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Papers by grace lindsay
British Journal of Cardiac Nursing, 2014
British Journal of Cardiac Nursing, 2013
Physiotherapy, 1995
Objective To examine the extent of uptake of medication for secondary prevention of coronary hear... more Objective To examine the extent of uptake of medication for secondary prevention of coronary heart disease in older British men and women before (1998)(1999)(2000)(2001) and after the implementation of the national service framework. Design Two population based, longitudinal studies of men and women aged 60-79 in 1998-2001, based in one general practice in each of 24 British towns. Participants Men and women with established coronary heart disease at the two time points (respectively 817 and 465 in 1998-2001, 857 and 548 in 2003), aged 60-79 in 1998-2001. Main outcome measures Prevalence of use of antiplatelet medication, statins, blockers, angiotensin converting enzyme (ACE) inhibitors, and other blood pressure lowering treatments (individually and in combination) assessed in 1998-2001 and 2003.
Aim and objective. The accuracy with which patients recall their cardiac symptoms prior to aorta-... more Aim and objective. The accuracy with which patients recall their cardiac symptoms prior to aorta-coronary artery bypass grafting is assessed approximately one year after surgery together with patient-related factors potentially influencing accuracy of recall.
Journal of Clinical Nursing, 2009
Aim and objective. The accuracy with which patients recall their cardiac symptoms prior to aorta... more Aim and objective. The accuracy with which patients recall their cardiac symptoms prior to aorta-coronary artery bypass grafting is assessed approximately one year after surgery together with patient-related factors potentially influencing accuracy of recall.Background. This is a novel investigation of patient’s rating of preoperative symptom severity before and approximately one year following aorta-coronary artery bypass grafting.Design. Patients undergoing aorta-coronary artery bypass grafting (n = 208) were recruited preoperatively and 177 of these were successfully followed up at 16·4 (SD 2·1) months after surgery and asked to describe current and recalled preoperative symptoms using a 15-point numerical scale.Method. Accuracy of recall was measured and correlated (Pearson’s correlation) with current and past symptoms, health-related quality of life and coronary artery disease risk factors. Hypothesis tests used Student’s t-test and the chi-squared test.Results. Respective angina and breathlessness scores were recalled accurately by 16·9% and 14·1% while 59% and 58% were inaccurate by more than one point. Although the mean preoperative and recalled scores for severity of both angina and breathlessness and were not statistically different, patients who recalled most accurately their preoperative scores had, on average, significantly higher preoperative scores than those with less accurate recall. Patients whose angina and breathlessness symptoms were relieved by operation had significantly better accuracy of recall than patients with greater levels of symptoms postoperatively.Conclusion. Patient’s rating of preoperative symptom severity before and one year following aorta-coronary artery bypass grafting was completely accurate in approximately one sixth of patients with similar proportions of the remaining patients overestimating and underestimating symptoms. The extent to which angina and breathlessness was relieved by operation was a significant factor in improving accuracy of recall.Relevance to clinical practice. Factors associated with accuracy of recall of symptoms provide useful insights for clinicians when interpreting patients’ views of the effectiveness of aorta-coronary artery bypass grafting for the relief of symptoms associated with coronary heart disease.
Cardiovascular Drugs and Therapy, 2004
Journal of Clinical Nursing, 2009
Aims. The primary aim of this study was to examine the needs of older people in relation to card... more Aims. The primary aim of this study was to examine the needs of older people in relation to cardiac rehabilitation and to determine if these were currently being met. A secondary aim was to compare illness representations, quality of life and anxiety and depression in groups with different levels of attendance at a cardiac rehabilitation programme.Background. Coronary heart disease accounted for over seven million cardiovascular deaths globally in 2001. Associated deaths increase with age and are highest in those older than 65. Effective cardiac rehabilitation can assist independent function and maintain health but programme uptake rates are low. We have, therefore, focussed specifically on the older patient to determine reasons for the low uptake.Design. Mixed methods.Methods. A purposive sample of 31 older men and women (≥65 years) completed three questionnaires to determine illness representations, quality of life and anxiety and depression. They then underwent a brief clinical assessment and participated in a face-to-face audio-taped interview.Results. Quantitative: Older adults, who did not attend a cardiac rehabilitation programme, had significantly poorer personal control and depression scores (p < 0·01) and lower quality of life scores than those who had attended. Few achieved recommended risk factor reduction targets. Qualitative: The three main themes identified as reflecting the views and experiences of and attendance at the cardiac rehabilitation programme were: ‘The sensible thing to do’, ‘Assessing the impact’ and ‘Nothing to gain’.Conclusions. Irrespective of level of attendance, cardiac rehabilitation programmes are not meeting the needs of many older people either in terms of risk factor reduction or programme uptake. More appropriate programmes are needed.Relevance to clinical practice. Cardiac rehabilitation nurses are ideally placed to identify the rehabilitation needs of older people. Identifying these from the older person’s perspective could help guide more appropriate intervention strategies.
Journal of Human Hypertension, 2002
The objective of the study was to examine medically managed secondary prevention at one year afte... more The objective of the study was to examine medically managed secondary prevention at one year after coronary artery bypass grafting (CABG). In all, 214 consecutive patients undergoing isolated elective CABG seen four weeks preoperatively and one year postoperatively. Preoperative systolic blood pressure averaged 135 7 20 mmHg, which increased to 148 7 25 mmHg (Po0.0001) as did diastolic pressure (81 7 12 to 87 7 13 mmHg; Po0.0001). Anginal symptoms were reported by 45.1% (Po0.0001) although median severity scored lower (4.0 [3.0-5.4] vs 0 [0-2.0]; Po0.0001). Breathlessness decreased from 93% to 64% (Po0.0001) and was scored less severely (4.0 [2.0-5.0] vs 2.0 [0-4.0]; Po0.0001. In all, 88% with postoperative angina reported dyspnoea against 44% of those without (Po0.0001). Calcium antagonist use was more common in patients with angina (27.2% vs 5.1%; Po0.0001), but not nitrates (P ¼ 0.8695), diuretics (P ¼ 0.4218), digoxin (P ¼ 0.2565), b-blockers (P ¼ 0.0820), or ACE inhibitors (P ¼ 0.7256). Preoperatively 166 patients (80.2%) took aspirin vs 69.2% afterwards (P ¼ 0.0131). Twelve patients (6.5%) received warfarin after operation vs none preoperatively. Two took digoxin (0.97%) preoperatively and 14 (7.7%) postoperatively (P ¼ 0.001) for chronic atrial fibrillation. One of these took warfarin. Longacting nitrate use fell from 63.4% to 15.8% (P o0.0001). Short-acting nitrate use fell similarly (Po0.0001). Preoperatively 37 patients (17.9%) took ACE inhibitors vs 44 postoperatively (24.2%); 39 had not received them before. Preoperatively 48 (23.2%) took diuretics vs 30 (16.5%) postoperatively (P ¼ 0.127); 24 had not previously taken diuretics. More patients took HMGCoA inhibitors postoperatively (P ¼ 0.0068) and total cholesterol was significantly reduced with a concomitant increase in HDL fraction. Smoking habit was virtually unchanged from 17.8% to 15.1% (P ¼ 0.5023). In conclusion: angina was common. Apart from statin prescribing, postoperative secondary prevention measures were poorly applied, less widespread and less effective than preoperatively. The implications are disturbing.
European Journal of Cardiovascular Nursing, 2006
Background: The aim of the coronary artery bypass graft operation is to relieve anginal symptoms ... more Background: The aim of the coronary artery bypass graft operation is to relieve anginal symptoms and improve functional ability, quality of life and survival. However, having the surgery does not always have the desired outcomes. Although numerous studies have investigated the outcomes of coronary artery bypass graft operation, little attention has been given to patients' perceptions of the outcomes or effects of the operation on health and well-being over time. Aim: To explore patients' perspectives on the effects of coronary artery bypass surgery on health and well-being over time. Methods: As part of a larger mixed methods study, 62 in-depth audio-taped interviews with men and women who had undergone coronary artery bypass approximately 7 years earlier were conducted. Interviews were audio-taped and transcribed. Data were analysed thematically. This paper reports the findings from the qualitative component of the larger study. Findings: The four main themes: FRecovery and Rehabilitation_, FSeven Years On_, FMaintaining a Positive Approach_, and FHealth Behaviour Change_ reflect the main areas of focus emerging across the interviews and provide credible overarching descriptors of the subthemes they encompass. The 11 sub-themes identified were recognised as central to the patients' experiences of their health and well-being over the longer-term. Conclusions: Although most patients report improved health and well-being after coronary artery bypass operation, many have described their recovery and rehabilitation as a complex process with both short and long term effects. The insights provided by participants help improve our understanding of the impact of the operation on patients' health and well-being over time. We believe these insights will help us to anticipate the possible needs of future patients and enable us develop appropriate interventions that may facilitate self-management for optimal recovery and health maintenance.
Age and Ageing, 2004
Background: over the next 20 years it is anticipated that there will be a significant increase in... more Background: over the next 20 years it is anticipated that there will be a significant increase in those aged 75 and over, and a consequent increase in cardiovascular disease, cancer and chronic illness. As this shift takes effect, there will be an increased need for treatment strategies that are of known benefit to this age group and a consequent rise in demand for clinical trials that are conducted specifically with the older population. Because factors that motivate older individuals to participate in clinical trials may differ from those that influence younger adults, it is important to evaluate the strategies used to encourage recruitment and retention and to determine how appropriate these are. Aim: evaluation of the reasons why subjects agree to participate in a controlled clinical trial of vascular disease prevention and the strategies used to improve compliance and protocol adherence. Setting: Scotland. Subjects: 2,520 Prospective Study of Pravastatin in the Elderly at Risk participants, aged 70-82 with either pre-existing vascular disease or at least one major vascular risk factor (hypertension, cigarette smoking, or diabetes mellitus). Design of study: two-stage iterative survey. Stage I was exploratory. Results: curiosity, or an interest in finding out more about the study, 'a desire to support research', and anticipated personal benefits, such as health screening, were the most important motivators for generating initial interest in the trial. Ongoing health monitoring was the most important recruitment and retention motivator (P = 0.001). Conclusions: curiosity, self interest and altruism may act as motivators at different points in the study time-line. However, fostering positive relationships between staff and recruits, and keeping recruits informed about the progress of the study are likely to maximise the retention of older subjects to long-term trials.
Coronary Health Care, 1999
Coronary Health Care, 1998
Coronary Health Care, 1998
Coronary Health Care, 1999
Coronary Health Care, 1997
The problem addressed in the study was to gain a greater understanding of the health benefits of ... more The problem addressed in the study was to gain a greater understanding of the health benefits of coronary artery bypass grafting (CABG). The purpose of the study was to assess general health status, using the short-form (SF)-36 questionnaire, approximately 12 months following CABG, and to document any associations between pre-operative health status, level of social support, coronary artery disease (CAD) risk factors, CAD symptom severity and post-operative health status. The study was prospective and observational in design and included assessments at two time points, namely pre-operatively in a hospital outpatient department (1995-1996) and post-operatively at home (1996-1997). Two hundred and fourteen patients awaiting elective CABG were recruited a month before the expected date of operation. Pre-operative assessment included: (1), severity of symptoms; (2), CAD risk factors; (3), SF-36 questionnaire; and (4), social activities questionnaire. Post-operative assessment measured health status using the SF-36 instrument (mean, 16.4 months). Correlation and multiple linear regression analyses were used to identify factors associated with improved health status following CABG. Two hundred and fourteen patients were assessed pre-operatively and underwent CABG. There was a 4.8% 30-day mortality rate, and 183 patients were followed for a mean of 16.4 months after CABG. SF-36 scores following CABG were improved across all of the eight domains (P<0.001). A higher social network score and higher pre-operative health status were associated with improved health status. Patients with lower health levels (SF-36 scores) prior to CABG were less likely to gain improvement in health (SF-36 scores) following CABG. Lower SF-36 scores following operation were influenced by the presence of diabetes mellitus, cigarette smoking, younger age, a high socio-economic deprivation category and higher alcohol intake. Many patients had uncorrected CAD risk factors at pre-operative assessment. The SF-36 instrument was shown to be a useful and sensitive tool to assess differences and changes in the general health status of patients before and following CABG. High levels of social support were associated with improved health status post-operatively. Lower pre-operative general health status, the presence of diabetes mellitus and cigarette smoking were associated with poorer post-operative general health status.
Heart, 2001
Objectives-To assess health status, level of social support, and presence of coronary artery dise... more Objectives-To assess health status, level of social support, and presence of coronary artery disease risk factors before and after coronary artery bypass grafting (CABG); to assess symptomatic relief approximately 12 months postoperatively; and to examine the association between preoperative health status and recurrence of symptoms. Design-Observational study. Setting-Preoperatively, in hospital outpatient department (1995)(1996); postoperatively, at home . Subjects and methods-Patients awaiting elective CABG were recruited one month before the expected date of operation. Preoperative assessment included severity of symptoms, coronary artery disease risk factors, short form 36 (SF-36) questionnaire, and social activities questionnaire. The presence and severity of angina and breathlessness were reported postoperatively (mean 16.4 months). Multiple regression analysis was used to identify factors associated with improved outcome following CABG. Main outcome measure-Patient reported presence and severity of angina and breathlessness. Results-183 patients were followed for a mean of 16.4 months after CABG. Angina and breathlessness were completely relieved in 55% and 36% of patients, respectively. In patients with residual symptoms, the severity was significantly reduced (angina p < 0.001; breathlessness, p = 0.02). Patients with low SF-36 scores and low social network scores preoperatively were less likely to be relieved of symptoms (p < 0.001). Health status and social support levels preoperatively were lower than in other reported coronary artery disease patients groups. Preoperatively, coronary artery disease risk factors were higher than recommended in current guidelines: 67.4% had raised plasma cholesterol, 39.0% were hypertensive, 80% were moderately obese, and 22.9% were smokers. Conclusions-Recurrence of symptoms exceeded other published studies. Patients' perception of general health, symptoms, and social support influences outcome. (Heart 2001;85:80-86)
Objective-To evaluate the eVectiveness of a nurse led shared care programme to improve coronary h... more Objective-To evaluate the eVectiveness of a nurse led shared care programme to improve coronary heart disease risk factor levels and general health status and to reduce anxiety and depression in patients awaiting coronary artery bypass grafting (CABG). Design-Randomised controlled trial.
Journal of Advanced Nursing, 2002
Background. Emergency Nurse Practitioners (ENP) are increasingly managing minor injuries in Acci... more Background. Emergency Nurse Practitioners (ENP) are increasingly managing minor injuries in Accident and Emergency departments across the United Kingdom. This study aimed to develop methods and tools that could be used to measure the quality of ENP-led care. These tools were then tested in a randomized controlled trial.Methods. A convenience sample of 199 eligible patients, over 16 years old, and with specific minor injuries was randomized either to ENP-led care ( n = 99) or Senior House Officer (SHO)-led care ( n = 100) and were diagnosed, treated, referred or discharged by this lead clinician. Following treatment, patients were asked to complete a patient satisfaction questionnaire related to the consultation. Clinical documentation was assessed using a ‘Documentation Audit Tool’. A follow-up questionnaire was sent to all patients at 1 month. Return visits to the department and missed injuries were monitored.Results. Patients were satisfied with the level of care from both ENPs and SHOs. However, they reported that ENPs were easier to talk to ( P = 0·009); gave them information on accident and illness prevention ( P = 0·001); and gave them enough information on their injury ( P = 0·007). Overall they were more satisfied with the treatment provided by ENPs than with that from SHOs ( P < 0·001). ENPs' clinical documentation was of higher quality than SHOs ( P < 0·001). No differences were found in recovery times, level of symptoms, time off work or unplanned follow-up between groups. Missed injuries were the same for both groups ( n = 1 in each group).Conclusion. The study was sufficiently large to demonstrate higher levels of patient satisfaction and clinical documentation quality with ENP-led than SHO-led care. A larger study involving 769 patients in each arm would be required to detect a 2% difference in missed injury rates. The methods and tools used in this trial could be used in Accident and Emergency departments to measure the quality of ENP-led care.
British Journal of Cardiac Nursing, 2014
British Journal of Cardiac Nursing, 2013
Physiotherapy, 1995
Objective To examine the extent of uptake of medication for secondary prevention of coronary hear... more Objective To examine the extent of uptake of medication for secondary prevention of coronary heart disease in older British men and women before (1998)(1999)(2000)(2001) and after the implementation of the national service framework. Design Two population based, longitudinal studies of men and women aged 60-79 in 1998-2001, based in one general practice in each of 24 British towns. Participants Men and women with established coronary heart disease at the two time points (respectively 817 and 465 in 1998-2001, 857 and 548 in 2003), aged 60-79 in 1998-2001. Main outcome measures Prevalence of use of antiplatelet medication, statins, blockers, angiotensin converting enzyme (ACE) inhibitors, and other blood pressure lowering treatments (individually and in combination) assessed in 1998-2001 and 2003.
Aim and objective. The accuracy with which patients recall their cardiac symptoms prior to aorta-... more Aim and objective. The accuracy with which patients recall their cardiac symptoms prior to aorta-coronary artery bypass grafting is assessed approximately one year after surgery together with patient-related factors potentially influencing accuracy of recall.
Journal of Clinical Nursing, 2009
Aim and objective. The accuracy with which patients recall their cardiac symptoms prior to aorta... more Aim and objective. The accuracy with which patients recall their cardiac symptoms prior to aorta-coronary artery bypass grafting is assessed approximately one year after surgery together with patient-related factors potentially influencing accuracy of recall.Background. This is a novel investigation of patient’s rating of preoperative symptom severity before and approximately one year following aorta-coronary artery bypass grafting.Design. Patients undergoing aorta-coronary artery bypass grafting (n = 208) were recruited preoperatively and 177 of these were successfully followed up at 16·4 (SD 2·1) months after surgery and asked to describe current and recalled preoperative symptoms using a 15-point numerical scale.Method. Accuracy of recall was measured and correlated (Pearson’s correlation) with current and past symptoms, health-related quality of life and coronary artery disease risk factors. Hypothesis tests used Student’s t-test and the chi-squared test.Results. Respective angina and breathlessness scores were recalled accurately by 16·9% and 14·1% while 59% and 58% were inaccurate by more than one point. Although the mean preoperative and recalled scores for severity of both angina and breathlessness and were not statistically different, patients who recalled most accurately their preoperative scores had, on average, significantly higher preoperative scores than those with less accurate recall. Patients whose angina and breathlessness symptoms were relieved by operation had significantly better accuracy of recall than patients with greater levels of symptoms postoperatively.Conclusion. Patient’s rating of preoperative symptom severity before and one year following aorta-coronary artery bypass grafting was completely accurate in approximately one sixth of patients with similar proportions of the remaining patients overestimating and underestimating symptoms. The extent to which angina and breathlessness was relieved by operation was a significant factor in improving accuracy of recall.Relevance to clinical practice. Factors associated with accuracy of recall of symptoms provide useful insights for clinicians when interpreting patients’ views of the effectiveness of aorta-coronary artery bypass grafting for the relief of symptoms associated with coronary heart disease.
Cardiovascular Drugs and Therapy, 2004
Journal of Clinical Nursing, 2009
Aims. The primary aim of this study was to examine the needs of older people in relation to card... more Aims. The primary aim of this study was to examine the needs of older people in relation to cardiac rehabilitation and to determine if these were currently being met. A secondary aim was to compare illness representations, quality of life and anxiety and depression in groups with different levels of attendance at a cardiac rehabilitation programme.Background. Coronary heart disease accounted for over seven million cardiovascular deaths globally in 2001. Associated deaths increase with age and are highest in those older than 65. Effective cardiac rehabilitation can assist independent function and maintain health but programme uptake rates are low. We have, therefore, focussed specifically on the older patient to determine reasons for the low uptake.Design. Mixed methods.Methods. A purposive sample of 31 older men and women (≥65 years) completed three questionnaires to determine illness representations, quality of life and anxiety and depression. They then underwent a brief clinical assessment and participated in a face-to-face audio-taped interview.Results. Quantitative: Older adults, who did not attend a cardiac rehabilitation programme, had significantly poorer personal control and depression scores (p < 0·01) and lower quality of life scores than those who had attended. Few achieved recommended risk factor reduction targets. Qualitative: The three main themes identified as reflecting the views and experiences of and attendance at the cardiac rehabilitation programme were: ‘The sensible thing to do’, ‘Assessing the impact’ and ‘Nothing to gain’.Conclusions. Irrespective of level of attendance, cardiac rehabilitation programmes are not meeting the needs of many older people either in terms of risk factor reduction or programme uptake. More appropriate programmes are needed.Relevance to clinical practice. Cardiac rehabilitation nurses are ideally placed to identify the rehabilitation needs of older people. Identifying these from the older person’s perspective could help guide more appropriate intervention strategies.
Journal of Human Hypertension, 2002
The objective of the study was to examine medically managed secondary prevention at one year afte... more The objective of the study was to examine medically managed secondary prevention at one year after coronary artery bypass grafting (CABG). In all, 214 consecutive patients undergoing isolated elective CABG seen four weeks preoperatively and one year postoperatively. Preoperative systolic blood pressure averaged 135 7 20 mmHg, which increased to 148 7 25 mmHg (Po0.0001) as did diastolic pressure (81 7 12 to 87 7 13 mmHg; Po0.0001). Anginal symptoms were reported by 45.1% (Po0.0001) although median severity scored lower (4.0 [3.0-5.4] vs 0 [0-2.0]; Po0.0001). Breathlessness decreased from 93% to 64% (Po0.0001) and was scored less severely (4.0 [2.0-5.0] vs 2.0 [0-4.0]; Po0.0001. In all, 88% with postoperative angina reported dyspnoea against 44% of those without (Po0.0001). Calcium antagonist use was more common in patients with angina (27.2% vs 5.1%; Po0.0001), but not nitrates (P ¼ 0.8695), diuretics (P ¼ 0.4218), digoxin (P ¼ 0.2565), b-blockers (P ¼ 0.0820), or ACE inhibitors (P ¼ 0.7256). Preoperatively 166 patients (80.2%) took aspirin vs 69.2% afterwards (P ¼ 0.0131). Twelve patients (6.5%) received warfarin after operation vs none preoperatively. Two took digoxin (0.97%) preoperatively and 14 (7.7%) postoperatively (P ¼ 0.001) for chronic atrial fibrillation. One of these took warfarin. Longacting nitrate use fell from 63.4% to 15.8% (P o0.0001). Short-acting nitrate use fell similarly (Po0.0001). Preoperatively 37 patients (17.9%) took ACE inhibitors vs 44 postoperatively (24.2%); 39 had not received them before. Preoperatively 48 (23.2%) took diuretics vs 30 (16.5%) postoperatively (P ¼ 0.127); 24 had not previously taken diuretics. More patients took HMGCoA inhibitors postoperatively (P ¼ 0.0068) and total cholesterol was significantly reduced with a concomitant increase in HDL fraction. Smoking habit was virtually unchanged from 17.8% to 15.1% (P ¼ 0.5023). In conclusion: angina was common. Apart from statin prescribing, postoperative secondary prevention measures were poorly applied, less widespread and less effective than preoperatively. The implications are disturbing.
European Journal of Cardiovascular Nursing, 2006
Background: The aim of the coronary artery bypass graft operation is to relieve anginal symptoms ... more Background: The aim of the coronary artery bypass graft operation is to relieve anginal symptoms and improve functional ability, quality of life and survival. However, having the surgery does not always have the desired outcomes. Although numerous studies have investigated the outcomes of coronary artery bypass graft operation, little attention has been given to patients' perceptions of the outcomes or effects of the operation on health and well-being over time. Aim: To explore patients' perspectives on the effects of coronary artery bypass surgery on health and well-being over time. Methods: As part of a larger mixed methods study, 62 in-depth audio-taped interviews with men and women who had undergone coronary artery bypass approximately 7 years earlier were conducted. Interviews were audio-taped and transcribed. Data were analysed thematically. This paper reports the findings from the qualitative component of the larger study. Findings: The four main themes: FRecovery and Rehabilitation_, FSeven Years On_, FMaintaining a Positive Approach_, and FHealth Behaviour Change_ reflect the main areas of focus emerging across the interviews and provide credible overarching descriptors of the subthemes they encompass. The 11 sub-themes identified were recognised as central to the patients' experiences of their health and well-being over the longer-term. Conclusions: Although most patients report improved health and well-being after coronary artery bypass operation, many have described their recovery and rehabilitation as a complex process with both short and long term effects. The insights provided by participants help improve our understanding of the impact of the operation on patients' health and well-being over time. We believe these insights will help us to anticipate the possible needs of future patients and enable us develop appropriate interventions that may facilitate self-management for optimal recovery and health maintenance.
Age and Ageing, 2004
Background: over the next 20 years it is anticipated that there will be a significant increase in... more Background: over the next 20 years it is anticipated that there will be a significant increase in those aged 75 and over, and a consequent increase in cardiovascular disease, cancer and chronic illness. As this shift takes effect, there will be an increased need for treatment strategies that are of known benefit to this age group and a consequent rise in demand for clinical trials that are conducted specifically with the older population. Because factors that motivate older individuals to participate in clinical trials may differ from those that influence younger adults, it is important to evaluate the strategies used to encourage recruitment and retention and to determine how appropriate these are. Aim: evaluation of the reasons why subjects agree to participate in a controlled clinical trial of vascular disease prevention and the strategies used to improve compliance and protocol adherence. Setting: Scotland. Subjects: 2,520 Prospective Study of Pravastatin in the Elderly at Risk participants, aged 70-82 with either pre-existing vascular disease or at least one major vascular risk factor (hypertension, cigarette smoking, or diabetes mellitus). Design of study: two-stage iterative survey. Stage I was exploratory. Results: curiosity, or an interest in finding out more about the study, 'a desire to support research', and anticipated personal benefits, such as health screening, were the most important motivators for generating initial interest in the trial. Ongoing health monitoring was the most important recruitment and retention motivator (P = 0.001). Conclusions: curiosity, self interest and altruism may act as motivators at different points in the study time-line. However, fostering positive relationships between staff and recruits, and keeping recruits informed about the progress of the study are likely to maximise the retention of older subjects to long-term trials.
Coronary Health Care, 1999
Coronary Health Care, 1998
Coronary Health Care, 1998
Coronary Health Care, 1999
Coronary Health Care, 1997
The problem addressed in the study was to gain a greater understanding of the health benefits of ... more The problem addressed in the study was to gain a greater understanding of the health benefits of coronary artery bypass grafting (CABG). The purpose of the study was to assess general health status, using the short-form (SF)-36 questionnaire, approximately 12 months following CABG, and to document any associations between pre-operative health status, level of social support, coronary artery disease (CAD) risk factors, CAD symptom severity and post-operative health status. The study was prospective and observational in design and included assessments at two time points, namely pre-operatively in a hospital outpatient department (1995-1996) and post-operatively at home (1996-1997). Two hundred and fourteen patients awaiting elective CABG were recruited a month before the expected date of operation. Pre-operative assessment included: (1), severity of symptoms; (2), CAD risk factors; (3), SF-36 questionnaire; and (4), social activities questionnaire. Post-operative assessment measured health status using the SF-36 instrument (mean, 16.4 months). Correlation and multiple linear regression analyses were used to identify factors associated with improved health status following CABG. Two hundred and fourteen patients were assessed pre-operatively and underwent CABG. There was a 4.8% 30-day mortality rate, and 183 patients were followed for a mean of 16.4 months after CABG. SF-36 scores following CABG were improved across all of the eight domains (P<0.001). A higher social network score and higher pre-operative health status were associated with improved health status. Patients with lower health levels (SF-36 scores) prior to CABG were less likely to gain improvement in health (SF-36 scores) following CABG. Lower SF-36 scores following operation were influenced by the presence of diabetes mellitus, cigarette smoking, younger age, a high socio-economic deprivation category and higher alcohol intake. Many patients had uncorrected CAD risk factors at pre-operative assessment. The SF-36 instrument was shown to be a useful and sensitive tool to assess differences and changes in the general health status of patients before and following CABG. High levels of social support were associated with improved health status post-operatively. Lower pre-operative general health status, the presence of diabetes mellitus and cigarette smoking were associated with poorer post-operative general health status.
Heart, 2001
Objectives-To assess health status, level of social support, and presence of coronary artery dise... more Objectives-To assess health status, level of social support, and presence of coronary artery disease risk factors before and after coronary artery bypass grafting (CABG); to assess symptomatic relief approximately 12 months postoperatively; and to examine the association between preoperative health status and recurrence of symptoms. Design-Observational study. Setting-Preoperatively, in hospital outpatient department (1995)(1996); postoperatively, at home . Subjects and methods-Patients awaiting elective CABG were recruited one month before the expected date of operation. Preoperative assessment included severity of symptoms, coronary artery disease risk factors, short form 36 (SF-36) questionnaire, and social activities questionnaire. The presence and severity of angina and breathlessness were reported postoperatively (mean 16.4 months). Multiple regression analysis was used to identify factors associated with improved outcome following CABG. Main outcome measure-Patient reported presence and severity of angina and breathlessness. Results-183 patients were followed for a mean of 16.4 months after CABG. Angina and breathlessness were completely relieved in 55% and 36% of patients, respectively. In patients with residual symptoms, the severity was significantly reduced (angina p < 0.001; breathlessness, p = 0.02). Patients with low SF-36 scores and low social network scores preoperatively were less likely to be relieved of symptoms (p < 0.001). Health status and social support levels preoperatively were lower than in other reported coronary artery disease patients groups. Preoperatively, coronary artery disease risk factors were higher than recommended in current guidelines: 67.4% had raised plasma cholesterol, 39.0% were hypertensive, 80% were moderately obese, and 22.9% were smokers. Conclusions-Recurrence of symptoms exceeded other published studies. Patients' perception of general health, symptoms, and social support influences outcome. (Heart 2001;85:80-86)
Objective-To evaluate the eVectiveness of a nurse led shared care programme to improve coronary h... more Objective-To evaluate the eVectiveness of a nurse led shared care programme to improve coronary heart disease risk factor levels and general health status and to reduce anxiety and depression in patients awaiting coronary artery bypass grafting (CABG). Design-Randomised controlled trial.
Journal of Advanced Nursing, 2002
Background. Emergency Nurse Practitioners (ENP) are increasingly managing minor injuries in Acci... more Background. Emergency Nurse Practitioners (ENP) are increasingly managing minor injuries in Accident and Emergency departments across the United Kingdom. This study aimed to develop methods and tools that could be used to measure the quality of ENP-led care. These tools were then tested in a randomized controlled trial.Methods. A convenience sample of 199 eligible patients, over 16 years old, and with specific minor injuries was randomized either to ENP-led care ( n = 99) or Senior House Officer (SHO)-led care ( n = 100) and were diagnosed, treated, referred or discharged by this lead clinician. Following treatment, patients were asked to complete a patient satisfaction questionnaire related to the consultation. Clinical documentation was assessed using a ‘Documentation Audit Tool’. A follow-up questionnaire was sent to all patients at 1 month. Return visits to the department and missed injuries were monitored.Results. Patients were satisfied with the level of care from both ENPs and SHOs. However, they reported that ENPs were easier to talk to ( P = 0·009); gave them information on accident and illness prevention ( P = 0·001); and gave them enough information on their injury ( P = 0·007). Overall they were more satisfied with the treatment provided by ENPs than with that from SHOs ( P < 0·001). ENPs' clinical documentation was of higher quality than SHOs ( P < 0·001). No differences were found in recovery times, level of symptoms, time off work or unplanned follow-up between groups. Missed injuries were the same for both groups ( n = 1 in each group).Conclusion. The study was sufficiently large to demonstrate higher levels of patient satisfaction and clinical documentation quality with ENP-led than SHO-led care. A larger study involving 769 patients in each arm would be required to detect a 2% difference in missed injury rates. The methods and tools used in this trial could be used in Accident and Emergency departments to measure the quality of ENP-led care.