Gerry Humphris | University of St Andrews (original) (raw)
Papers by Gerry Humphris
Clinical oncology (Royal College of Radiologists (Great Britain)), 2003
Quality of Life (QOL) is now a standard end-point in clinical trials. The aim of this non-cohort ... more Quality of Life (QOL) is now a standard end-point in clinical trials. The aim of this non-cohort study was to assess the practical issues surrounding the collection of QOL data in a non-trial setting, and to determine whether it is feasible and worthwhile.
Psychosomatic medicine
Objective: We test predictions from contrasting theories that primary care physicians offer medic... more Objective: We test predictions from contrasting theories that primary care physicians offer medical care to patients with medically unexplained symptoms in response to a) patients' attribution of symptoms to disease and demand for treatment or b) their progressive elaboration of their symptoms in the attempt to engage their physicians. Methods: Primary care physicians identified consecutive patients who consulted with symptoms that the physician considered unexplained by physical disease. Four hundred twenty consultations with 36 physicians were audio recorded and transcribed, and physician and patient speech was coded turn by turn. Hierarchical logistic regression analysis modeled the probability of the physician proposing medical care as a function of the quantity of patients' speech of specific kinds that preceded it. Results: Whether physicians proposed medical care was unrelated to patients' attributions to disease or demands for treatment. Proposals of explicitly somatic responses (drugs, investigation or specialist referral) became more likely after patients had elaborated their symptoms and less likely after patients indicated psychosocial difficulties. Proposals of a further primary care consultation were responses simply to lengthening consultation. Conclusions: The findings are incompatible with the influential assumption that physicians offer medical care to patients with unexplained symptoms because the patients demand treatment for a physical disease. Instead, the reason why many of these patients receive high levels of medical care should be sought by investigating the motivations behind physicians' responses to patients' symptom presentation.
A prospective study of dental anxiety in a cohort of children followed from 5 to 9 years of age
International journal of paediatric dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children, 2009
Background. The development of dental anxiety in children is poorly understood.Aims. The aims o... more Background. The development of dental anxiety in children is poorly understood.Aims. The aims of this study were to measure changes in dental anxiety over time and to examine the relationship between anxiety, dental care, and other factors.Design. A prospective cohort study of children in the north-west of England followed from 5 to 9 years of age. The participants were clinically examined and their parents completed the same questionnaire at 5 and 9 years.Results. The majority (54.3%N = 38) of participants who were anxious at 5 years were no longer anxious at 9 years, but a large proportion of children who were anxious at 5 remained anxious at 9 years of age (45.7%N = 32). During the follow-up period, a larger proportion of children developed anxiety (11.7%N = 85) than the proportion of children who were reported as being anxious at baseline (8.8%N = 70). At 9 years of age, dental anxiety was significantly associated with girls; parental anxiety; a history of extraction; and irregular, asymptomatic dental visiting. These factors were also significantly associated with dental anxiety at 5 years old.Conclusions. Dental anxiety was cumulative in the study population over time, and its development influenced by multiple variables. Results suggest that adverse conditioning and vicarious learning are both important in the development of this condition.
Cancer nursing
Quality of life Recurrence Loco-regional recurrence after radical primary treatment of oral cance... more Quality of life Recurrence Loco-regional recurrence after radical primary treatment of oral cancer is associated with poor prognosis and major patient and carer distress. The patient's psychosocial response to recurrence is underreported in the literature. This is one of the few papers to address in detail this stage in a patient's cancer journey. Qualitative methodology was used. Patients were recruited over a 13-month period. Analysis of recorded transcripts from 9 patients suggested that their illness experience and psychological response to diagnosis were multifaceted. Six key themes were identified, which were subdivided into 23 categories. Themes included emotional reactions, reevaluation, active coping strategies, life changes, support, and improvement in relationships. Emotional reactions ranged from shock and devastation, to fear and uncertainty, to hopelessness, to shame, to denial. Not all reactions were negative, and more positive experiences such as newfound openness and improvement in relationships were expressed. There is heightened emotional vulnerability, and this leads to potentially difficult management issues among clinicians and members of the multidisciplinary team. Extreme sensitivity is required by all the individuals involved in providing healthcare at this acute time of patient and carer distress.
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 2013
Background The effect of reassurance in managing distress among children who receive procedures o... more Background The effect of reassurance in managing distress among children who receive procedures of a less aversive nature has not been fully investigated. Purpose This study aimed to investigate the relationship between reassurance by dental staff and distress behavior of preschool children receiving preventive procedures in a community setting. Methods Nurse–child interactions (n = 270) during fluoride varnish application were video recorded and coded. Multilevel logistic regression modeled the probability of the occurrence of child distress behavior as a function of reassurance provision, controlling for child-level and nurse-level variables. Results Child distress behavior was positively related to nurse verbal reassurance but negatively linked to the time that this reassurance occurred. Both child initial anxiety and nurse nonprocedural training increased the probability of observable distress behavior. Conclusions The use of verbal reassurance to promote reception of mild invasive procedures was counterindicated, especially when offered early in the intervention (ClinicalTrials.gov number: NCT00881790).
Rehabilitation after critical illness: a randomized, controlled trial
Critical care medicine, 2003
To evaluate the effectiveness of a rehabilitation program following critical illness to aid physi... more To evaluate the effectiveness of a rehabilitation program following critical illness to aid physical and psychological recovery.
Dentists' training and willingness to treat adolescents with learning disabilities: the mediating role of social and clinical factors
Community dental health, 2013
To test a theoretical model based on Cohen's dental profession factors (training; practit... more To test a theoretical model based on Cohen's dental profession factors (training; practitioner attitudes; geography) to investigate practitioners' willingness to treat adolescents with learning disabilities (LD) in primary dental care. A sample of all 537 primary care dentists working in a mainly urban area of Northern Ireland and a more rural area of Scotland. Willingness to treat adolescents with LD. Questionnaire survey of demographic profile, undergraduate education, current knowledge, attitudes towards individuals with LD and willingness to treat this patient group. A path analytical approach (multiple meditational model) was used. Three hundred dentists participated giving a valid response rate of 61%. Undergraduate education and current knowledge (training) strengthened a social model perspective promoting positive attitudes and willingness to treat adolescents with LD. Undergraduate education and current knowledge about disability did not significantly contribute to dentists whose attitudes were underpinned by the medical model of disability. Therefore geography (rural or urban location) was not an influential factor in willingness to treat adolescents with LD. This does not exclude the possibility that area of work may have an influence as a consequence of undergraduate university attended. This model identifies the importance of undergraduate and continuing dental education with regard to modifying professional attitudes (social and clinical factors) to assist practitioners treat adolescents with LD and provide them with inclusive dental services in primary dental care.
Psycho-oncology, 2009
Background: Fear of recurrence (FOR) has been increasingly recognised as an issue of significant ... more Background: Fear of recurrence (FOR) has been increasingly recognised as an issue of significant burden for most cancer patients, and has been associated with psychological morbidity and reduced quality of life. More recently, the impact of recurrence fears has been indicated in the families of cancer patients. However, there has been a lack of prospective research.Aim: To systematically examine distress and illness concerns among patient–carer dyads.Methods: A multi-centre prospective study of head and neck cancer patients and their carers (patients, n=101; carers, n=101), surveyed at two time-points following diagnosis.Results: Carers recorded higher recurrence concerns on average than the patient group (p<0.001). A predictive path model of patient and carer self-reports of distress and FORs was explored, with an excellent overall fit of the final model (χ2=15.4, df=12, p=0.22, Comparative Fit Index (CFI)=0.994, Root Mean Square Estimate of Approximation (RMSEA)=0.053).Conclusions: The preliminary results establish that early fears and distress within individuals govern later reports on these same attributes, but that there is some weak evidence of influence from one attribute to another within and across individuals in the dyad. Future prospective dyadic research is warranted to ascertain the level of these fears over an extended time and their relationship to patient and carer adaptation. Intervention may be needed to reduce this disease concern to a manageable level at an early stage of the illness trajectory. Copyright © 2008 John Wiley & Sons, Ltd.
Conversion tables for the Corah and Modified Dental Anxiety Scales
Community dental health, 2007
Résumé/Abstract Dental anxiety assessment can be achieved by using brief multi-item scales. Corah... more Résumé/Abstract Dental anxiety assessment can be achieved by using brief multi-item scales. Corah's Dental Anxiety Scale has been used extensively since the 1970s. However the scale has some flaws which led to the design of the Modified Dental Anxiety Scale ...
The behaviour of extended duties dental nurses and the acceptance of fluoride varnish application in preschool children
British dental journal, 2012
Extended duties dental nurses (EDDNs) have been trained to deliver fluoride varnish applications ... more Extended duties dental nurses (EDDNs) have been trained to deliver fluoride varnish applications to preschool children as part of the Childsmile initiative in Scotland. To determine a detailed behavioural profile of the EDDNs during the administration of the fluoride varnish to confirm professional manner and identify differences in nurse behaviours between successful and unsuccessful application sessions. Nurse-child interactions were video recorded and nurse behaviours coded and analysed using a specially developed coding scheme (SABICS). Behaviour frequency and duration were measured and correlations were calculated. Differences in behaviour were examined between successful and unsuccessful application sessions. Three hundred and three interactions were coded out of 456 recorded application sessions. No incident occurred where nurses threatened or placed undue stress on a child. In unsuccessful, compared with successful, application sessions, nurses demonstrated higher frequency and duration of the following behaviours: &amp;amp;amp;#39;permission seeking&amp;amp;amp;#39;, &amp;amp;amp;#39;offer of task alternative&amp;amp;amp;#39;, &amp;amp;amp;#39;information seeking&amp;amp;amp;#39; and &amp;amp;amp;#39;reassurance&amp;amp;amp;#39;, controlling for length of procedure. Whereas with successful applications, &amp;amp;amp;#39;praise&amp;amp;amp;#39;, &amp;amp;amp;#39;instruction&amp;amp;amp;#39; and &amp;amp;amp;#39;information-giving&amp;amp;amp;#39; were used more frequently and for a longer duration, compared with unsuccessful applications. The EDDNs demonstrated a professional manner working with preschool children. They behaved differently between successful and unsuccessful application sessions. Sequential analysis is needed to examine causal effects of behaviours and its effects on delivery outcomes.
Measuring children's dental anxiety
Evidence-based dentistry, 2012
Medline and the Social Science Index Citation databases were searched. Studies had to have used m... more Medline and the Social Science Index Citation databases were searched. Studies had to have used measures of dental anxiety completed by children themselves (≤16 years), been published in English and reported primary data. Non-validated measures, those using proxy measures and non-dentally specific measures were excluded. Data were extracted independently using a standardised form. Validity and reliability of the questionnaires were assessed, and measures were evaluated against a theoretical framework of dental anxiety. A qualitative summary of the measures is presented. Sixty studies met the inclusion criteria. These covered seven &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;trait&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; and two &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;state&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; measures of dental anxiety used to assess children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s dental anxiety over the past decade. The findings from this systematic review can be used to help guide dental academics, clinicians, psychologists and epidemiologists to choose the most appropriate measure of dental anxiety for their intended use. Future work should involve evaluating the content and developmental validity of existing measures with further consideration given to the use of theoretical frameworks to develop this field.
Normalisation of unexplained symptoms by general practitioners: a functional typology
The British journal of general practice : the journal of the Royal College of General Practitioners, 2004
Patients often present in primary care with physical symptoms that doctors cannot readily explain... more Patients often present in primary care with physical symptoms that doctors cannot readily explain. The process of reassuring these patients is challenging, complex and poorly understood. To construct a typology of general practitioners&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (GPs&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;) normalising explanations, based on their effect on the process and outcome of consultations involving patients with medically unexplained symptoms. Qualitative analysis of audiotaped consultations between patients and GPs. Seven general practices in Merseyside, United Kingdom. Transcripts of audiotaped consultations between 21 GPs and 36 patients with medically unexplained symptoms were analysed inductively, to identify types of normalising speech used by GPs. Normalisation without explanation included rudimentary reassurance and the authority of a negative test result. Patients persisted in requesting explanation and elaborated or extended their symptoms, rendering somatic management more likely. Normalisation with ineffective explanation provided a tangible physical explanation for symptoms, unrelated to patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s expressed concerns. This was also counterproductive. Normalisation with effective explanation provided tangible mechanisms grounded in patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; concerns, often linking physical and psychological factors. These explanations were accepted by patients; those linking physical and psychological factors contributed to psychosocial management outcomes. The routine exercise of normalisation by GPs contains approaches that are ineffective and may exacerbate patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; presentation. However, it also contains types of explanation that may reduce the need for symptomatic investigation or treatment. These findings can inform the development of well-grounded educational interventions for GPs.
International journal of surgery (London, England), 2006
Head and neck cancer; Quality of life; Psychology; Patient information needs Abstract The patient... more Head and neck cancer; Quality of life; Psychology; Patient information needs Abstract The patient with head and neck (H&N) cancer is prone to psychological distress immediately following diagnosis and during the treatment phase. Lowered mood is typical and tends to extend beyond the treatment phase. There is little evidence for a specific treatment method predicting a characteristic psychological response. Rather, patients' reactions vary widely according to fears of recurrence, health beliefs, personality, coping and available support. Patient reports of quality of life show a return to pre-treatment status after a year but are determined to some degree by initial depression levels and dispositional factors such as optimism. Information provided to patients (e.g. leaflets, booklets of written guidance) by specialist treatment centres about the disease and its management require sustained effort in their design and distribution. Our understanding of patient responses to this disease has improved and has assisted in the development of psychological interventions. Controlled trials will provide important evidence of the components, effects and sustainability of these experimental programmes, and improve overall care plans for this often neglected patient group.
General hospital psychiatry
More than half of all outpatient visits are trigged by physical symptoms which, in turn, are not ... more More than half of all outpatient visits are trigged by physical symptoms which, in turn, are not adequately explained by medical disorders at least half of the time. Further, the presence and severity of somatic symptoms often correlate more strongly with psychological, cognitive and behavioral factors than with physiological or biological findings. Finally, our understanding of the etiology, evaluation, and management of somatic symptoms and functional syndromes is less advanced than our knowledge of many defined medical and psychiatric disorders. This special section, edited by Kurt Kroenke, M.D., will highlight original studies that advance the science and clinical care of somatic symptoms.
Assessment of problems with appearance, following surgery for oral and oro-pharyngeal cancer using the University of Washington appearance domain and the Derriford appearance scale
Oral oncology, 2008
The first aim of this study was to describe appearance issues in patients following surgery for o... more The first aim of this study was to describe appearance issues in patients following surgery for oral and oro-pharyngeal squamous cell carcinoma using the Derriford appearance scale (DAS24) and the University of Washington Quality of Life Questionnaire Version 4 appearance item (UWQOL v4). Another aim was to compare these two questionnaires and justify a cut-off in the UWQOL. Also the study compares the cancer group to reference data and explores associations with clinical factors. 383 alive and disease free patients and treated between 1992 and 2005 were sent the survey of which 252 (66%) responded. Age (younger patients), T stage 3 and 4 and adjuvant radiotherapy were key factors in patients reporting problems with appearance. There was excellent correlation between the two questionnaires. A cut-off of less than 75 in the UWQOLv4 appearance item captured most of the problems raised in the DAS24. The cancer cohort had similar DAS24 scores to the general population sample and had more positive scores than the clinical reference group (burns etc patient). In conclusion the UWQOL appearance domain appears to be a suitable means of screening for appearance issues in this cohort and could act as a trigger for further assessment and treatment.
The immediate effect on knowledge, attitudes and intentions in primary care attenders of a patient information leaflet: a randomized control trial replication and extension
British dental journal, 2003
To determine whether the influence of a leaflet on mouth cancer improves knowledge, related attit... more To determine whether the influence of a leaflet on mouth cancer improves knowledge, related attitudes and intention to accept a mouth screen. Randomized controlled trial. Dental and medical waiting rooms in the North West of England. Nine hundred and forty nine patients from 16 practices were invited to participate. Standardized multi-item scales of six outcome measures including knowledge, beliefs and intention to accept an oral cancer screen. A patient information leaflet was given to a randomized intervention group of patients. A single sheet questionnaire was completed by both groups of patients (immediately following leaflet administration in the intervention arm of study). t tests were used to compare outcome variables between patients with and without access to the leaflet with Boneferroni correction. Participation rate was high (91%). Knowledge (P <0.001) and intentions (P = 0.003) benefited from patient access to leaflet. Anxiety was not raised with leaflet exposure. Some beliefs about the screening procedure appeared to be slightly improved by reading the leaflet (p <0.05). This study supports previous findings of an immediate positive effect of an information leaflet on patients' knowledge of oral cancer and willingness to accept an oral cancer screen.
Social science & medicine (1982), 2005
British dental journal, 2003
Objectives To examine the relationship between dental anxiety, dental attendance and past treatme... more Objectives To examine the relationship between dental anxiety, dental attendance and past treatment history in 5-year-old children after taking into account confounding influences. Methods A cross sectional study of all 5-year-old children living in Ellesmere Port and Chester. All children were clinically examined and dmft and its components were recorded. A postal questionnaire was sent to parents of participating children to identify whether children attended the dentist on a regular asymptomatic basis or only when experiencing problems. Additionally parents were asked to judge whether they and their child were anxious about dental treatment. The socio-economic status of the family was measured using the Townsend Material Deprivation Index of the electoral ward in which they resided. The bivariate relationships between anxiety and reported attendance, caries experience, past extraction and restoration history were assessed using chi-square and t-tests. Multiple logistic regression analyses were used to identify predictors for dental anxiety. Results A total of 1,745 children received both a clinical examination and a questionnaire and 1,437 parents responded, a response rate of 82.3%. One in ten parents (10.8%) judged their child to be dentally anxious. Anxious children had significantly (p<0.001) more caries experience (dmft 2.58 vs 1.12). Multiple logistic regression analyses confirmed that anxious children were more likely to be irregular attenders (OR 3.33, 95% CI 2.22, 5.00), have anxious parents (OR 1.60, 95% CI 1.09, 2.36), and to have undergone dental extraction in the past (OR 3.50, 95% CI 2.10, 5.85), after controlling for gender and socioeconomic status. A past history of restoration was not a significant predictor of anxiety after controlling for other factors.
Patient education and counseling, 2011
Objective: To present the Verona-Coding Definitions of Emotional Sequences consensus definitions ... more Objective: To present the Verona-Coding Definitions of Emotional Sequences consensus definitions to code Provider responses (VR-CoDES-P) to patient cues and concerns as described by Zimmermann et al. [2,.
Clinical oncology (Royal College of Radiologists (Great Britain)), 2003
Quality of Life (QOL) is now a standard end-point in clinical trials. The aim of this non-cohort ... more Quality of Life (QOL) is now a standard end-point in clinical trials. The aim of this non-cohort study was to assess the practical issues surrounding the collection of QOL data in a non-trial setting, and to determine whether it is feasible and worthwhile.
Psychosomatic medicine
Objective: We test predictions from contrasting theories that primary care physicians offer medic... more Objective: We test predictions from contrasting theories that primary care physicians offer medical care to patients with medically unexplained symptoms in response to a) patients' attribution of symptoms to disease and demand for treatment or b) their progressive elaboration of their symptoms in the attempt to engage their physicians. Methods: Primary care physicians identified consecutive patients who consulted with symptoms that the physician considered unexplained by physical disease. Four hundred twenty consultations with 36 physicians were audio recorded and transcribed, and physician and patient speech was coded turn by turn. Hierarchical logistic regression analysis modeled the probability of the physician proposing medical care as a function of the quantity of patients' speech of specific kinds that preceded it. Results: Whether physicians proposed medical care was unrelated to patients' attributions to disease or demands for treatment. Proposals of explicitly somatic responses (drugs, investigation or specialist referral) became more likely after patients had elaborated their symptoms and less likely after patients indicated psychosocial difficulties. Proposals of a further primary care consultation were responses simply to lengthening consultation. Conclusions: The findings are incompatible with the influential assumption that physicians offer medical care to patients with unexplained symptoms because the patients demand treatment for a physical disease. Instead, the reason why many of these patients receive high levels of medical care should be sought by investigating the motivations behind physicians' responses to patients' symptom presentation.
A prospective study of dental anxiety in a cohort of children followed from 5 to 9 years of age
International journal of paediatric dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children, 2009
Background. The development of dental anxiety in children is poorly understood.Aims. The aims o... more Background. The development of dental anxiety in children is poorly understood.Aims. The aims of this study were to measure changes in dental anxiety over time and to examine the relationship between anxiety, dental care, and other factors.Design. A prospective cohort study of children in the north-west of England followed from 5 to 9 years of age. The participants were clinically examined and their parents completed the same questionnaire at 5 and 9 years.Results. The majority (54.3%N = 38) of participants who were anxious at 5 years were no longer anxious at 9 years, but a large proportion of children who were anxious at 5 remained anxious at 9 years of age (45.7%N = 32). During the follow-up period, a larger proportion of children developed anxiety (11.7%N = 85) than the proportion of children who were reported as being anxious at baseline (8.8%N = 70). At 9 years of age, dental anxiety was significantly associated with girls; parental anxiety; a history of extraction; and irregular, asymptomatic dental visiting. These factors were also significantly associated with dental anxiety at 5 years old.Conclusions. Dental anxiety was cumulative in the study population over time, and its development influenced by multiple variables. Results suggest that adverse conditioning and vicarious learning are both important in the development of this condition.
Cancer nursing
Quality of life Recurrence Loco-regional recurrence after radical primary treatment of oral cance... more Quality of life Recurrence Loco-regional recurrence after radical primary treatment of oral cancer is associated with poor prognosis and major patient and carer distress. The patient's psychosocial response to recurrence is underreported in the literature. This is one of the few papers to address in detail this stage in a patient's cancer journey. Qualitative methodology was used. Patients were recruited over a 13-month period. Analysis of recorded transcripts from 9 patients suggested that their illness experience and psychological response to diagnosis were multifaceted. Six key themes were identified, which were subdivided into 23 categories. Themes included emotional reactions, reevaluation, active coping strategies, life changes, support, and improvement in relationships. Emotional reactions ranged from shock and devastation, to fear and uncertainty, to hopelessness, to shame, to denial. Not all reactions were negative, and more positive experiences such as newfound openness and improvement in relationships were expressed. There is heightened emotional vulnerability, and this leads to potentially difficult management issues among clinicians and members of the multidisciplinary team. Extreme sensitivity is required by all the individuals involved in providing healthcare at this acute time of patient and carer distress.
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 2013
Background The effect of reassurance in managing distress among children who receive procedures o... more Background The effect of reassurance in managing distress among children who receive procedures of a less aversive nature has not been fully investigated. Purpose This study aimed to investigate the relationship between reassurance by dental staff and distress behavior of preschool children receiving preventive procedures in a community setting. Methods Nurse–child interactions (n = 270) during fluoride varnish application were video recorded and coded. Multilevel logistic regression modeled the probability of the occurrence of child distress behavior as a function of reassurance provision, controlling for child-level and nurse-level variables. Results Child distress behavior was positively related to nurse verbal reassurance but negatively linked to the time that this reassurance occurred. Both child initial anxiety and nurse nonprocedural training increased the probability of observable distress behavior. Conclusions The use of verbal reassurance to promote reception of mild invasive procedures was counterindicated, especially when offered early in the intervention (ClinicalTrials.gov number: NCT00881790).
Rehabilitation after critical illness: a randomized, controlled trial
Critical care medicine, 2003
To evaluate the effectiveness of a rehabilitation program following critical illness to aid physi... more To evaluate the effectiveness of a rehabilitation program following critical illness to aid physical and psychological recovery.
Dentists' training and willingness to treat adolescents with learning disabilities: the mediating role of social and clinical factors
Community dental health, 2013
To test a theoretical model based on Cohen's dental profession factors (training; practit... more To test a theoretical model based on Cohen's dental profession factors (training; practitioner attitudes; geography) to investigate practitioners' willingness to treat adolescents with learning disabilities (LD) in primary dental care. A sample of all 537 primary care dentists working in a mainly urban area of Northern Ireland and a more rural area of Scotland. Willingness to treat adolescents with LD. Questionnaire survey of demographic profile, undergraduate education, current knowledge, attitudes towards individuals with LD and willingness to treat this patient group. A path analytical approach (multiple meditational model) was used. Three hundred dentists participated giving a valid response rate of 61%. Undergraduate education and current knowledge (training) strengthened a social model perspective promoting positive attitudes and willingness to treat adolescents with LD. Undergraduate education and current knowledge about disability did not significantly contribute to dentists whose attitudes were underpinned by the medical model of disability. Therefore geography (rural or urban location) was not an influential factor in willingness to treat adolescents with LD. This does not exclude the possibility that area of work may have an influence as a consequence of undergraduate university attended. This model identifies the importance of undergraduate and continuing dental education with regard to modifying professional attitudes (social and clinical factors) to assist practitioners treat adolescents with LD and provide them with inclusive dental services in primary dental care.
Psycho-oncology, 2009
Background: Fear of recurrence (FOR) has been increasingly recognised as an issue of significant ... more Background: Fear of recurrence (FOR) has been increasingly recognised as an issue of significant burden for most cancer patients, and has been associated with psychological morbidity and reduced quality of life. More recently, the impact of recurrence fears has been indicated in the families of cancer patients. However, there has been a lack of prospective research.Aim: To systematically examine distress and illness concerns among patient–carer dyads.Methods: A multi-centre prospective study of head and neck cancer patients and their carers (patients, n=101; carers, n=101), surveyed at two time-points following diagnosis.Results: Carers recorded higher recurrence concerns on average than the patient group (p<0.001). A predictive path model of patient and carer self-reports of distress and FORs was explored, with an excellent overall fit of the final model (χ2=15.4, df=12, p=0.22, Comparative Fit Index (CFI)=0.994, Root Mean Square Estimate of Approximation (RMSEA)=0.053).Conclusions: The preliminary results establish that early fears and distress within individuals govern later reports on these same attributes, but that there is some weak evidence of influence from one attribute to another within and across individuals in the dyad. Future prospective dyadic research is warranted to ascertain the level of these fears over an extended time and their relationship to patient and carer adaptation. Intervention may be needed to reduce this disease concern to a manageable level at an early stage of the illness trajectory. Copyright © 2008 John Wiley & Sons, Ltd.
Conversion tables for the Corah and Modified Dental Anxiety Scales
Community dental health, 2007
Résumé/Abstract Dental anxiety assessment can be achieved by using brief multi-item scales. Corah... more Résumé/Abstract Dental anxiety assessment can be achieved by using brief multi-item scales. Corah's Dental Anxiety Scale has been used extensively since the 1970s. However the scale has some flaws which led to the design of the Modified Dental Anxiety Scale ...
The behaviour of extended duties dental nurses and the acceptance of fluoride varnish application in preschool children
British dental journal, 2012
Extended duties dental nurses (EDDNs) have been trained to deliver fluoride varnish applications ... more Extended duties dental nurses (EDDNs) have been trained to deliver fluoride varnish applications to preschool children as part of the Childsmile initiative in Scotland. To determine a detailed behavioural profile of the EDDNs during the administration of the fluoride varnish to confirm professional manner and identify differences in nurse behaviours between successful and unsuccessful application sessions. Nurse-child interactions were video recorded and nurse behaviours coded and analysed using a specially developed coding scheme (SABICS). Behaviour frequency and duration were measured and correlations were calculated. Differences in behaviour were examined between successful and unsuccessful application sessions. Three hundred and three interactions were coded out of 456 recorded application sessions. No incident occurred where nurses threatened or placed undue stress on a child. In unsuccessful, compared with successful, application sessions, nurses demonstrated higher frequency and duration of the following behaviours: &amp;amp;amp;#39;permission seeking&amp;amp;amp;#39;, &amp;amp;amp;#39;offer of task alternative&amp;amp;amp;#39;, &amp;amp;amp;#39;information seeking&amp;amp;amp;#39; and &amp;amp;amp;#39;reassurance&amp;amp;amp;#39;, controlling for length of procedure. Whereas with successful applications, &amp;amp;amp;#39;praise&amp;amp;amp;#39;, &amp;amp;amp;#39;instruction&amp;amp;amp;#39; and &amp;amp;amp;#39;information-giving&amp;amp;amp;#39; were used more frequently and for a longer duration, compared with unsuccessful applications. The EDDNs demonstrated a professional manner working with preschool children. They behaved differently between successful and unsuccessful application sessions. Sequential analysis is needed to examine causal effects of behaviours and its effects on delivery outcomes.
Measuring children's dental anxiety
Evidence-based dentistry, 2012
Medline and the Social Science Index Citation databases were searched. Studies had to have used m... more Medline and the Social Science Index Citation databases were searched. Studies had to have used measures of dental anxiety completed by children themselves (≤16 years), been published in English and reported primary data. Non-validated measures, those using proxy measures and non-dentally specific measures were excluded. Data were extracted independently using a standardised form. Validity and reliability of the questionnaires were assessed, and measures were evaluated against a theoretical framework of dental anxiety. A qualitative summary of the measures is presented. Sixty studies met the inclusion criteria. These covered seven &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;trait&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; and two &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;state&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; measures of dental anxiety used to assess children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s dental anxiety over the past decade. The findings from this systematic review can be used to help guide dental academics, clinicians, psychologists and epidemiologists to choose the most appropriate measure of dental anxiety for their intended use. Future work should involve evaluating the content and developmental validity of existing measures with further consideration given to the use of theoretical frameworks to develop this field.
Normalisation of unexplained symptoms by general practitioners: a functional typology
The British journal of general practice : the journal of the Royal College of General Practitioners, 2004
Patients often present in primary care with physical symptoms that doctors cannot readily explain... more Patients often present in primary care with physical symptoms that doctors cannot readily explain. The process of reassuring these patients is challenging, complex and poorly understood. To construct a typology of general practitioners&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (GPs&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;) normalising explanations, based on their effect on the process and outcome of consultations involving patients with medically unexplained symptoms. Qualitative analysis of audiotaped consultations between patients and GPs. Seven general practices in Merseyside, United Kingdom. Transcripts of audiotaped consultations between 21 GPs and 36 patients with medically unexplained symptoms were analysed inductively, to identify types of normalising speech used by GPs. Normalisation without explanation included rudimentary reassurance and the authority of a negative test result. Patients persisted in requesting explanation and elaborated or extended their symptoms, rendering somatic management more likely. Normalisation with ineffective explanation provided a tangible physical explanation for symptoms, unrelated to patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s expressed concerns. This was also counterproductive. Normalisation with effective explanation provided tangible mechanisms grounded in patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; concerns, often linking physical and psychological factors. These explanations were accepted by patients; those linking physical and psychological factors contributed to psychosocial management outcomes. The routine exercise of normalisation by GPs contains approaches that are ineffective and may exacerbate patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; presentation. However, it also contains types of explanation that may reduce the need for symptomatic investigation or treatment. These findings can inform the development of well-grounded educational interventions for GPs.
International journal of surgery (London, England), 2006
Head and neck cancer; Quality of life; Psychology; Patient information needs Abstract The patient... more Head and neck cancer; Quality of life; Psychology; Patient information needs Abstract The patient with head and neck (H&N) cancer is prone to psychological distress immediately following diagnosis and during the treatment phase. Lowered mood is typical and tends to extend beyond the treatment phase. There is little evidence for a specific treatment method predicting a characteristic psychological response. Rather, patients' reactions vary widely according to fears of recurrence, health beliefs, personality, coping and available support. Patient reports of quality of life show a return to pre-treatment status after a year but are determined to some degree by initial depression levels and dispositional factors such as optimism. Information provided to patients (e.g. leaflets, booklets of written guidance) by specialist treatment centres about the disease and its management require sustained effort in their design and distribution. Our understanding of patient responses to this disease has improved and has assisted in the development of psychological interventions. Controlled trials will provide important evidence of the components, effects and sustainability of these experimental programmes, and improve overall care plans for this often neglected patient group.
General hospital psychiatry
More than half of all outpatient visits are trigged by physical symptoms which, in turn, are not ... more More than half of all outpatient visits are trigged by physical symptoms which, in turn, are not adequately explained by medical disorders at least half of the time. Further, the presence and severity of somatic symptoms often correlate more strongly with psychological, cognitive and behavioral factors than with physiological or biological findings. Finally, our understanding of the etiology, evaluation, and management of somatic symptoms and functional syndromes is less advanced than our knowledge of many defined medical and psychiatric disorders. This special section, edited by Kurt Kroenke, M.D., will highlight original studies that advance the science and clinical care of somatic symptoms.
Assessment of problems with appearance, following surgery for oral and oro-pharyngeal cancer using the University of Washington appearance domain and the Derriford appearance scale
Oral oncology, 2008
The first aim of this study was to describe appearance issues in patients following surgery for o... more The first aim of this study was to describe appearance issues in patients following surgery for oral and oro-pharyngeal squamous cell carcinoma using the Derriford appearance scale (DAS24) and the University of Washington Quality of Life Questionnaire Version 4 appearance item (UWQOL v4). Another aim was to compare these two questionnaires and justify a cut-off in the UWQOL. Also the study compares the cancer group to reference data and explores associations with clinical factors. 383 alive and disease free patients and treated between 1992 and 2005 were sent the survey of which 252 (66%) responded. Age (younger patients), T stage 3 and 4 and adjuvant radiotherapy were key factors in patients reporting problems with appearance. There was excellent correlation between the two questionnaires. A cut-off of less than 75 in the UWQOLv4 appearance item captured most of the problems raised in the DAS24. The cancer cohort had similar DAS24 scores to the general population sample and had more positive scores than the clinical reference group (burns etc patient). In conclusion the UWQOL appearance domain appears to be a suitable means of screening for appearance issues in this cohort and could act as a trigger for further assessment and treatment.
The immediate effect on knowledge, attitudes and intentions in primary care attenders of a patient information leaflet: a randomized control trial replication and extension
British dental journal, 2003
To determine whether the influence of a leaflet on mouth cancer improves knowledge, related attit... more To determine whether the influence of a leaflet on mouth cancer improves knowledge, related attitudes and intention to accept a mouth screen. Randomized controlled trial. Dental and medical waiting rooms in the North West of England. Nine hundred and forty nine patients from 16 practices were invited to participate. Standardized multi-item scales of six outcome measures including knowledge, beliefs and intention to accept an oral cancer screen. A patient information leaflet was given to a randomized intervention group of patients. A single sheet questionnaire was completed by both groups of patients (immediately following leaflet administration in the intervention arm of study). t tests were used to compare outcome variables between patients with and without access to the leaflet with Boneferroni correction. Participation rate was high (91%). Knowledge (P <0.001) and intentions (P = 0.003) benefited from patient access to leaflet. Anxiety was not raised with leaflet exposure. Some beliefs about the screening procedure appeared to be slightly improved by reading the leaflet (p <0.05). This study supports previous findings of an immediate positive effect of an information leaflet on patients' knowledge of oral cancer and willingness to accept an oral cancer screen.
Social science & medicine (1982), 2005
British dental journal, 2003
Objectives To examine the relationship between dental anxiety, dental attendance and past treatme... more Objectives To examine the relationship between dental anxiety, dental attendance and past treatment history in 5-year-old children after taking into account confounding influences. Methods A cross sectional study of all 5-year-old children living in Ellesmere Port and Chester. All children were clinically examined and dmft and its components were recorded. A postal questionnaire was sent to parents of participating children to identify whether children attended the dentist on a regular asymptomatic basis or only when experiencing problems. Additionally parents were asked to judge whether they and their child were anxious about dental treatment. The socio-economic status of the family was measured using the Townsend Material Deprivation Index of the electoral ward in which they resided. The bivariate relationships between anxiety and reported attendance, caries experience, past extraction and restoration history were assessed using chi-square and t-tests. Multiple logistic regression analyses were used to identify predictors for dental anxiety. Results A total of 1,745 children received both a clinical examination and a questionnaire and 1,437 parents responded, a response rate of 82.3%. One in ten parents (10.8%) judged their child to be dentally anxious. Anxious children had significantly (p<0.001) more caries experience (dmft 2.58 vs 1.12). Multiple logistic regression analyses confirmed that anxious children were more likely to be irregular attenders (OR 3.33, 95% CI 2.22, 5.00), have anxious parents (OR 1.60, 95% CI 1.09, 2.36), and to have undergone dental extraction in the past (OR 3.50, 95% CI 2.10, 5.85), after controlling for gender and socioeconomic status. A past history of restoration was not a significant predictor of anxiety after controlling for other factors.
Patient education and counseling, 2011
Objective: To present the Verona-Coding Definitions of Emotional Sequences consensus definitions ... more Objective: To present the Verona-Coding Definitions of Emotional Sequences consensus definitions to code Provider responses (VR-CoDES-P) to patient cues and concerns as described by Zimmermann et al. [2,.