Keele University

About: Keele University is a education organization based out in Newcastle-under-Lyme, United Kingdom. It is known for research contribution in the topics: Population & Stars. The organization has 11318 authors who have published 26323 publications receiving 894671 citations. The organization is also known as: Keele University.

Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease

Abstract: Objective To test the effectiveness of an integrated collaborative care model for people with depression and long term physical conditions. Design Cluster randomised controlled trial. Setting 36 general practices in the north west of England. Participants 387 patients with a record of diabetes or heart disease, or both, who had depressive symptoms (≥10 on patient health questionaire-9 (PHQ-9)) for at least two weeks. Mean age was 58.5 (SD 11.7). Participants reported a mean of 6.2 (SD 3.0) long term conditions other than diabetes or heart disease; 240 (62%) were men; 360 (90%) completed the trial. Interventions Collaborative care included patient preference for behavioural activation, cognitive restructuring, graded exposure, and/or lifestyle advice, management of drug treatment, and prevention of relapse. Up to eight sessions of psychological treatment were delivered by specially trained psychological wellbeing practitioners employed by Improving Access to Psychological Therapy services in the English National Health Service; integration of care was enhanced by two treatment sessions delivered jointly with the practice nurse. Usual care was standard clinical practice provided by general practitioners and practice nurses. Main outcome measures The primary outcome was reduction in symptoms of depression on the self reported symptom checklist-13 depression scale (SCL-D13) at four months after baseline assessment. Secondary outcomes included anxiety symptoms (generalised anxiety disorder 7), self management (health education impact questionnaire), disability (Sheehan disability scale), and global quality of life (WHOQOL-BREF). Results 19 general practices were randomised to collaborative care and 20 to usual care; three practices withdrew from the trial before patients were recruited. 191 patients were recruited from practices allocated to collaborative care, and 196 from practices allocated to usual care. After adjustment for baseline depression score, mean depressive scores were 0.23 SCL-D13 points lower (95% confidence interval −0.41 to −0.05) in the collaborative care arm, equal to an adjusted standardised effect size of 0.30. Patients in the intervention arm also reported being better self managers, rated their care as more patient centred, and were more satisfied with their care. There were no significant differences between groups in quality of life, disease specific quality of life, self efficacy, disability, and social support. Conclusions Collaborative care that incorporates brief low intensity psychological therapy delivered in partnership with practice nurses in primary care can reduce depression and improve self management of chronic disease in people with mental and physical multimorbidity. The size of the treatment effects were modest and were less than the prespecified effect but were achieved in a trial run in routine settings with a deprived population with high levels of mental and physical multimorbidity. Trial registration ISRCTN80309252.

Systematic review of randomized controlled trials of nonpharmacological interventions for fibromyalgia.

Abstract: Objective Little is known of the effectiveness of nonpharmacological interventions for fibromyalgia syndrome (FMS). The authors therefore carried out a systematic review from 1980 to May 2000 of randomized controlled trials (RCTs) of nonpharmacological interventions for FMS. Method A search of computerized databases was supplemented by hand searching of bibliographies of key publications. The methodological quality of studies included in the review was evaluated independently by two researchers according to a set of formal criteria. Discrepancies in scoring were resolved through discussion. Results The review yielded 25 RCTs, and the main categories of interventions tested in the studies were exercise therapy, educational intervention, relaxation therapy, cognitive-behavioral therapy, acupuncture, and forms of hydrotherapy. Methodological quality of studies was fairly low (mean score = 49.5/100). Most studies had small samples (median for individual treatment groups after randomization = 20), and the mean power of the studies to detect a medium effect ( > or = 0.5) was 0.36. Sixteen studies had blinded outcome assessment, but patients were blinded in only 6 studies. The median longest follow-up was 16 weeks. Statistically significant between-group differences on at least one outcome variable were reported in 17 of the 24 studies. Conclusions The varying combinations of interventions studied in the RCTs and the wide range of outcome measures used make it hard to form conclusions across studies. Strong evidence did not emerge in respect to any single intervention, though preliminary support of moderate strength existed for aerobic exercise. There is a need for larger, more methodologically rigorous RCTs in this area.

The state of the gas and the relation between gas and star formation at low metallicity: the small magellanic cloud

Abstract: We compare atomic gas, molecular gas, and the recent star formation rate (SFR) inferred from H{alpha} in the Small Magellanic Cloud (SMC). By using infrared dust emission and local dust-to-gas ratios, we construct a map of molecular gas that is independent of CO emission. This allows us to disentangle conversion factor effects from the impact of metallicity on the formation and star formation efficiency of molecular gas. On scales of 200 pc to 1 kpc (where the distributions of H{sub 2} and star formation match well) we find a characteristic molecular gas depletion time of {tau}{sup mol} d{sub ep} {approx} 1.6 Gyr, similar to that observed in the molecule-rich parts of large spiral galaxies on similar spatial scales. This depletion time shortens on much larger scales to {approx}0.6 Gyr because of the presence of a diffuse H{alpha} component, and lengthens on much smaller scales to {approx}7.5 Gyr because the H{alpha} and H{sub 2} distributions differ in detail. We estimate the systematic uncertainties in our dust-based {tau}{sup mol}{sub dep} measurement to be a factor of {approx}2-3. We suggest that the impact of metallicity on the physics of star formation in molecular gas has at most this magnitude, rather than the factormore » of {approx}40 suggested by the ratio of SFR to CO emission. The relation between SFR and neutral (H{sub 2} + H{sub i}) gas surface density is steep, with a power-law index {approx}2.2 {+-} 0.1, similar to that observed in the outer disks of large spiral galaxies. At a fixed total gas surface density the SMC has a 5-10 times lower molecular gas fraction (and star formation rate) than large spiral galaxies. We explore the ability of the recent models by Krumholz et al. and Ostriker et al. to reproduce our observations. We find that to explain our data at all spatial scales requires a low fraction of cold, gravitationally bound gas in the SMC. We explore a combined model that incorporates both large-scale thermal and dynamical equilibrium and cloud-scale photodissociation region structure and find that it reproduces our data well, as well as predicting a fraction of cold atomic gas very similar to that observed in the SMC.« less