL variables and between HRQoL and clinical variables makes it difficult to identify prime predictors. We need to identify variables that are as independent of each other as possible to maximize predictive power and produce more consistent results.

BMC Medicine, 2013

Background: Despite being a core business of medicine, end of life care (EoLC) is neglected. It i... more Background: Despite being a core business of medicine, end of life care (EoLC) is neglected. It is hampered by research that is difficult to conduct with no common standards. We aimed to develop evidence-based guidance on the best methods for the design and conduct of research on EoLC to further knowledge in the field.

Falls in adults and older people are a major public health concern in terms of mortality, morbidi... more Falls in adults and older people are a major public health concern in terms of mortality, morbidity and costs to health and social services. Rheumatoid arthritis (RA) is linked to an increased risk of falls resulting in osteoporotic fractures, due to lower limb joint involvement resulting in impaired mobility, balance and postural stability (Armstrong et al., 2005; Huusko et al., 2001). However, there has been little research in this area to date. The findings from a prospective cohort study of 559 adults with RA, using a longitudinal design will be presented. Patients were recruited from outpatient departments in four hospitals in the Northwest of England. Patients were followed up for 1 year after the initial measurements, using self-reported falls calendars, fall event forms and follow up telephone calls. The baseline assessments included measures of medication, eyesight, other diseases, painful feet, previous fractures, surgery or joint replacement(s), swollen/joint assessment to measure current RA disease activity and previous use of steroids, strength and balance. They also completed a questionnaire that included information on their functional ability, history of falling, fear of falling, pain, fatigue and falls risk. The findings from this study will assist in understanding the extent of the problems of falls in people with RA and also the particular risk factors. Efforts can then be focused on minimising the risk factors through proven interventions and reducing falls and fall related injuries.

Journal of Advanced Nursing, 1998

Midwifery, 2000

Objective: to describe the views of women using one team midwifery scheme and compare them with w... more Objective: to describe the views of women using one team midwifery scheme and compare them with women using more traditional models of midwifery care.

Midwifery, 1998

Objective: as part of an evaluation of a team midwifery scheme we assessed the satisfaction of co... more Objective: as part of an evaluation of a team midwifery scheme we assessed the satisfaction of community and hospital midwives and their views about working practices and care provided.

Pain, 2008

Psychological and social factors have been shown, separately, to predict outcome in individuals w... more Psychological and social factors have been shown, separately, to predict outcome in individuals with chronic low back pain. Few previous studies, however, have integrated both psychological and social factors, using prospective study of clinic populations of low back pain patients, to identify which are the most important targets for treatment. One hundred and eight patients with chronic low back pain, newly referred to an orthopaedic outpatient clinic, completed assessments of demographic characteristics, details of back pain, measures of anxiety and depression (Hospital Anxiety and Depression Scale, HADS), fearful beliefs about pain (Fear Avoidance Beliefs Questionnaire), social stresses (Life Events and Difficulties Schedule) and physical aspects of health-related quality of life [SF-36 Physical Component summary Score scale (PCS)]. Six months later subjects completed the SF-36 PCS and the number of healthcare contacts during follow-up was recorded. Independent predictors of SF-36 PCS at 6-month follow-up were duration of pain [(standardised regression coefficient (beta)=-0.18, p=0.04), HADS score (beta)=-0.27, p=0.003] and back pain related social difficulties (beta=-0.42, p<0.0005). Number of healthcare contacts over the 6 months ranged from 1 to 29, and was independently predicted by perceived cause of pain [Incident Rate Ratio (IRR)=1.46, p=0.03], Fear Avoidance Beliefs about work (IRR=1.02, p=0.009) and back pain related social difficulties (IRR=1.16, p=0.03). To conclude, anxiety, depression, fear avoidance beliefs relating to work and back pain related stresses predict impairment in subsequent physical health-related quality of life and number of healthcare contacts. Interventions targeting these psychosocial variables in clinic patients may lead to improved quality of life and healthcare costs.

Background: Breathlessness is common in advanced cancer. The Breathlessness Intervention Service ... more Background: Breathlessness is common in advanced cancer. The Breathlessness Intervention Service (BIS) is a multi-disciplinary complex intervention theoretically underpinned by a palliative care approach, utilising evidence-based non-pharmacological and pharmacological interventions to support patients with advanced disease. We sought to establish whether BIS was more effective, and cost-effective, for patients with advanced cancer and their carers than standard care.

Publications by C Todd

Background Falls in older people result in a substantial use of resources in the NHS and care hom... more Background Falls in older people result in a substantial use of resources in the NHS and care homes. One way to reduce the burden would be to identify the factors associated with the likelihood of being discharged to a care home rather than being discharged home after fall-related hospitalization. We investigate the associations between discharge destination after fall-related hospital admission with ecological factors (area deprivation, ethnicity and rurality) and individual level factors (age, gender and co-morbidities). Methods We extracted data for patients aged over 50 admitted from their 'usual residence' with a fall-related diagnosis from the Hospital Episode Statistics (HES) database. Results Increasing age, people with severe co-morbidities and people who live in less deprived, predominantly white or rural areas, were more likely to be discharged to a different residence (all P-values , 0.001). We estimated that 88.3% of people from an area classified as most deprived, urban and .5% Asian would return home, compared with 78.0% from least deprived, village/isolated and all white area. Conclusion Further research is required to examine whether these patterns reflect appropriate care or alternatively that some subgroups of society have less access to care homes than others. These factors may have public health implications for the equitable allocation of budgets for the provision of care for elderly patients discharged from hospital after a fall.

Palliative and Supportive Care, 2009

Self-reported health-related quality of life (HRQoL) is an important predictor of survival alongs... more Self-reported health-related quality of life (HRQoL) is an important predictor of survival alongside clinical variables and physicians' prediction. This study assessed whether better prediction is achieved using generic (SF-36) HRQoL measures or cancer-specific (EORTC QLQ-C30) measures that include symptoms. Fifty-four lung and 46 colorectal patients comprised the sample. Ninety-four died before study conclusion. EORTC QLQ-C30 and SF-36 scores and demographic and clinical information were collected at baseline. Follow-up was 5 years. Deaths were flagged by the Office of National Statistics. Cox regression survival analyses were conducted. Surviving cases were censored in the analysis. Univariate analyses showed that survival was significantly associated with better EORTC QLQ-C30 physical functioning, role functioning, and global health and less dyspnea and appetite loss. For the SF-36, survival was significantly associated with better emotional role functioning, general health, energy/vitality, and social functioning. The SF-36 summary score for mental health was significantly related to better survival, whereas the SF-36 summary score for physical health was not. In the multivariate analysis, only the SF-36 mental health summary score remained an independent, significant predictor, mainly due to considerable intercorrelations between HRQoL scales. However, models combining the SF-36 mental health summary score with diagnosis explained a similar amount of variance (12%-13%) as models combining diagnosis with single scale SF-36 Energy/Vitality or EORTC QLQ-C30 Appetite Loss. HRQoL contributes significantly to prediction of survival. Generic measures are at least as useful as disease-specific measures including symptoms. Intercorrelations between HRQoL variables and between HRQoL and clinical variables makes it difficult to identify prime predictors. We need to identify variables that are as independent of each other as possible to maximize predictive power and produce more consistent results.

BMC Medicine, 2013

Background: Despite being a core business of medicine, end of life care (EoLC) is neglected. It i... more Background: Despite being a core business of medicine, end of life care (EoLC) is neglected. It is hampered by research that is difficult to conduct with no common standards. We aimed to develop evidence-based guidance on the best methods for the design and conduct of research on EoLC to further knowledge in the field.

Falls in adults and older people are a major public health concern in terms of mortality, morbidi... more Falls in adults and older people are a major public health concern in terms of mortality, morbidity and costs to health and social services. Rheumatoid arthritis (RA) is linked to an increased risk of falls resulting in osteoporotic fractures, due to lower limb joint involvement resulting in impaired mobility, balance and postural stability (Armstrong et al., 2005; Huusko et al., 2001). However, there has been little research in this area to date. The findings from a prospective cohort study of 559 adults with RA, using a longitudinal design will be presented. Patients were recruited from outpatient departments in four hospitals in the Northwest of England. Patients were followed up for 1 year after the initial measurements, using self-reported falls calendars, fall event forms and follow up telephone calls. The baseline assessments included measures of medication, eyesight, other diseases, painful feet, previous fractures, surgery or joint replacement(s), swollen/joint assessment to measure current RA disease activity and previous use of steroids, strength and balance. They also completed a questionnaire that included information on their functional ability, history of falling, fear of falling, pain, fatigue and falls risk. The findings from this study will assist in understanding the extent of the problems of falls in people with RA and also the particular risk factors. Efforts can then be focused on minimising the risk factors through proven interventions and reducing falls and fall related injuries.

Journal of Advanced Nursing, 1998

Midwifery, 2000

Objective: to describe the views of women using one team midwifery scheme and compare them with w... more Objective: to describe the views of women using one team midwifery scheme and compare them with women using more traditional models of midwifery care.

Midwifery, 1998

Objective: as part of an evaluation of a team midwifery scheme we assessed the satisfaction of co... more Objective: as part of an evaluation of a team midwifery scheme we assessed the satisfaction of community and hospital midwives and their views about working practices and care provided.

Pain, 2008

Psychological and social factors have been shown, separately, to predict outcome in individuals w... more Psychological and social factors have been shown, separately, to predict outcome in individuals with chronic low back pain. Few previous studies, however, have integrated both psychological and social factors, using prospective study of clinic populations of low back pain patients, to identify which are the most important targets for treatment. One hundred and eight patients with chronic low back pain, newly referred to an orthopaedic outpatient clinic, completed assessments of demographic characteristics, details of back pain, measures of anxiety and depression (Hospital Anxiety and Depression Scale, HADS), fearful beliefs about pain (Fear Avoidance Beliefs Questionnaire), social stresses (Life Events and Difficulties Schedule) and physical aspects of health-related quality of life [SF-36 Physical Component summary Score scale (PCS)]. Six months later subjects completed the SF-36 PCS and the number of healthcare contacts during follow-up was recorded. Independent predictors of SF-36 PCS at 6-month follow-up were duration of pain [(standardised regression coefficient (beta)=-0.18, p=0.04), HADS score (beta)=-0.27, p=0.003] and back pain related social difficulties (beta=-0.42, p<0.0005). Number of healthcare contacts over the 6 months ranged from 1 to 29, and was independently predicted by perceived cause of pain [Incident Rate Ratio (IRR)=1.46, p=0.03], Fear Avoidance Beliefs about work (IRR=1.02, p=0.009) and back pain related social difficulties (IRR=1.16, p=0.03). To conclude, anxiety, depression, fear avoidance beliefs relating to work and back pain related stresses predict impairment in subsequent physical health-related quality of life and number of healthcare contacts. Interventions targeting these psychosocial variables in clinic patients may lead to improved quality of life and healthcare costs.

Background: Breathlessness is common in advanced cancer. The Breathlessness Intervention Service ... more Background: Breathlessness is common in advanced cancer. The Breathlessness Intervention Service (BIS) is a multi-disciplinary complex intervention theoretically underpinned by a palliative care approach, utilising evidence-based non-pharmacological and pharmacological interventions to support patients with advanced disease. We sought to establish whether BIS was more effective, and cost-effective, for patients with advanced cancer and their carers than standard care.

Background Falls in older people result in a substantial use of resources in the NHS and care hom... more Background Falls in older people result in a substantial use of resources in the NHS and care homes. One way to reduce the burden would be to identify the factors associated with the likelihood of being discharged to a care home rather than being discharged home after fall-related hospitalization. We investigate the associations between discharge destination after fall-related hospital admission with ecological factors (area deprivation, ethnicity and rurality) and individual level factors (age, gender and co-morbidities). Methods We extracted data for patients aged over 50 admitted from their 'usual residence' with a fall-related diagnosis from the Hospital Episode Statistics (HES) database. Results Increasing age, people with severe co-morbidities and people who live in less deprived, predominantly white or rural areas, were more likely to be discharged to a different residence (all P-values , 0.001). We estimated that 88.3% of people from an area classified as most deprived, urban and .5% Asian would return home, compared with 78.0% from least deprived, village/isolated and all white area. Conclusion Further research is required to examine whether these patterns reflect appropriate care or alternatively that some subgroups of society have less access to care homes than others. These factors may have public health implications for the equitable allocation of budgets for the provision of care for elderly patients discharged from hospital after a fall.