East London NHS Foundation Trust

London, United Kingdom

East London NHS Foundation Trust

London, United Kingdom
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Rohricht F.,University of Essex | Papadopoulos N.,East London NHS Foundation Trust | Priebe S.,Queen Mary, University of London
Journal of Affective Disorders | Year: 2013

Background: Chronic major depressive disorder and dysthymia are associated with a high burden and substantial care costs. New and more effective treatments are required. This is the first randomized controlled trial designed to evaluate the effectiveness of Body Psychotherapy (BPT) in patients with chronic depression. Methods: Patients with chronic depressive syndromes (more than 2 years symptomatic) and a total score of 20 on the Hamilton Rating Scale for Depression (HAMD) were randomly allocated to either immediate BPT or a waiting group which received BUT 12 weeks later. BUT was manualized, delivered in small groups in 20 sessions over a 10 weeks period, and provided in addition to treatment as usual. In an intention to treat analysis, primary outcome were depressive symptoms at the end of treatment adjusted for baseline symptom levels. Secondary outcomes were self-esteem and subjective quality of life. Results: Thirty-one patients were included and twenty-one received the intervention. At the end of treatment patients in the immediate BUT group had significantly lower depressive symptom scores than the waiting group (mean difference 87, 95% confidence interval 10-167). Secondary outcomes did not show statistically significant differences. When the scores of the waiting group before and after BUT (as offered after the waiting period) were also considered in the analysis, the differences with the initial waiting group remained significant. Conclusions: The results suggest that BUT may be an effective treatment option for patients with chronic depression. Difficulty recruiting and subsequent attrition was one of the limitations, but the findings merit further trials with larger samples and process studies to identify the precise therapeutic mechanisms. © 2013 Elsevier BY. All rights reserved. © 2013 Elsevier B.V. All rights reserved.

Wherton J.,Center for Primary Care and Public Health | Sugarhood P.,East London NHS Foundation Trust | Procter R.,University of Warwick | Hinder S.,Center for Primary Care and Public Health | Greenhalgh T.,University of Oxford
Implementation Science | Year: 2015

Background: The low uptake of telecare and telehealth services by older people may be explained by the limited involvement of users in the design. If the ambition of 'care closer to home' is to be realised, then industry, health and social care providers must evolve ways to work with older people to co-produce useful and useable solutions. Method: We conducted 10 co-design workshops with users of telehealth and telecare, their carers, service providers and technology suppliers. Using vignettes developed from in-depth ethnographic case studies, we explored participants' perspectives on the design features of technologies and services to enable and facilitate the co-production of new care solutions. Workshop discussions were audio recorded, transcribed and analysed thematically. Results: Analysis revealed four main themes. First, there is a need to raise awareness and provide information to potential users of assisted living technologies (ALTs). Second, technologies must be highly customisable and adaptable to accommodate the multiple and changing needs of different users. Third, the service must align closely with the individual's wider social support network. Finally, the service must support a high degree of information sharing and coordination. Conclusions: The case vignettes within inclusive and democratic co-design workshops provided a powerful means for ALT users and their carers to contribute, along with other stakeholders, to technology and service design. The workshops identified a need to focus attention on supporting the social processes that facilitate the collective efforts of formal and informal care networks in ALT delivery and use. © 2015 Wherton et al.

Priebe S.,Queen Mary, University of London | Priebe S.,Newham Center for Mental Health | Richardson M.,Queen Mary, University of London | Cooney M.,East London NHS Foundation Trust | And 2 more authors.
Psychotherapy and Psychosomatics | Year: 2011

Background: Numerous studies have shown that the quality of the therapeutic relationship (TR) between the patient and the clinician is an important predictor of the outcome of different forms of psychotherapy. It is less clear whether the TR also predicts outcomes of psychiatric treatment programmes in patients with psychosis (i.e. outside conventional psychotherapy). Methods: We conducted a systematic review and identified 9 primary studies that prospectively tested the association of the TR with 3 outcomes, i.e. hospitalisation, symptom levels and functioning. Because of the heterogeneity of the methods used, a meta-analysis was not feasible. A vote counting method was used to determine the number of statistically significant effects in the hypothesised direction (i.e. that a more positive TR predicts more favourable outcomes). Results: For each outcome, a χ2 analysis showed that the number of statistically significant findings in the hypothesised direction was greater than expected if the null hypothesis of no association were true. However, studies had methodological shortcomings, and the effect sizes of positive associations were rather small. Conclusion: It may be concluded that there is some, but not overwhelming, evidence that the TR predicts outcomes of complex psychiatric treatment programmes in patients with psychosis, and that methodologically more rigorous research is required. Such research should measure the TR at initial stages of treatment and use validated assessment instruments for both TR and outcomes. © 2011 S. Karger AG, Basel.

Mitchell G.,East London NHS Foundation Trust | Pistrang N.,University College London
Psychology and Psychotherapy: Theory, Research and Practice | Year: 2011

Background. One avenue for addressing the social consequences of mental health problems is through befriending, a supportive relationship in which one-to-one companionship is provided on a regular basis. Although there is some evidence that befriending can improve psychological and social functioning, little is known about how it works. Objective. This qualitative study aimed to understand the helping processes occurring in befriending relationships, from the perspectives of both befriendees and befrienders. Method. Semi-structured interviews were conducted individually and jointly with eight befriendees and their corresponding befrienders. Thematic analysis was carried out on the data set of 23 interviews. Results. The analysis generated nine themes concerning qualities of the relationship valued by befriendees and befrienders (e.g., empathy and mutuality), processes of making meaning (e.g., considering alternative perspectives), and how change was effected in befriendees' lives (e.g., learning how to have healthier relationships with others). The accounts emphasized the importance of the quality of the relationship itself, and highlighted aspects of the relationship that were sometimes difficult to negotiate. Conclusions. The findings suggest that befriending shares commonalities with other types of psychological help. However, it is also characterized by some particular challenges, such as establishing an empathic relationship and managing boundaries and endings. © 2010 The British Psychological Society.

Greenhalgh T.,University of Oxford | Procter R.,Coventry University | Wherton J.,Center for Primary Care and Public Health | Sugarhood P.,East London NHS Foundation Trust | And 2 more authors.
BMC Medicine | Year: 2015

Background: We sought to define quality in telehealth and telecare with the aim of improving the proportion of patients who receive appropriate, acceptable and workable technologies and services to support them living with illness or disability. Methods: This was a three-phase study: (1) interviews with seven technology suppliers and 14 service providers, (2) ethnographic case studies of 40 people, 60 to 98 years old, with multi-morbidity and assisted living needs and (3) 10 co-design workshops. In phase 1, we explored barriers to uptake of telehealth and telecare. In phase 2, we used ethnographic methods to build a detailed picture of participants' lives, illness experiences and technology use. In phase 3, we brought users and their carers together with suppliers and providers to derive quality principles for assistive technology products and services. Results: Interviews identified practical, material and organisational barriers to smooth introduction and continued support of assistive technologies. The experience of multi-morbidity was characterised by multiple, mutually reinforcing and inexorably worsening impairments, producing diverse and unique care challenges. Participants and their carers managed these pragmatically, obtaining technologies and adapting the home. Installed technologies were rarely fit for purpose. Support services for technologies made high (and sometimes oppressive) demands on users. Six principles emerged from the workshops. Quality telehealth or telecare is 1) ANCHORED in a shared understanding of what matters to the user; 2) REALISTIC about the natural history of illness; 3) CO-CREATIVE, evolving and adapting solutions with users; 4) HUMAN, supported through interpersonal relationships and social networks; 5) INTEGRATED, through attention to mutual awareness and knowledge sharing; 6) EVALUATED to drive system learning. Conclusions: Technological advances are important, but must be underpinned by industry and service providers following a user-centred approach to design and delivery. For the ARCHIE principles to be realised, the sector requires: (1) a shift in focus from product ('assistive technologies') to performance ('supporting technologies-in-use'); (2) a shift in the commissioning model from standardised to personalised home care contracts; and (3) a shift in the design model from 'walled garden', branded products to inter-operable components that can be combined and used flexibly across devices and platforms. © 2015 Greenhalgh et al.; licensee BioMed Central.

Dowsett C.,East London NHS Foundation Trust
Wounds UK | Year: 2011

Advances in technology over the last ten years have allowed for greater choice of compression therapy. Leg ulcer services need to provide up-to-date, high quality services that ensure safety, effectiveness and improvements to the patient experience. This includes monitoring and reporting on leg ulcer healing rates and prevention of recurrence. This paper discusses a redesign in a community leg ulcer service, including the introduction of RAL compression hosiery. Healing rates improved from 36% at 12 weeks to 72%, and from 40% at 24 weeks to 100%. Recurrence rates for venous leg ulcers also reduced from 18-20% to 5.8%.

Dowsett C.,East London NHS Foundation Trust
Wounds UK | Year: 2012

Leg ulcers are common and expensive to treat, with the quality of care varying widely across different areas. The introduction of nurse-led community-based clinics has shown increased ulcer healing rates and lowered rates of recurrence. The author assesses the benefits of following this model of care and explains how providers can set up a business case for service redesign.

Bottlender R.,East London NHS Foundation Trust | Bottlender R.,Ludwig Maximilians University of Munich | Strauss A.,Ludwig Maximilians University of Munich | Moller H.-J.,Ludwig Maximilians University of Munich
Schizophrenia Research | Year: 2010

Background: Interest in social functioning of people suffering from mental illnesses has been increasing over the last few years. Only few studies have investigated differences in social functioning in affective, schizoaffective and schizophrenic patients in the long-term and in a comparative approach. Method: The present study is part of a 15 year follow-up study on patients suffering from severe mental illness. The here reported findings refer to the data of a sample of 177 patients with life-time diagnoses belonging to the schizophrenic, schizoaffective or affective spectrum according to the ICD-10 criteria. Psychopathological, socio-demographic and other illness-related variables were assessed at the index hospitalisation and at the 15 year follow-up evaluation by using the assessment system published by the Association for Methodology and Documentation in Psychiatry (AMDP-system). Information about patients' social disability was assessed by using a modified and further developed version of the WHO disability assessment scale, the (Mannheim) Disability Assessment Schedule (DAS-M scale). Prevalence rates of social disability and differences in the severity of social disability between different groups of mental illnesses were evaluated. And the association between social disability, diagnoses and psychopathology was analysed. Results: Compared to affective and schizoaffective patients, schizophrenic patients showed significantly higher levels of social disability in almost all domains. Severe to very severe levels of disability were found in 64% of schizophrenic patients and only in 19% of schizoaffective patients and 5% of affective patients. However, on a descriptive level all three diagnostic groups presented with similar maxima and minima in their profiles of social disability. Multiple regression analyses revealed that the apathy syndrome had the highest impact on the presence of severe social disability with all other psychopathological syndromes, gender, age and diagnosis having no statistically significant influence. Conclusion: Findings indicate that patients' disabilities in different diagnostic groups seem to be of a similar quality and nature despite differences in their severity. The impact of psychopathology on disability seems to be more important than the one of diagnosis per se. © 2009 Elsevier B.V. All rights reserved.

Dowsett C.,East London NHS Foundation Trust
Wounds UK | Year: 2012

Negative pressure wound therapy (NPWT) has become more accessible and is frequently used in the management of a variety of wounds. However, disparity exists in aspects of NPWT, such as the optimal pressure and the best wound filler. Gaps also exist in the evidence base for the use of NPWT in some wound types, for example in leg ulcers. In an attempt to address this, international consensus statements have been developed by an expert panel and are being disseminated in the UK. This article discusses the recommendations and provides an insight into current thinking and practice on the use of NPWT in acute and chronic wounds.

Pimm J.,East London NHS Foundation Trust
Psychiatrist | Year: 2013

The experience of rejection of an article submitted for publication to a scientific journal can be particularly anxiety provoking, especially when the furtherance of an academic career or the gaining of a permanent post might be riding on getting it published. Many papers fail to get past the first hurdle and are not sent out for peer review, often as a result of the most basic of errors: the results are not generalisable, the paper adds nothing new to the subject, there are flaws in the study design or inappropriate statistics were used. Attention paid to formulating a clear research question and the adoption at the outset of a doable, interesting project will often help to avoid disappointment.

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