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Preston H.,St Catherines Hospice | Fineberg I.C.,Lancaster University | Callagher P.,Royal Preston Hospital Care and Research Center | Mitchell D.J.,Lancashire Teaching Hospitals NHS Foundation Trust
Palliative Medicine | Year: 2012

Increasing emphasis is being placed on the need for advanced care planning (ACP) at the end of life. The Preferred Priorities for Care (PPC) document is a patient-held record promoted by the End of Life Care Strategy as an ACP tool to promote discussion and communication amongst patients, family and health care providers. However, little research exists into evaluating its effectiveness or exploring patient and carer views, particularly in non-malignant disease. Because the majority of patients with Motor Neurone Disease (MND) lose verbal communication, early discussion of patients' wishes and preferences, a central aspect of ACP, is vital. This study examined MND patients' bereaved relatives' experiences of using the PPC document and their perceptions about its impact on end-of-life care using qualitative methods. Key findings adding to existing literature were that the PPC document was felt to have little impact on end-of-life care amongst this patient group and that there was a perceived lack of awareness of the document amongst health care professionals (HCPs), in particular hospital staff. This was felt to limit the effectiveness of the document. This has obvious implications for practice, looking at awareness amongst HCPs and ways to improve this situation, particularly in light of the current pressures to meet patient preferences at the end of life. © SAGE Publications 2011.


Hayward M.,University of Sussex | Berry K.,University of Manchester | Ashton A.,Lancashire Teaching Hospitals NHS Foundation Trust
Clinical Psychology Review | Year: 2011

Cognitive models of auditory hallucinations are being elaborated in an attempt to more fully understand the variables that determine the distress often experienced by hearers. There is a growing body of literature that aims to explore the relevance of the concept of 'relating' to the experience of auditory hallucinations. This review explored the relevance of interpersonal perspectives to both understandings of and therapy for auditory hallucinations. Eighteen papers were included, published between 1989 and 2010. Studies have utilised and are reviewed within three different theoretical perspectives: Benjamin's Structural Analysis of Social Behaviour; Gilbert's Social Rank Theory; and Birtchnell's Relating Theory. Qualitative studies have explored the nature of the person's relationships with their auditory hallucinations, and are also reviewed. Collectively, the studies suggest that the experience of auditory hallucinations can be understood within interpersonal frameworks, and the relationships that hearers develop with their hallucinations share many properties with interpersonal relationships within the social world. Two themes were prominent across studies: an understanding of the power of the hearer, relative to both auditory hallucinations and social relationships; and the broader influence of social factors that extends beyond power to encompass broader patterns of relating. Findings are considered with regard to clinical implications and future research. © 2011 Elsevier Ltd.


Background: The results of ZOO11 have shaken our thinking and approach for the axillary management of small invasive breast cancers where the incidence and burden of axillary metastasis would be much less than that of ZOO11 population. The traditional approach of sentinel lymph node biopsy (SLNB) for “all invasive cancers” is challenged because of the diminishing role of axillary lymph nodes (ALNs) status in guiding the adjuvant systemic therapy. Certainly this raises the question of whether SLNB can be avoided in a select group of patients without compromising clinical outcomes. The aim of this study was to identify such a group of patients in whom SLNB is no longer required. Method: Patients with breast cancers ≤2 cm in size and clinically negative axilla who underwent breast conserving surgery (BCS) and SLNB were identified. Patients were divided into different groups; incidence of ALNs metastasis, further non-SLNs metastasis and a total number of tumour positive ALNs of ≥4 were determined. Results: A total of 194 patients met the criteria; incidence of tumour positive SLNs, further non-SLNs metastasis and a total number of tumour positive ALNs of ≥4 varied between different groups and was 9.3–15.5 %, 0–35 % and 0–2.6 %, respectively. Patients with T1b, grade 1–2 tumours had less than 5 % risk of ALNs macrometastasis. Conclusion: It is possible to identify a group of patients whose burden of axillary disease is acceptably low enough that SLNB can be avoided. Feasibility of a non-inferiority randomised controlled trial (RCT) in a select group of patients with or without SLNB has been explored to compare the distant disease free, disease free and overall survival and axillary relapse rate (ARR). © 2013, The Japanese Breast Cancer Society.


Kendall D.L.,Lancashire Teaching Hospitals NHS Foundation Trust | Amin R.,University College London | Clayton P.E.,University of Manchester
Pediatric Drugs | Year: 2014

Metformin is the first-line treatment for type 2 diabetes (T2D) in adults, children and young people, particularly in obese or overweight patients. Many studies have demonstrated that metformin is associated with weight reduction in adults and in prevention or delay of T2D onset in those who are at increased risk. In 2012, metformin was recommended by the UK National Institute for Health and Care Excellence as a treatment option in adults aged 18 years or over, who remain at high risk of T2D, despite participation in an intensive lifestyle-change programme. Prevalence of childhood obesity is increasing and is associated with elevated long-term risk of T2D and other adverse cardio-metabolic events; however, consensus is lacking on intervention strategies aimed at reducing this risk. This article discusses the rationale and evidence for the use of metformin in obese children and young people at high risk of T2D. © Springer International Publishing 2013.


Keeling M.,Lancashire Teaching Hospitals NHS Foundation Trust | Bambrough J.,Salford Royal NHS Foundation Trust | Simpson J.,Lancaster University
Psycho-Oncology | Year: 2013

Objective People with low-grade brain tumour experience a range of emotional, behavioural and psychosocial consequences. Using Leventhal's self-regulation model to explore biopsychosocial factors associated with distress, we examine the relationships between illness perceptions, coping and depression, anxiety and positive affect. Methods A cross-sectional, self-report study in which 74 people (54% women) diagnosed with a low-grade brain tumour completed the Illness Perceptions Questionnaire-Revised was conducted. Mean time since diagnosis was 27.69 months (SD = 19.79). Mean age was 38.30 years (SD = 10.67). The Illness Perceptions Questionnaire-Revised, in addition to clinical, demographic and coping variables previously associated with psychological distress, was used to predict three psychological outcomes: depression, anxiety and positive affect. Results Hierarchical multiple regression analyses demonstrated that a biopsychosocial causal attribution was a significant predictor of anxiety and depression. Illness identity also emerged as a significant predictor of depression scores. Coping through self-blame was the only coping variable to emerge as a significant predictor of anxiety scores. A combination of coping through venting, acceptance, positive reframing, denial, behavioural disengagement and self-blame contributed to the variance in all three psychological outcome scores. No illness perception variables significantly predicted positive affect. Conclusions Illness perceptions play a significant role in emotional distress experienced by people with low-grade brain tumours. Illness perceptions did not play a significant role in positive affect. Coping variables were shown to significantly contribute to the scores on all three psychological outcomes. Results suggest interventions targeted at modifying illness perceptions and enhancing problem-focused coping strategies may reduce psychological distress. Copyright © 2012 John Wiley & Sons, Ltd.

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